Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

Medicare Current Beneficiary Survey (MCBS)

Attachment 4 English Questionnaire Comprehensive Format Section by SectionHI_05.01.0001

Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

OMB: 0938-0568

Document [pdf]
Download: pdf | pdf
BOX HIBEG

BOX HIBEG

Page Order # :

1483

BOX INSTRUCTIONS
( HIQ3345 )	

IF (SP IS IN THE SUPPLEMENTAL SAMPLE), GO TO HIMCINTR - HIINTR1
( HIQ3348 ).
ELSE GO TO BOX MC1AA - (HIQ3350 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

1:41:04 PM Monday, November 17, 2008	

Page 1 of 353

HIMCINTR

HIMCINTR

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

HIINTR1

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1484

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:

SHOW CARD HIMC

Question Text:

The next questions are about health insurance. It’s important to
understand how beneficiaries cover the costs of their medical care,
such as doctor visits, prescribed medicines, hospital stays, and other
health care. As you know, there are many ways that people on
Medicare receive health insurance benefits. This card outlines the
types of health insurance that I’ll be asking you about. You may want
to refer to this card as we talk about (your/SP’s) health insurance
coverage.

Int. Instr II:

1:41:05 PM Monday, November 17, 2008

Page 2 of 353

HIMCINTR
INPUT FIELDS / ROUTING
HIINTR1

Field1:
Cheshire Name:

( HIQ3348 )

TEMP

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TContinueEMPTY
1
No
No

Number Label
1 Continue

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX MC1AA - (HIQ3350 )

English text: CONTINUE
Attribute
Empty

Route
BOX MC1AA - (HIQ3350 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:41:07 PM Monday, November 17, 2008

Page 3 of 353

BOX MC1AA

BOX MC1AA

Page Order # :

1485

BOX INSTRUCTIONS
( HIQ3350 )	

IF (SP IS IN THE SUPPLEMENTAL SAMPLE) AND (SP HAS A LOADED
CMS MEDICARE MANAGED CARE PLAN), GO TO MC1 - LOADCORR (
HIQ3430 ).
ELSE IF (SP IS NOT IN THE SUPPLEMENTAL SAMPLE) AND (SP HAS A
MEDICARE MANAGED CARE PLAN THAT WAS "CURRENT" AT THE TIME
OF THE PREVIOUS ROUND INTERVIEW), GO TO HIMC1A - MHMOSAME (
HIQ3591 ).
ELSE GO TO HIMC1 - MHMOCOV ( HIQ3600 ).

ASSIGNMENTS
Create current round PLRO for Medicare Plan where PLAN.PLANTYPE = 1/Medicare.
PLRO KEY = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
Set plan status = current. See detailed instructions below:

PLROPLAN

Create PLRO where PLRO.PLROPLAN = 01.


PLRORND

Create PLRO where PLRO.PLRORND = current

round.

COVTIME

Set PLRO.COVTIME = 1/WholeTime.

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

51

MHMOCurrPrevRnd

Medicare Managed Care plan "current" at time of
previous round interview =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

50

LoadedMHMO

Loaded CMS Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.

DESIGN NOTES

1:41:07 PM Monday, November 17, 2008	

Page 4 of 353

MC1

MC1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

LOADCORR

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1550

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Always display "(Health Maintenance Organizations)" and
"(Preferred Provider Organizations)" in parenthesis.
Display "currently" in BOLD.
Display the name of the loaded CMS Medicare Managed Care Plan
in the next-to-last sentence, PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

1:41:09 PM Monday, November 17, 2008

As you may know, Medicare allows beneficiaries in certain parts of
the country to enroll in Medicare Advantage plans, such as HMOs
(Health Maintenance Organizations) and PPOs (Preferred Provider
Organizations), to receive their Medicare-covered health care.
According to Medicare records, (you are/SP is) currently enrolled in
Page 5 of 353

MC1
a Medicare Advantage Plan called (CMS MEDICARE MANAGED
CARE PLAN NAME). Is this information correct?
Int. Instr II:

INPUT FIELDS / ROUTING

LOADCORR

Field1:
Cheshire Name:

( HIQ3430 )

HRND.LOADCORR

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HIMC1 - (HIQ4010 )

English text: YES
No

MC2 - WHATWRNG ( HIQ3440 )

English text: NO
Attribute
Don't know

Route
MC11 - REFERMED ( HIQ3560 )

Refusal

BOX HIMC4 - (HIQ4500 )

BACKGROUND VARIABLE ASSIGNMENTS
If CMS reported that the SP was enrolled in a Medicare Managed Care plan, a current
round PLAN and PLRO will be generated at the home office and will be preloaded with
release of case. The preloaded records will include the following information:
PLAN.PLANNUM = Number of CMS loaded plan
PLAN.PLANRNDC=current round
PLAN.PLANTYPE=5/MHMO
PLAN.MHMOLRND=current round
PLRO.PLROPLAN = PLAN.PLANNUM
PLRO.PLRORND=current round
PLRO.COVANYTM=1/Yes.
The status of the loaded CMS Medicare Managed Care plan may be determined by the
response to MC1, HRND.LOADCORR.
1:41:11 PM Monday, November 17, 2008

Page 6 of 353

MC1
Plan details will be collected on this PLAN and PLRO records. When setting status of this
plan, set variable on PLRO where PLRO.PLROPLAN=this PLAN.PLANNUM and
PLRO.PLRORND=current round.
See detailed instructions below:
COVCURNT	

If LOADCORR = 1/Yes, set
PLRO.COVCURNT=1/Yes.
if LOADCORR = DK or RF, set
PLRO.COVCURNT=2/No.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

50

LoadedMHMO

Loaded CMS Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.

DESIGN NOTES

1:41:11 PM Monday, November 17, 2008	

Page 7 of 353

MC2

MC2

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

WHATWRNG

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

1560

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:	

Display the name of the loaded CMS Medicare Managed Care Plan,
PLAN.PLNAME.

Question display:
Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:	

(CMS MEDICARE MANAGED CARE PLAN NAME)

Int. Instr I:
Question Text:	

How is this information incorrect?

Int. Instr II:	

SELECT ONLY ONE. IF MORE THAN ONE RESPONSE IS
APPLICABLE, SELECT THE RESPONSE THAT IS CLOSEST TO
THE TOP OF THE LIST.

INPUT FIELDS / ROUTING

1:41:13 PM Monday, November 17, 2008	

Page 8 of 353

MC2
WHATWRNG

Field1:

HRND.WHATWRNG

Cheshire Name:
Item Text display:

( HIQ3440 )

Display the name of the loaded CMS Medicare Managed
Care Plan in the response categories, PLAN.PLNAME.

Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
TWhatwrng
1
No
No

Number Label
1 EnrolledNewPlan	

2

3

4

5

FieldSize:
Min Value:
Max Value:
Mask:

Route
MC2B - YDISNROL ( HIQ3450 )

English text: SP DISENROLLED FROM (CMS MHMO PLAN NAME), ENROLLED IN NEW
MEDICARE ADVANTAGE PLAN
DoesNotThinkItsPlan	
MC3 - PRIMPHYS ( HIQ3480 )
English text: SP HAS PLAN CALLED (CMS MHMO PLAN NAME), R DOESN'T THINK IT'S A
MEDICARE ADVANTAGE PLAN
Disenrolled	
MC2B - YDISNROL ( HIQ3450 )
English text: SP NOW DISENROLLED FROM (CMS MHMO PLAN NAME), NO LONGER IN
ANY MEDICARE ADVANTAGE PLAN
EnrolledButNotThisPlan	
MC4 - SAMEPLAN ( HIQ3490 )
English text: SP ENROLLED IN MEDICARE ADVANTAGE PLAN, BUT NEVER (CMS MHMO
PLAN NAME)
NeverEnrolled	
MC11 - REFERMED ( HIQ3560 )
English text: SP NEVER COVERED BY OR ENROLLED IN (CMS MHMO PLAN NAME)

Attribute

Route

BACKGROUND VARIABLE ASSIGNMENTS
The status of the loaded CMS Medicare Managed Care plan may be set depending on
response to MC2. When setting status of this plan, set PLRO variable on PLRO where
PLRO.PLROPLAN=this PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
COVCURNT	

If WHATWRNG=2/DoesNotThinkItsPlan, set
PLRO.COVCURNT=1/Yes.
Else if WHATWRNG = 1/EnrolledNewPlan,
3/Disenrolled or 5/NeverEnrolled, set

1:41:17 PM Monday, November 17, 2008	

Page 9 of 353

MC2
PLRO.COVCURNT=2/No.
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

50

LoadedMHMO

Loaded CMS Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.

DESIGN NOTES

1:41:17 PM Monday, November 17, 2008

Page 10 of 353

MC2B

MC2B

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

YDISNROL

Field 2:

YDISNROS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

1575

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display the name of the loaded CMS Medicare Managed Care Plan,
PLAN.PLNAME.

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

What is the most important reason (you/SP) stopped the (CMS
MEDICARE MANAGED CARE PLAN NAME)
coverage?

Int. Instr II:
INPUT FIELDS / ROUTING

1:41:20 PM Monday, November 17, 2008	

Page 11 of 353

MC2B

1:41:27 PM Monday, November 17, 2008

Page 12 of 353


MC2B
YDISNROL

Field1:
Cheshire Name:

( HIQ3450 )

PLRO.YDISNROL

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TDisenrol
1
No
No

Number Label
1 TooExpensive
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX MC1A - (HIQ3470 )

English text: TOO EXPENSIVE OR COULDN'T AFFORD
DissatisfiedWithQuality
BOX MC1A - (HIQ3470 )

4

English text: SP DISSATISFIED WITH QUALITY OF CARE
ToGetRx
BOX MC1A - (HIQ3470 )
English text: TO GET RX COVERAGE IN ANOTHER PLAN
BenefitBesideRx
BOX MC1A - (HIQ3470 )

5

English text: TO GET BENEFIT COVERAGE OTHER THAN RX
OutOfBusiness
BOX MC1A - (HIQ3470 )

6

English text: PLAN WENT OUT OF BUSINESS/STOPPED MEDICARE COVERAGE
PlanChangedName
BOX MC1A - (HIQ3470 )

7

English text: PLAN NAME CHANGED OR PLAN WAS BOUGHT BY/MERGED WITH
ANOTHER PLAN
DrLeftPlan
BOX MC1A - (HIQ3470 )

3

8
9
10
11
91

English text: DOCTOR LEFT PLAN/DIED/RETIRED
CouldntGetAppt
BOX MC1A - (HIQ3470 )
English text: DIFFICULTIES GETTING APPTS OR SEEING PARTICULAR PROVIDERS
SpMoved
BOX MC1A - (HIQ3470 )
English text: SP MOVED OUT OF PLAN AREA
DidNotLikeChoice
BOX MC1A - (HIQ3470 )
English text: SP DIDN'T LIKE CHOICE OF DOCTORS
WantedChoice
BOX MC1A - (HIQ3470 )
English text: SP WANTED CHOICE OF DOCTORS
Other
MC2B - YDISNROS ( HIQ3460 )
English text: OTHER

Attribute
Don't know

Route
BOX MC1A - (HIQ3470 )

1:41:38 PM Monday, November 17, 2008

Page 13 of 353

MC2B

Don't know
Refusal

BOX MC1A - (HIQ3470 )

( HIQ3460 )

YDISNROS

Field2:
Cheshire Name:

PLRO.YDISNROS

Item Text display:

Display "(SPECIFY)" in same blue font used for interviewer

instructions.


Item Text:

OTHER (SPECIFY)


Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


String

TOthrspec

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]

30

Route
BOX MC1A - (HIQ3470 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

50

LoadedMHMO

Loaded CMS Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.

DESIGN NOTES

1:41:40 PM Monday, November 17, 2008

Page 14 of 353

BOX MC1A

BOX MC1A

Page Order # :

1580

BOX INSTRUCTIONS
( HIQ3470 )

IF MC2 - WHATWRNG = 1/EnrolledNewPlan, GO TO MC5 ­
PLAN_MHMOMCA ( HIQ3500 ).
ELSE GO TO HIMC16 - MHMOMORE ( HIQ4450 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

1:41:40 PM Monday, November 17, 2008

Page 15 of 353

MC3

MC3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PRIMPHYS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1590

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:

In many Medicare Advantage Plans, such as HMOs or PPOs, the
health plan gives the patient a list of doctors from which he chooses
a primary care physician. This primary care physician provides the
patient’s usual medical care and can refer the patient to specialists,
if necessary. (Do you/Does SP) have a primary care physician?

Int. Instr II:

INPUT FIELDS / ROUTING


1:41:41 PM Monday, November 17, 2008

Page 16 of 353

MC3
PRIMPHYS

Field1:
Cheshire Name:

( HIQ3480 )

HRND.PRIMPHYS

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HIMC1 - (HIQ4010 )

English text: YES
No

BOX HIMC1 - (HIQ4010 )

English text: NO
Attribute
Don't know

Route
BOX HIMC1 - (HIQ4010 )

Refusal

BOX HIMC1 - (HIQ4010 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:41:43 PM Monday, November 17, 2008

Page 17 of 353

MC4

MC4

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

SAMEPLAN

Enable Functions:	

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

1600

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

Display the name of the loaded CMS Medicare Managed Care Plan,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

Is it possible that (your/SP’s) current insurance plan is just another
	
name for (CMS MEDICARE MANAGED CARE PLAN NAME), or are
they not the same plans?

Int. Instr II:
INPUT FIELDS / ROUTING

1:41:44 PM Monday, November 17, 2008	

Page 18 of 353

MC4
( HIQ3490 )

SAMEPLAN

Field1:
Cheshire Name:

HRND.SAMEPLAN

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TSamePlan

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 Same
2

Route
BOX HIMC1 - (HIQ4010 )

English text: SAME PLANS
NotSame

MC5 - PLAN_MHMOMCA ( HIQ3500 )

English text: NOT THE SAME PLANS
Attribute
Don't know

Route
MC5 - PLAN_MHMOMCA ( HIQ3500 )

Refusal

MC5 - PLAN_MHMOMCA ( HIQ3500 )

BACKGROUND VARIABLE ASSIGNMENTS
The status of the loaded CMS Medicare Managed Care plan may be set depending on
response to MC4. When setting status of this plan, set PLRO variable on PLRO where
PLRO.PLROPLAN=this PLAN.PLANNUM and PLRO.PLRORND=current round. See
detailed instructions below:
COVCURNT

If MC4 - SAMEPLAN=1/Yes, set
PLRO.COVCURNT=1/Yes.
Else set PLRO.COVCURNT=2/No.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

1:41:47 PM Monday, November 17, 2008

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
Page 19 of 353

MC4
50

LoadedMHMO

Loaded CMS Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.

DESIGN NOTES

1:41:47 PM Monday, November 17, 2008

Page 20 of 353

MC5

MC5

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PLAN_MHMOMCA

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Name:

Plan Roster

Roster Type:

Single Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

1610

Display as ' Add a Plan '
Display as ' Edit a Plan '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Roster/Grid Instructions:	

Display all health insurance plans from the Plan Roster except for
the loaded CMS Medicare Managed Care Plan.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare plan
Medicaid
Tricare
Public Plans
Private Plans
Medicare Prescription Drug Plans

Roster/Grid display:	

COL #
1

1:41:48 PM Monday, November 17, 2008	

HEADER
Plan Name

INSTRUCTIONS
Display PLAN.PLNAME.

Page 21 of 353

MC5
2

Plan Type

Display PLAN.PLANTYPE:
1/Medicare, display "(MCAR)"
2/Medicaid, display "(MCAD)"
3/PublicPlan, display "(PUBL)"
4/PrivatePlan, display "(PRIV)"
5/MHMO, display "(MHMO)"
6/Tricare, display "(TRIC)"
7/MPDP, display "(MPDP)"

3

Plan Status

Display CURRENT ROUND PLAN
STATUS.

Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

What is the name of the Medicare Advantage Plan that provides
(your/SP’s) health care?

Int. Instr II:

SELECT OR ADD ONLY ONE MEDICARE ADVANTAGE PLAN AT
THIS ROSTER.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PLAN_MHMOMCA

( HIQ3500 )

TEMP

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

String
TPlanPick8
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

8

Route
BOX HIMC1 - (HIQ4010 )

BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:

PLAN key = PLAN.PLANBASE + PLAN.PLANNUM


1:41:49 PM Monday, November 17, 2008

Page 22 of 353

MC5
PLAN.PLANNUM = Number of plan selected at MC5.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at MC5.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
The plan selected at MC5 is the SP's current Medicare Managed Care plan for the present
round. To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
PLROPLAN	

PLRO.PLROPLAN=PLAN.PLANNUM of PLAN
selected.

PLRORND	

PLRO.PLRORND=current round.

COVANYTM	

Set PLRO.COVANYTM=1/Yes for plan selected at
MC5.

COVCURNT	

Set PLRO.COVCURNT=1/Yes for plan selected at
MC5.

PLANTYPE	

If PLAN added to roster, set
PLAN.PLANTYPE=5/MHMO.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
95

PlanIsCurrent

If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

53

PlanTypes

Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Managed Care: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.

1:41:49 PM Monday, November 17, 2008	

Page 23 of 353

MC5
50

LoadedMHMO

Loaded CMS Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.

DESIGN NOTES

1:41:49 PM Monday, November 17, 2008

Page 24 of 353

MC11

MC11

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

REFERMED

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1670

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Do you refer to (your/SP’s) Medicare coverage by any name besides
	
Medicare?

Int. Instr II:
INPUT FIELDS / ROUTING

1:41:50 PM Monday, November 17, 2008

Page 25 of 353

MC11
REFERMED

Field1:
Cheshire Name:

( HIQ3560 )

HRND.REFERMED

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TRefermed
1
No
No

Number Label
1 MedicareOnly
2

English text: MEDICARE ONLY
OtherName

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HIMC4 - (HIQ4500 )
MC12 - PLAN_MHMOMCB ( HIQ3570 )

English text: OTHER NAME
Attribute
Don't know

Route
BOX HIMC4 - (HIQ4500 )

Refusal

BOX HIMC4 - (HIQ4500 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:41:52 PM Monday, November 17, 2008

Page 26 of 353

MC12

MC12

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PLAN_MHMOMCB

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Name:

Plan Roster

Roster Type:

Single Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

1680

Display as ' Add a Plan '
Display as ' Edit a Plan '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Roster/Grid Instructions:	

Display all health insurance plans from the Plan Roster except for
the loaded CMS Medicare Managed Care Plan.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare plan
Medicaid
Tricare
Public Plans
Private Plans
Medicare Prescription Drug Plans

Roster/Grid display:	

COL #
1

1:41:53 PM Monday, November 17, 2008	

HEADER
Plan Name

INSTRUCTIONS
Display PLAN.PLNAME.

Page 27 of 353

MC12
2

Plan Type	

Display PLAN.PLANTYPE:
1/Medicare, display "(MCAR)"
2/Medicaid, display "(MCAD)"
3/PublicPlan, display "(PUBL)"
4/PrivatePlan, display "(PRIV)"
5/MHMO, display "(MHMO)"
6/Tricare, display "(TRIC)"
7/MPDP, display "(MPDP)"

3

Plan Status	

Display CURRENT ROUND PLAN
STATUS.

Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

What do you call (your/SP’s) coverage?
	

Int. Instr II:

SELECT OR ADD ONLY ONE MEDICARE ADVANTAGE PLAN AT

THIS ROSTER.

INPUT FIELDS / ROUTING

Field1:	
Cheshire Name:

PLAN_MHMOMCB

( HIQ3570 )

TEMP

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:


String
TPlanPick8
1

No
No


Number Label	
1 [Continuous answer.]	

FieldSize:
Min Value:

Max Value:

Mask:


8

Route
BOX HIMC1 - (HIQ4010 )

BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM

PLAN.PLANNUM = Number of plan selected at MC12.


1:41:54 PM Monday, November 17, 2008	

Page 28 of 353

MC12
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at MC12.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
The plan selected at MC12 is the SP's current Medicare Managed Care plan for the present
round. To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
PLROPLAN	

PLRO.PLROPLAN=PLAN.PLANNUM of PLAN
selected.

PLRORND	

PLRO.PLRORND=current round.

COVANYTM	

Set PLRO.COVANYTM=1/Yes for plan selected at
MC12.

COVCURNT	

Set PLRO.COVCURNT=1/Yes for plan selected at
MC12.

PLANTYPE	

If PLAN added to roster, set
PLAN.PLANTYPE=5/MHMO.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
95

PlanIsCurrent

If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

53

PlanTypes

Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Managed Care: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.

1:41:54 PM Monday, November 17, 2008	

Page 29 of 353

MC12
50

LoadedMHMO

Loaded CMS Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.

DESIGN NOTES

1:41:54 PM Monday, November 17, 2008

Page 30 of 353

HIMC1A

HIMC1A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

MHMOSAME

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1700

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display Medicare Managed Care plan that was current at the time of
the previous round interview, PLAN.PLNAME.

Question display:

Display Medicare Managed Care plan that was current at the time of
the previous round interview, PLAN.PLNAME.
If SP is deceased or institutionalized, display "Was SP covered
by...".
Else display "[Are you/Is (SP)] now covered...".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:	

MEDICARE ADVANTAGE PLAN = (MEDICARE MANAGED CARE
PLAN NAME)

Int. Instr I:
Question Text:	

At the time of the last interview [you were/(SP) was] covered by
(MEDICARE MANAGED CARE PLAN NAME).
[[Are you/Is (SP)] now covered by (MEDICARE MANAGED CARE

1:41:55 PM Monday, November 17, 2008	

Page 31 of 353

HIMC1A
PLAN NAME)?] [Was (SP) covered by (MEDICARE MANAGED
CARE PLAN NAME) on (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)?]
Int. Instr II:
INPUT FIELDS / ROUTING
MHMOSAME

Field1:
Cheshire Name:

( HIQ3591 )

HRND.MHMOSAME

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HIMC1 - (HIQ4010 )

English text: YES
No

HIMC1B1 - YDISNROL ( HIQ3593 )

English text: NO
Attribute
Don't know

Route
HIMC1C - MHMOOTHR ( HIQ3596 )

Refusal

BOX HIMC4 - (HIQ4500 )

BACKGROUND VARIABLE ASSIGNMENTS
The Medicare Managed Care plan being asked about at HIMC1A was SP's current
Medicare Managed Care plan at the time of the previous round interview. This also means
that the SP was covered by this Medicare Managed Care plan for some time during the
current round.
To set current round status of this plan, create a current round PLRO where
PLRO.PLROPLAN = this PLAN.PLANNUM.
PLRO KEY = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
Based on response to HIMC1A, HRND.MHMOSAME, set the status of this plan on the
current round PLRO.

1:41:58 PM Monday, November 17, 2008

Page 32 of 353

HIMC1A
See detailed instructions below:
PLROPLAN	

PLRO.PLROPLAN = PLAN.PLANNUM of MHMO
current at time of previous round.

PLRORND	

PLRO.PLRORND = current round.

COVANYTM	

Set PLRO.COVANYTM = 1/Yes.

COVCURNT	

If HIMC1A - MHMOSAME = 1/Yes, set
PLRO.COVCURNT=1/Yes.
Else set PLRO.COVCURNT = 2/No.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

51

MHMOCurrPrevRnd

Medicare Managed Care plan "current" at time of
previous round interview =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:41:58 PM Monday, November 17, 2008	

Page 33 of 353

HIMC1B1

HIMC1B1

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

YDISNROL

Field 2:

YDISNROS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

1703

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Dsipaly name of Medicare Managed Care plan that was current at
the time of the previous round interview, PLAN.PLNAME.

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

What is the most important reason (you/SP) stopped the

(MEDICARE MANAGED CARE PLAN NAME) coverage?

Int. Instr II:

INPUT FIELDS / ROUTING


1:42:01 PM Monday, November 17, 2008	

Page 34 of 353

HIMC1B1

1:42:08 PM Monday, November 17, 2008

Page 35 of 353


HIMC1B1
YDISNROL

Field1:
Cheshire Name:

( HIQ3593 )

PLRO.YDISNROL

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TDisenrol
1
No
No

Number Label
1 TooExpensive
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HIMC1C - MHMOOTHR ( HIQ3596 )

English text: TOO EXPENSIVE OR COULDN'T AFFORD
DissatisfiedWithQuality
HIMC1C - MHMOOTHR ( HIQ3596 )

4

English text: SP DISSATISFIED WITH QUALITY OF CARE
ToGetRx
HIMC1C - MHMOOTHR ( HIQ3596 )
English text: TO GET RX COVERAGE IN ANOTHER PLAN
BenefitBesideRx
HIMC1C - MHMOOTHR ( HIQ3596 )

5

English text: TO GET BENEFIT COVERAGE OTHER THAN RX
OutOfBusiness
HIMC1C - MHMOOTHR ( HIQ3596 )

6

English text: PLAN WENT OUT OF BUSINESS/STOPPED MEDICARE COVERAGE
PlanChangedName
HIMC1C - MHMOOTHR ( HIQ3596 )

7

English text: PLAN NAME CHANGED OR PLAN WAS BOUGHT BY/MERGED WITH
ANOTHER PLAN
DrLeftPlan
HIMC1C - MHMOOTHR ( HIQ3596 )

3

8
9
10
11
91

English text: DOCTOR LEFT PLAN/DIED/RETIRED
CouldntGetAppt
HIMC1C - MHMOOTHR ( HIQ3596 )
English text: DIFFICULTIES GETTING APPTS OR SEEING PARTICULAR PROVIDERS
SpMoved
HIMC1C - MHMOOTHR ( HIQ3596 )
English text: SP MOVED OUT OF PLAN AREA
DidNotLikeChoice
HIMC1C - MHMOOTHR ( HIQ3596 )
English text: SP DIDN'T LIKE CHOICE OF DOCTORS
WantedChoice
HIMC1C - MHMOOTHR ( HIQ3596 )
English text: SP WANTED CHOICE OF DOCTORS
Other
HIMC1B1 - YDISNROS ( HIQ3594 )
English text: OTHER

Attribute
Don't know

Route
HIMC1C - MHMOOTHR ( HIQ3596 )

1:42:20 PM Monday, November 17, 2008

Page 36 of 353

HIMC1B1

Don't know
Refusal

HIMC1C - MHMOOTHR ( HIQ3596 )
( HIQ3594 )

YDISNROS

Field2:
Cheshire Name:

PLRO.YDISNROS

Item Text display:

Display "(SPECIFY)" in same blue font used for interviewer

instructions.


Item Text:

OTHER (SPECIFY)


Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


String

TOthrspec

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]

30

Route
HIMC1C - MHMOOTHR ( HIQ3596 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

51

MHMOCurrPrevRnd

Medicare Managed Care plan "current" at time of
previous round interview =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:42:21 PM Monday, November 17, 2008

Page 37 of 353

HIMC1C

HIMC1C

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

MHMOOTHR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1704

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is deceased or institutionalized, display "was SP".
Else display "(have you/has SP) been".
Display name of Medicare Managed Care Plan that was current at
the time of the previous round interview, PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:	

SHOW CARD HIMC1

Question Text:	

[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/INSTITUTIONALIZATION)], [(have you/has SP)
been/was SP] covered by any other Medicare Advantage Plans
besides (MEDICARE MANAGED CARE PLAN)?

Int. Instr II:

1:42:22 PM Monday, November 17, 2008	

Page 38 of 353

HIMC1C
INPUT FIELDS / ROUTING
MHMOOTHR

Field1:
Cheshire Name:

( HIQ3596 )

HRND.MHMOOTHR

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HIMC3 - MHMOCURR ( HIQ3970 )

English text: YES
No
English text: NO

BOX HIMC4 - (HIQ4500 )

Attribute
Don't know

Route
BOX HIMC4 - (HIQ4500 )

Refusal

BOX HIMC4 - (HIQ4500 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute

1:42:25 PM Monday, November 17, 2008

Page 39 of 353

HIMC1C
SP is Deceased =
MRES.SPALIVE=3/Deceased.
52

DeletedPlans	

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

51

MHMOCurrPrevRnd	

Medicare Managed Care plan "current" at time of
previous round interview =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:42:25 PM Monday, November 17, 2008	

Page 40 of 353

HIMC1

HIMC1

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

MHMOCOV

Enable Functions:	

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

1710

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

Always display "(may)" and "(Health Maintenance Organizations)"
and "(Preferred Provider Organizations)" in parenthesis.
Note to programmer: Currently all states have at least one

Medicare Managed Care plan, however, this can change.

Therefore, we are leaving in this display fill:

If there are no Medicare Managed Care Plans in SP's state, display

"any".

Else display "(one of these/any)". Always display in parenthesis.

If there are Medicare Managed Care Plans in SP’s state, display
"Please look at this card.".
Else do not display.
If there are Medicare Managed Care Plans in SP’s state, display
"SHOW CARD HIMC1" interviewer instruction. Do not display in

parenthesis. Parenthesis indicate that this is a display fill.

Else do not display.

If SP is deceased or institutionalized, display "had (SP)".

Else if SP is the respondent, display "have you".

Else display "has (SP)".


Multi Field display:

Roster/Grid Instructions:

1:42:27 PM Monday, November 17, 2008	

Page 41 of 353

HIMC1
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:

(SHOW CARD HIMC1)

Question Text:

As you (may) know, Medicare allows beneficiaries in certain parts of
the country to enroll in Medicare Advantage plans, such as HMOs
(Health Maintenance Organizations) and PPOs (Preferred Provider
Organizations), to receive their Medicare-covered health care.
(Please look at this card.) At any time [since (REFERENCE
DATE)/between (REFERENCE DATE) and (DATE OF DEATH/DATE
OF INSTITUTIONALIZATION),] [have you/has (SP)/had (SP)] been
enrolled in or covered by [any/(one of these/any)] Medicare
Advantage plans?

Int. Instr II:
INPUT FIELDS / ROUTING

1:42:29 PM Monday, November 17, 2008

Page 42 of 353

HIMC1
( HIQ3600 )

MHMOCOV

Field1:
Cheshire Name:

HRND.MHMOCOV

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HIMC3 - MHMOCURR ( HIQ3970 )

English text: YES
No

BOX HIMC4 - (HIQ4500 )

English text: NO
Attribute
Don't know

Route
BOX HIMC4 - (HIQ4500 )

Refusal

BOX HIMC4 - (HIQ4500 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

340

AllStateWithMHMO

If there are Medicare Managed Care plans in SP's state =
All States have at least one Medicare Advantage Plan.

DESIGN NOTES

1:42:31 PM Monday, November 17, 2008

Page 43 of 353

HIMC3

HIMC3

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

MHMOCURR

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

1890

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If (SP is alive and not institutionalized), display "currently".
Else do not display.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

(Are you/Is SP/Was SP) (currently) covered by or enrolled in a
Medicare Advantage Plan [on (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]?

Int. Instr II:
INPUT FIELDS / ROUTING

1:42:33 PM Monday, November 17, 2008	

Page 44 of 353

HIMC3
MHMOCURR

Field1:
Cheshire Name:

( HIQ3970 )

HRND.MHMOCURR

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HIMC5 - PLAN_MHMO ( HIQ4000 )

English text: YES
No

BOX HIMC2 - (HIQ4440 )

English text: NO
Attribute
Don't know

Route
BOX HIMC2 - (HIQ4440 )

Refusal

BOX HIMC2 - (HIQ4440 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =

1:42:36 PM Monday, November 17, 2008

Page 45 of 353

HIMC3
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
HIMC3 is also called from ST, NS, CPS when a Medicare Managed Care
Plan is added at the Source of Payment roster and SP has not already
reported a current Medicare Managed Care Plan.

1:42:36 PM Monday, November 17, 2008

Page 46 of 353

HIMC5

HIMC5

Page Order # :

Design Screen Type:	

Roster

Fields:	

Field 1:

PLAN_MHMO

Enable Functions:	

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Name:

Plan Roster

Roster Type:

Single Item Select

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:	

Add Line
Delete Line

No
No

1920

Display as ' Add a Plan '
Display as ' Edit a Plan '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Always display "[What is the name…"] in brackets.
If SP is deceased, display "on (DATE OF DEATH)".

Else if SP is institutionalized, display "on (DATE OF

INSTITUTIONALIZATION)" .

Else do not display.

If SP is deceased or institutionalized, display "covered".

Else display "covers".


Multi Field display:

Roster/Grid Instructions:

Display all health insurance plans from the Plan Roster.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare plan
Medicare Managed Care plan if "current" at the time of the previous
round interview
Medicaid
Tricare
Public Plans
Private Plans
Medicare Prescription Drug Plans

Roster/Grid display:

COL #
1

1:42:36 PM Monday, November 17, 2008	

HEADER
Plan Name

INSTRUCTIONS
Display PLAN.PLNAME.
Page 47 of 353

HIMC5
2

Plan Type

Display PLAN.PLANTYPE:
1/Medicare, display "(MCAR)"
2/Medicaid, display "(MCAD)"
3/PublicPlan, display "(PUBL)"
4/PrivatePlan, display "(PRIV)"
5/MHMO, display "(MHMO)"
6/Tricare, display "(TRIC)"
7/MPDP, display "(MPDP)"

3

Plan Status

Display CURRENT ROUND PLAN
STATUS.

Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

[What is the name of the Medicare Advantage Plan that (currently
covers/covered) [you/(SP)] [on (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]?]

Int. Instr II:

SELECT OR ADD ONLY ONE MEDICARE ADVANTAGE PLAN AT
THIS ROSTER.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PLAN_MHMO

( HIQ4000 )

TEMP

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

String
TPlanPick32
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

32

Route
BOX HIMC1 - (HIQ4010 )

BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:

1:42:37 PM Monday, November 17, 2008

Page 48 of 353

HIMC5
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at HIMC5.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HIMC5.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
The plan selected at HIMC5 is the SP's current Medicare Managed Care plan for the
present round. To set status of PLAN, create current round PLRO where
PLRO.PLROPLAN=this PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
COVANYTM	

Set PLRO.COVANYTM=1/Yes for plan selected at
HIMC5.

COVCURNT	

Set PLRO.COVCURNT=1/Yes for plan selected at
HIMC5.

PLANTYPE	

If PLAN added to roster, set
PLAN.PLANTYPE=5/MHMO.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
95

PlanIsCurrent

If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

50

LoadedMHMO

Loaded CMS Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.

65

MHMOCurrent

SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

1:42:37 PM Monday, November 17, 2008	

Page 49 of 353

HIMC5
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

53

PlanTypes

Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Managed Care: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.

51

MHMOCurrPrevRnd

Medicare Managed Care plan "current" at time of
previous round interview =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES
HIMC5 is called from ST, NS, CPS when a Medicare Managed Care Plan is
added at the Source of Payment roster and SP has already reported a
current Medicare Managed Care plan but has now reported a change
regarding which Medicare Managed Care plan is current.

1:42:37 PM Monday, November 17, 2008

Page 50 of 353

BOX HIMC1

BOX HIMC1

Page Order # :

1930

BOX INSTRUCTIONS
( HIQ4010 )	

THIS PLAN IS THE SP'S CURRENT MEDICARE MANAGED CARE PLAN .
GO TO HIMC6 - MHMORX ( HIQ4020 ).

ASSIGNMENTS
The PLAN directed to BOX HIMC1 is the SP's current Medicare Managed Care plan this
round.

TECHNICAL NOTES

DESIGN NOTES
If Supplemental Case and PLAN currently being asked about is the
loaded CMS plan, this plan is considered "NEW" (PLAN.PLANRNDC=52)
and should route to HIMC6.

1:42:37 PM Monday, November 17, 2008	

Page 51 of 353

HIMC6

HIMC6

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

MHMORX

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1940

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
If respondent is the SP, display "you personally have".
Else if SP is deceased or institutionalized, display "(SP) personally
had".
Else display "(SP) personally has".
Display "you" or "(SP)' in "(you personally have/(SP) personally
has/(SP) personally had)" in BOLD.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

1:42:39 PM Monday, November 17, 2008

[Do you/Does (SP)/Did (SP)] have prescribed medicine coverage

through (CURRENT MEDICARE MANAGED CARE PLAN)?
Page 52 of 353

HIMC6
[PROBE: I am asking about the type of insurance coverage that
(you personally have/(SP) personally has/(SP) personally had), not
what the plan offers everyone.]
Int. Instr II:
INPUT FIELDS / ROUTING
( HIQ4020 )

MHMORX

Field1:
Cheshire Name:

PLRO.MHMORX

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HIMC1CC1 - (HIQ4030 )

English text: YES
No

BOX HIMC1CC1 - (HIQ4030 )

English text: NO
Attribute
Don't know

Route
BOX HIMC1CC1 - (HIQ4030 )

Refusal

BOX HIMC1CC1 - (HIQ4030 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4

Respondent

1:42:41 PM Monday, November 17, 2008

On MRES where MRES.MRESRND = current round:
Page 53 of 353

HIMC6
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
52

DeletedPlans	

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

65

MHMOCurrent	

SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

59

SPStatus	

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =

MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY

SP is Institutionalized =

MRES.SPALIVE=2/AliveAndInstitute

SP is Deceased =

MRES.SPALIVE=3/Deceased.


DESIGN NOTES
HIMC6 is call from ST, NS, CPS when a new Medicare HMO is added to
the SOP roster that is the SP's current MHMO.

1:42:41 PM Monday, November 17, 2008	

Page 54 of 353

BOX HIMC1CC1

BOX HIMC1CC1

Page Order # :

1950

BOX INSTRUCTIONS
( HIQ4030 )	

IF (THIS MEDICARE MANAGED CARE PLAN IS NEW OR HAS BEEN
"RESTARTED"), GO TO HIMC7 - MHMODENT ( HIQ4280 ).
ELSE GO TO BOX HIMC2 - (HIQ4440 ).

ASSIGNMENTS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

61

ThisPlanNew

This Plan is new =
PLAN.PLANRNDC = current round and
PLAN.PLANSUMM ^= 1/Yes.
Exclude Deleted Plans. See T.N. 52.

74

ThisMHMORestarted

This MHMO Plan has been restarted =
For this PLAN, there is not a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes ).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:42:41 PM Monday, November 17, 2008	

Page 55 of 353

HIMC7

HIMC7

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

MHMODENT

Enable Functions:	

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2100

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

(Do you/Does SP/Did SP) have dental coverage through (CURRENT

MEDICARE MANAGED CARE PLAN NAME)?

Int. Instr II:
INPUT FIELDS / ROUTING

1:42:43 PM Monday, November 17, 2008	

Page 56 of 353

HIMC7
MHMODENT

Field1:	
Cheshire Name:

( HIQ4280 )

PLRO.MHMODENT

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label	
1 Yes	
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HIMC8 - MHMOEYE ( HIQ4290 )

English text: YES
No	

HIMC8 - MHMOEYE ( HIQ4290 )

English text: NO
Attribute
Don't know

Route
HIMC8 - MHMOEYE ( HIQ4290 )

Refusal

HIMC8 - MHMOEYE ( HIQ4290 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans	

1:42:46 PM Monday, November 17, 2008	

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

Page 57 of 353

HIMC7
65

MHMOCurrent

SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:42:46 PM Monday, November 17, 2008

Page 58 of 353

HIMC8

HIMC8

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

MHMOEYE

Enable Functions:	

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2110

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

(Do you/Does SP/Did SP) have optical coverage through
(CURRENT MEDICARE MANAGED CARE PLAN NAME), that is, for
eyeglasses or contact lenses?

Int. Instr II:
INPUT FIELDS / ROUTING

1:42:47 PM Monday, November 17, 2008	

Page 59 of 353

HIMC8
( HIQ4290 )

MHMOEYE

Field1:	
Cheshire Name:

PLRO.MHMOEYE

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label	
1 Yes	
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HIMC9 - MHMOPCAR ( HIQ4300 )

English text: YES
No	

HIMC9 - MHMOPCAR ( HIQ4300 )

English text: NO
Attribute
Don't know

Route
HIMC9 - MHMOPCAR ( HIQ4300 )

Refusal

HIMC9 - MHMOPCAR ( HIQ4300 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans	

1:42:50 PM Monday, November 17, 2008	

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

Page 60 of 353

HIMC8
65

MHMOCurrent

SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:42:50 PM Monday, November 17, 2008

Page 61 of 353

HIMC9

HIMC9

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

MHMOPCAR

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2120

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

(Do you/Does SP/Did SP) have coverage for preventive care such
as routine annual physicals through (CURRENT MEDICARE
MANAGED CARE PLAN NAME)?

Int. Instr II:
INPUT FIELDS / ROUTING

1:42:51 PM Monday, November 17, 2008	

Page 62 of 353

HIMC9
MHMOPCAR

Field1:	
Cheshire Name:

( HIQ4300 )

PLRO.MHMOPCAR

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label	
1 Yes	
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HIMC10 - MHMONH ( HIQ4310 )

English text: YES
No	

HIMC10 - MHMONH ( HIQ4310 )

English text: NO
Attribute
Don't know

Route
HIMC10 - MHMONH ( HIQ4310 )

Refusal

HIMC10 - MHMONH ( HIQ4310 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans	

1:42:54 PM Monday, November 17, 2008	

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

Page 63 of 353

HIMC9
65

MHMOCurrent

SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:42:54 PM Monday, November 17, 2008

Page 64 of 353

HIMC10

HIMC10

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

MHMONH

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2130

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

(Does your/Does SP’s/Did SP’s) (CURRENT MEDICARE
MANAGED CARE PLAN NAME) coverage include nursing home
care over and beyond what Medicare normally covers?
[EXPLAIN IF NECESSARY: Under regular fee-for-service, Medicare
pays for limited skilled nursing facility (SNF) care during a benefit
period. In 2009, the first 20 days are paid in full and the next 80
days require a copayment of up to $133.50 per day.]

Int. Instr II:
1:42:56 PM Monday, November 17, 2008	

Page 65 of 353

HIMC10
INPUT FIELDS / ROUTING
( HIQ4310 )

MHMONH

Field1:	
Cheshire Name:

PLRO.MHMONH

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label	
1 Yes	
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HIMC11 - MHMOPAY ( HIQ4320 )

English text: YES
No	
English text: NO

HIMC11 - MHMOPAY ( HIQ4320 )

Attribute
Don't know

Route
HIMC11 - MHMOPAY ( HIQ4320 )

Refusal

HIMC11 - MHMOPAY ( HIQ4320 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans	

1:42:58 PM Monday, November 17, 2008	

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

Page 66 of 353

HIMC10
65

MHMOCurrent

SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:42:59 PM Monday, November 17, 2008

Page 67 of 353

HIMC11

HIMC11

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

MHMOPAY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2140

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is deceased or institutionalized, display "was".
Else display "is".
If SP is deceased or institutionalized, display "have paid".
Else display "pay".
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

Besides the cost of [your/(SP’s)] Medicare Part B premium, (is/was)
there an additional cost for [your/(SP’s)] (CURRENT MEDICARE
MANAGED CARE PLAN NAME) coverage? Please do not include
any amount that [you/(SP)] may (pay/have paid) as a co-payment for

1:43:00 PM Monday, November 17, 2008	

Page 68 of 353

HIMC11
an office visit or a prescribed medicine.
[EXPLAIN IF NECESSARY: Some managed care plans may charge
a monthly premium to cover the cost of the deductibles and
coinsurance for Medicare-covered services or because they provide
services that are not covered by Medicare such as prescribed
medicines, routine exams, and dental, eye, or hearing. Plans that
have premiums typically charge from $50 to $75 per month.]
Int. Instr II:

INPUT FIELDS / ROUTING

MHMOPAY

Field1:
Cheshire Name:

( HIQ4320 )

PLRO.MHMOPAY

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HIMC12 - MHMOAMT ( HIQ4330 )

English text: YES
No

BOX HIMC2 - (HIQ4440 )

English text: NO
Attribute
Don't know

Route
BOX HIMC2 - (HIQ4440 )

Refusal

BOX HIMC2 - (HIQ4440 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

1:43:03 PM Monday, November 17, 2008

Page 69 of 353

HIMC11

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

65

MHMOCurrent

SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

DESIGN NOTES

1:43:03 PM Monday, November 17, 2008

Page 70 of 353

HIMC12

HIMC12

Page Order # :

Design Screen Type:

Quantity Unit Hybrid

Fields:

Field 1:

MHMOAMT

Field 2:

MHMOUNIT

Field 3:

MHMOUNOS

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No

No

No

No


Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

2150

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display the name of the "current" Medicare Managed Care Plan,

PLAN.PLNAME.

If SP is deceased or institutionalized, display "was",

Else display "is".

If SP is deceased or institutionalized, display "(SP) paid".

Else if SP is respondent, "you pay".

Else display "(SP) pays".

If SP is deceased or institutionalized, display "have been".

Else display "be".

Always display "[Please do not include any copayments...]" in

brackets.

Display "additional" in BOLD.


Multi Field display:

Vertical Alignment


Roster/Grid Instructions:
Roster/Grid display:

1:43:06 PM Monday, November 17, 2008

Page 71 of 353

HIMC12
Report display:

TEXT:
Context Header:
Int. Instr I:
Not including the cost of [your/(SP’s)] Medicare Part B premium,
what (is/was) the additional amount that [you pay/(SP) pays/(SP)
paid] for (your/his/her) (CURRENT MEDICARE MANAGED CARE
PLAN NAME) coverage? [Please do not include any copayments or
any amount that may (be/have been) paid for anyone other than
[you/(SP)].]

Question Text:

[PROBE IF NECESSARY: Is that per year, per month, per week, or
what?]
Int. Instr II:
INPUT FIELDS / ROUTING
MHMOAMT

Field1:
Cheshire Name:

( HIQ4330 )

PLRO.MHMOAMT

Item Text display:
Item Text:
Label:

Label Position:


AMOUNT:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Real
TMippamt
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HIMC12A - MHMOCOST ( HIQ4360 )

Refusal

HIMC12A - MHMOCOST ( HIQ4360 )

1:43:12 PM Monday, November 17, 2008

FieldSize:
Min Value:
Max Value:
Mask:

0.01
99999.99
Dollars

Route
HIMC12 - MHMOUNIT ( HIQ4340 )

Page 72 of 353

HIMC12
MHMOUNIT

Field2:
Cheshire Name:

( HIQ4340 )

PLRO.MHMOUNIT

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TMippunit
1
No
No

Number Label
1 PerYear
2

English text: PER YEAR
Quarterly

FieldSize:
Min Value:
Max Value:
Mask:

Route
HIMC12A - MHMOCOST ( HIQ4360 )
HIMC12A - MHMOCOST ( HIQ4360 )

4

English text: QUARTERLY/EVERY 3 MONTHS
Bimonthly
HIMC12A - MHMOCOST ( HIQ4360 )
English text: BIMONTHLY/EVERY 2 MONTHS
PerMonth
HIMC12A - MHMOCOST ( HIQ4360 )

5

English text: PER MONTH
PerWeek

HIMC12A - MHMOCOST ( HIQ4360 )

6

English text: PER WEEK
SemiAnnually

HIMC12A - MHMOCOST ( HIQ4360 )

7

English text: SEMI-ANNUALLY/2 TIMES PER YEAR
SemiMonthly
HIMC12A - MHMOCOST ( HIQ4360 )

91

English text: SEMI-MONTHLY/2 TIMES PER MONTH
Other
HIMC12 - MHMOUNOS ( HIQ4350 )

3

English text: OTHER
Attribute
Don't know

Route
HIMC12A - MHMOCOST ( HIQ4360 )

Refusal

HIMC12A - MHMOCOST ( HIQ4360 )

1:43:19 PM Monday, November 17, 2008

Page 73 of 353

HIMC12
MHMOUNOS

Field3:
Cheshire Name:

( HIQ4350 )

PLRO.MHMOUNOS

Item Text display:
Item Text:

OTHER (SPECIFY)

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:


String
TOthrspec

FieldSize:
Min Value:

Max Value:

Mask:


1

No
No


Number Label
1 [Continuous answer.]

30

Route
HIMC12A - MHMOCOST ( HIQ4360 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:

If MHMOAMT ^= DK and MHMOAMT ^= RF, then:

If MHMOUNIT = 1/PerYear, then MHMOAMT = $50.00 - 10,000.00.

Else If MHMOUNIT = 2/Quarterly, then MHMOAMT = $15.00 - 

2500.00.

Else If MHMOUNIT = 3/Bimonthly, then MHMOAMT = $10.00 ­
1650.00.

Else If MHMOUNIT = 4/PerMonth, then MHMOAMT = $5.00 - 

850.00.

Else If MHMOUNIT = 5/PerWeek, then MHMOAMT = $5.00 - 200.00.

Else If MHMOUNIT = 6/Semiannually, then MHMOAMT = $25.00 - 

5,000.00.

Else If MHMOUNIT = 7/Semimonthly, then MHMOAMT = $2.00 - 

425.00.

Else If MHMOUNIT = 91/Other, then MHMOAMT = $5.00 - 15,000.00.

If not true, display message "THE AMOUNT ENTERED SEEMS

UNLIKELY. PLEASE VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES
66

SpouseInHH

1:43:20 PM Monday, November 17, 2008

SP has spouse living in the household =
There is a ROST where ROST.ROSTREL=2/Spouse and
ENUM where (ENUM.ENUMROST= ROST.ROSTNUM
and ENUM.ENUMRND=current round and
ENUM.NOTHHRSN = empty).

Page 74 of 353

HIMC12
52

DeletedPlans	

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

65

MHMOCurrent	

SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

59

SPStatus	

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =

MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY

SP is Institutionalized =

MRES.SPALIVE=2/AliveAndInstitute

SP is Deceased =

MRES.SPALIVE=3/Deceased.


4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

DESIGN NOTES

1:43:20 PM Monday, November 17, 2008	

Page 75 of 353

HIMC12A

HIMC12A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

MHMOCOST

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2160

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is deceased or institutionalized, display "Did".
Else display "Does".
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

(Does/Did) anyone else, such as an employer, a union or
professional organization pay all or some portion of the additional
cost for (your/SP’s) (CURRENT MEDICARE MANAGED CARE
PLAN NAME) coverage?

Int. Instr II:

1:43:22 PM Monday, November 17, 2008	

Page 76 of 353

HIMC12A
INPUT FIELDS / ROUTING
MHMOCOST

Field1:
Cheshire Name:

( HIQ4360 )

PLRO.MHMOCOST

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HIMC12B - MHMOWHO ( HIQ4370 )

English text: YES
No
English text: NO

BOX HIMC2 - (HIQ4440 )

Attribute
Don't know

Route
BOX HIMC2 - (HIQ4440 )

Refusal

BOX HIMC2 - (HIQ4440 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans	

1:43:24 PM Monday, November 17, 2008	

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

Page 77 of 353

HIMC12A
65

MHMOCurrent

SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

DESIGN NOTES

1:43:24 PM Monday, November 17, 2008

Page 78 of 353

HIMC12B

HIMC12B

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

MHMOWHO

Field 2:

MHMOWHOS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

2170

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is deceased or institutionalized, display "paid".
Else display "pays".
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

Who else (pays/paid) all or some portion of the additional cost for

(your/SP’s) (CURRENT MEDICARE MANAGED CARE PLAN
NAME) coverage?

Int. Instr II:

1:43:27 PM Monday, November 17, 2008	

Page 79 of 353

HIMC12B
INPUT FIELDS / ROUTING
MHMOWHO

Field1:
Cheshire Name:
Item Text display:

( HIQ4370 )

PLRO.MHMOWHO
[(SP's)/(MIP's)]: Display (SP's), SP's name, in response
text for "1/CurrentEmployer", "2/FormerEmployer", and
"3/Union".

Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
TMhmowho
1
No
No

FieldSize:
Min Value:
Max Value:
Mask:

Number Label
Route
1 CurrentEmployer
BOX HIMC2 - (HIQ4440 )
English text: [(SP's)/(MIP's)] CURRENT EMPLOYER
2 FormerEmployer
BOX HIMC2 - (HIQ4440 )
3

English text: (SP's/MIP's) FORMER EMPLOYER
Union
BOX HIMC2 - (HIQ4440 )

5

English text: (SP's/MIP's) UNION
SpousesCurrentEmployer
BOX HIMC2 - (HIQ4440 )
English text: SPOUSE'S CURRENT EMPLOYER
SpousesFormerEmployer
BOX HIMC2 - (HIQ4440 )

6

English text: SPOUSE'S FORMER EMPLOYER
ProfessionalOrg
BOX HIMC2 - (HIQ4440 )

4

7
91

English text: PROFESSIONAL/FRATERNAL ORGANIZATION
Medicaid
BOX HIMC2 - (HIQ4440 )
English text: MEDICAID/MEDICAL ASSISTANCE
Other
HIMC12B - MHMOWHOS ( HIQ4380 )
English text: OTHER

Attribute
Don't know

Route
BOX HIMC2 - (HIQ4440 )

Refusal

BOX HIMC2 - (HIQ4440 )

1:43:33 PM Monday, November 17, 2008

Page 80 of 353

HIMC12B
MHMOWHOS

Field2:
Cheshire Name:

( HIQ4380 )

PLRO.MHMOWHOS

Item Text display:

Display "(SPECIFY)" in same blue font used for interviewer

instructions.


Item Text:

OTHER (SPECIFY)


Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


String

TOthrspec

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]

30

Route
BOX HIMC2 - (HIQ4440 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

65

MHMOCurrent

SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

1:43:34 PM Monday, November 17, 2008

Page 81 of 353

HIMC12B
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

DESIGN NOTES

1:43:34 PM Monday, November 17, 2008

Page 82 of 353

BOX HIMC2

BOX HIMC2

Page Order # :

2220

BOX INSTRUCTIONS
( HIQ4440 )	

IF ADMINISTERING ST, GO TO BOX ST69A - (STQ2825 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS69A - (NSQ2825 ).
ELSE IF ADMINISTERING CPS, GO TO BOX CPS29A - (CPS1710 ).
ELSE IF HIMC1A - MHMOSAME = 1/Yes, GO TO BOX HIMC4 - (HIQ4500 ).
ELSE IF HIMC3 - MHMOCURR = 2/No, DK OR RF, GO TO HIMC17 PLAN_MHMOOTHER ( HIQ4460 ).
ELSE GO TO HIMC16 - MHMOMORE ( HIQ4450 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES
If administering ST, NS, CPS, you have completed the Medicare
Managed Care Plan detail questions for the Medicare Managed Care plan
added at the Source of Payment roster. Return to the section being
administered as specified above.

1:43:34 PM Monday, November 17, 2008	

Page 83 of 353

HIMC16

HIMC16

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

MHMOMORE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2230

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has a "current" Medicare Managed Care plan, then
If SP has a loaded CMS Medicare Managed Care plan that is not
"current", display "(CURRENT MEDICARE MANAGED CARE PLAN
NAME) and (CMS MEDICARE MANAGED CARE PLAN NAME)".
Else if SP had a Medicare Managed Care plan that was "current"
at the time of the previous round interview and is not "current" in the
present round, display "(CURRENT MEDICARE MANAGED CARE
PLAN) and (MEDICARE MANAGED CARE PLAN CURRENT AT
THE TIME OF PREVIOUS ROUND INTERVIEW)".
Else display "(CURRENT MEDICARE MANAGED CARE PLAN)".
Else then
If SP had a loaded CMS MEDICARE MANAGED CARE PLAN,
display "(CMS MEDICARE MANAGED CARE PLAN)".
Else display "(MEDICARE MANAGED CARE PLAN CURRENT
AT THE TIME OF PREVIOUS ROUND INTERVIEW)".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:

1:43:36 PM Monday, November 17, 2008

Page 84 of 353

HIMC16
Report display:

TEXT:
Context Header:
Int. Instr I:

SHOW CARD HIMC1

Question Text:

[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/ DATE OF INSTITUTIONALIZATION)], [have
you/has (SP)/had (SP)] been covered by any other Medicare
Advantage Plans besides (MEDICARE MANAGED CARE PLAN and
MEDICARE MANAGED CARE PLAN)?

Int. Instr II:
INPUT FIELDS / ROUTING
MHMOMORE

Field1:
Cheshire Name:

( HIQ4450 )

HRND.MHMOMORE

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HIMC17 - PLAN_MHMOOTHER ( HIQ4460 )

English text: YES
No
English text: NO

Attribute
Don't know

Route
BOX HIMC4 - (HIQ4500 )

Refusal

BOX HIMC4 - (HIQ4500 )

BOX HIMC4 - (HIQ4500 )

BACKGROUND VARIABLE ASSIGNMENTS

1:43:39 PM Monday, November 17, 2008

Page 85 of 353

HIMC16
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

65

MHMOCurrent

SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

50

LoadedMHMO

Loaded CMS Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.

51

MHMOCurrPrevRnd

Medicare Managed Care plan "current" at time of
previous round interview =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

DESIGN NOTES

1:43:39 PM Monday, November 17, 2008

Page 86 of 353

HIMC17

HIMC17

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PLAN_MHMOOTHER

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Name:

Plan Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No

Yes


Grid Functions:

Add Line
Delete Line

No
No

2240

Display as ' Add a Plan '

Display as ' Edit a Plan '


DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has a "current" Medicare Managed Care plan, then
If SP had a loaded CMS Medicare Managed Care plan that is not
"current", display "Besides (CURRENT MEDICARE MANAGED
CARE PLAN) and (CMS MEDICARE MANAGED CARE PLAN),
what other".
Else if SP had an Medicare Managed Care plan that was "current"
at the time of the previous round interview and is not "current" in the
present round, display "Besides (CURRENT MEDICARE
MANAGED CARE PLAN) and (MEDICARE MANAGED CARE
PLAN CURRENT AT THE TIME OF PREVIOUS ROUND
INTERVIEW), what other".
Else display "Besides (CURRENT MEDICARE MANAGED CARE
PLAN), what other".
Else if SP had a loaded CMS MEDICARE MANAGED CARE PLAN,
display "Besides (CMS MEDICARE MANAGED CARE PLAN),
what".
Else if SP had a Medicare Managed Care plan "current " at the time
of the prevoius round interview, display "Besides (MEDICARE
MANAGED CARE PLAN NAME CURRENT AT THE TIME OF
PREVIOUS ROUND INTERVIEW), what other".
Else display "What".

Multi Field display:

1:43:39 PM Monday, November 17, 2008

Page 87 of 353

HIMC17

Roster/Grid Instructions:

Display all health insurance plans from the Plan Roster.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare plan
Medicare Managed Care plan if "current" at the time of the previous
round interview
Medicare Managed Care plan if reported "current" in the current
round.
Medicaid
Tricare
Public Plans
Private Plans
Medicare Prescription Drug Plans

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

Plan Name

Display PLAN.PLNAME.

2

Plan Type

Display PLAN.PLANTYPE:
1/Medicare, display "(MCAR)"
2/Medicaid, display "(MCAD)"
3/PublicPlan, display "(PUBL)"
4/PrivatePlan, display "(PRIV)"
5/MHMO, display "(MHMO)"
6/Tricare, display "(TRIC)"
7/MPDP, display "(MPDP)"

3

Plan Status

Display CURRENT ROUND PLAN
STATUS.

Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

[Besides (MEDICARE MANAGED CARE PLAN and MEDICARE
MANAGED CARE PLAN), what other/What] Medicare Advantage
Plans provided (your/SP’s) health care since (REFERENCE DATE)?

Int. Instr II:

SELECT OR ADD MEDICARE ADVANTAGE PLAN NAMES AT
THIS ROSTER.

INPUT FIELDS / ROUTING

1:43:40 PM Monday, November 17, 2008

Page 88 of 353

HIMC17

Field1:
Cheshire Name:

PLAN_MHMOOTHER

( HIQ4460 )

TEMP

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

String
TPlanPick30
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HIMC4 - (HIQ4500 )

BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at HIMC17.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HIMC17.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
Plans selected at HIMC17 are Medicare Managed Care plans that the SP was enrolled in
for some time in the current round but are not the SP's current Medicare Managed Care
plan.
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
COVANYTM	

Set PLRO.COVANYTM = 1/Yes for all plan selected
at HIMC17.

COVCURNT	

Set PLRO.COVCURNT = 2/No for all plan selected
at HIMC17.

1:43:41 PM Monday, November 17, 2008	

Page 89 of 353

HIMC17
If PLAN added to roster, set
PLAN.PLANTYPE=5/MHMO.

PLANTYPE
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
51

MHMOCurrPrevRnd

Medicare Managed Care plan "current" at time of
previous round interview =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

95

PlanIsCurrent

If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

53

PlanTypes

Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Managed Care: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.

65

MHMOCurrent

SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

50

LoadedMHMO

Loaded CMS Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.

DESIGN NOTES

1:43:41 PM Monday, November 17, 2008

Page 90 of 353

BOX HIMC4

BOX HIMC4

Page Order # :

2270

BOX INSTRUCTIONS
( HIQ4500 )	

IF FALL ROUND AND (SP IS ALIVE AND NOT INSTITUTIONALIZED) AND
(SP HAS A MEDICARE MANAGED CARE PLAN THAT IS "CURRENT"), GO
TO HIMC19 - RECMHMO ( HIQ4510 ).
ELSE GO TO BOX HI1 - (HIQ4670 ).
.

ASSIGNMENTS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

65

MHMOCurrent

SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:43:41 PM Monday, November 17, 2008	

Page 91 of 353

HIMC19

HIMC19

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

RECMHMO

Enable Functions:	

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2280

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

Would you recommend (CURRENT MEDICARE MANAGED CARE

PLAN NAME) to your family or friends?

Int. Instr II:
INPUT FIELDS / ROUTING

1:43:42 PM Monday, November 17, 2008	

Page 92 of 353

HIMC19
( HIQ4510 )

RECMHMO

Field1:
Cheshire Name:

ACCS.RECMHMO

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HIMC5 - (HIQ4640 )

English text: YES
No

BOX HIMC5 - (HIQ4640 )

English text: NO
Attribute
Don't know

Route
BOX HIMC5 - (HIQ4640 )

Refusal

BOX HIMC5 - (HIQ4640 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans	

1:43:45 PM Monday, November 17, 2008	

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

Page 93 of 353

HIMC19
65

MHMOCurrent

SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:43:45 PM Monday, November 17, 2008

Page 94 of 353

BOX HIMC5

BOX HIMC5

Page Order # :

2340

BOX INSTRUCTIONS
( HIQ4640 )	

IF (SP HAS A MEDICARE MANAGED CARE PLAN THAT IS "CURRENT")
AND (THE NUMBER OF YEARS THE SP WAS COVERED BY A MANAGED
CARE PLAN HAS NEVER BEEN COLLECTED), GO TO HIMC24 ­
HMONUMYR ( HIQ4660 ).
ELSE GO TO BOX HI1 - (HIQ4670 ).

ASSIGNMENTS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

65

MHMOCurrent

SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

87

HIMC24NeverAsked

The number of years the SP was covered by a managed
care plan has never been collected =
BASE.HIMC24FL ^= 1/Yes.

DESIGN NOTES

1:43:45 PM Monday, November 17, 2008	

Page 95 of 353

HIMC24

HIMC24

Page Order # :

Design Screen Type:	

Numeric

Fields:	

Field 1:

HMONUMYR

Field 2:

HMONUM96

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

2360

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Display all fields at one time.

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

How many years [have you/has (SP)] been enrolled in a managed

care plan?

Int. Instr II:
INPUT FIELDS / ROUTING

1:43:47 PM Monday, November 17, 2008	

Page 96 of 353

HIMC24
HMONUMYR

Field1:
Cheshire Name:

( HIQ4660 )

ACCS.HMONUMYR

Item Text display:
Item Text:
Label:
Label Position:

NUMBER OF YEARS:
Left

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer
THnumyr
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Empty

Route
HIMC24 - HMONUM96 ( HIQ4662 )

Don't know

HIMC24 - HMONUM96 ( HIQ4662 )

Refusal

HIMC24 - HMONUM96 ( HIQ4662 )

1:43:51 PM Monday, November 17, 2008

FieldSize:

Min Value:
Max Value:
Mask:


1

96


Route
HIMC24 - HMONUM96 ( HIQ4662 )

Page 97 of 353

HIMC24
HMONUM96

Field2:
Cheshire Name:

( HIQ4662 )

NONE
If HMONUM96 = 1/LessThanYear, set Cheshire field
ACCS.HMONUMYR = 96 during data transformation.

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
THMONum96
1
No
No

Number Label
1 LessThanYear

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI1 - (HIQ4670 )

English text: LESS THAN ONE YEAR
Attribute
Empty

Route
BOX HI1 - (HIQ4670 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

If HMONUMYR ^= EMPTY then HMONUMYR = 1-25.

If not true, display message "UNLIKELY NUMBER OF YEARS.

PLEASE VERIFY."

HARD EDIT CHECKS
Edit #1

HMONUMYR and HMONUM96 cannot both be EMPTY.

If not true, display message "ENTRY REQUIRED. PLEASE ENTER

NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."

Edit #2

HMONUMYR and HMONUM96 cannot both be FILLED.

If not true, display message "INVALID ENTRY. PLEASE ENTER

NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."

TECHNICAL NOTES
1:43:53 PM Monday, November 17, 2008

Page 98 of 353

HIMC24

DESIGN NOTES

1:43:53 PM Monday, November 17, 2008

Page 99 of 353


BOX HI1

BOX HI1

Page Order # :

2370

BOX INSTRUCTIONS
( HIQ4670 )	

IF A MEDICAID PLAN WAS "CURRENT" AT THE TIME OF THE PREVIOUS
ROUND INTERVIEW, GO TO HI6 - COVTIME ( HIQ4770 ).
ELSE GO TO HI5INTRO - MCAIDINT ( HIQ4721 ).

ASSIGNMENTS
If Medicaid was current at the time of the previous round interview, then the SP was also
covered by Medicaid for some time during the current round.
If Medicaid was current at the time of the previous round interview, current round plan
details will be collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of Medicaid plan.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of Medicaid plan.
PLRO.PLRORND = current round.
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below.
PLROPLAN

PLRO.PLROPLAN = PLAN.PLANNUM of Medicaid
Plan current at time of previous round.

PLRORND

PLRO.PLRORND = current round.

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

67

MedicaidCurrentPrevRn
d

Medicaid "current" at the time of the previous round
interview =
There is a PLAN where PLAN.PLANTYPE=2/Medicaid
and PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=previous round & (COVTIME=1/WholeTime
or COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:43:53 PM Monday, November 17, 2008	

Page 100 of 353

HI5INTRO

HI5INTRO

Page Order # :

Design Screen Type:	

No Entry

Fields:	

Field 1:

MCAIDINT

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2420

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

If the Medicaid program is known by a name other than "Medicaid" in
the state where the SP currently lives, display SP’s state name for
Medicaid in the context header.

If there is more than one name, separate them by commas and

insert "or" as appropriate (e.g., NAME1, NAME2, or NAME3).

Else do not display.

A list of Medicaid Program names is shown in Attachment HI1 of the

general specifications.


Question display:

Display first instance of "Medicaid" in BOLD.
If the Medicaid program is known by a name other than "Medicaid"

in the state where SP currently lives, display ", also known as

[READ FROM ABOVE],".

Else do not display.

A list of Medicaid Program names is shown in Attachment HI1 of the

General Specs.


Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

1:43:55 PM Monday, November 17, 2008	

Page 101 of 353

HI5INTRO
TEXT:
[MEDICAID PROGRAM NAME(S)]

Context Header:
Int. Instr I:

SHOW CARD HI3
PLEASE READ THIS INTRODUCTION SLOWLY AND CLEARLY:
Medicaid (, also known as [READ FROM ABOVE],) is a state
program for low income persons or for persons on public
assistance. Sometimes persons with very large medical bills are
also covered by Medicaid. People covered by Medicaid usually have
a card that looks like this.

Question Text:

Int. Instr II:

INPUT FIELDS / ROUTING

MCAIDINT

Field1:
Cheshire Name:

( HIQ4721 )

TEMP

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TContinueEMPTY
1
No
No

Number Label
1 Continue

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI1B - (HIQ4730 )

English text: CONTINUE
Attribute
Empty

Route
BOX HI1B - (HIQ4730 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

1:43:57 PM Monday, November 17, 2008

Page 102 of 353

HI5INTRO
TECHNICAL NOTES

DESIGN NOTES

1:43:57 PM Monday, November 17, 2008

Page 103 of 353

BOX HI1B

BOX HI1B

Page Order # :

2430

BOX INSTRUCTIONS
( HIQ4730 )	

IF STATE IN WHICH SP LIVES DOES NOT OFFER A MEDICAID MANAGED
CARE PLAN, GO TO HI5 - AIDCOVER ( HIQ4750 ).
ELSE GO TO HI5INTRB - MCAIDINTB ( HIQ4741 ).

ASSIGNMENTS

TECHNICAL NOTES
68

StateNoMedicaidHMO

SP's state does not offer Medicaid Managed Care plan =
SP's most recent ADDR where ADDR.ADDRNUM="01"
has ADDR.STATE = AK, AL, AR, CT, DE, GA, IL, KS,
LA, MA, MD, ME, MI, MO, MS, MT, NC, ND, NH, NM, NV,
OH, OK, RI, SC, SD, VA, VT, WA, WV, or WY.

DESIGN NOTES

1:43:57 PM Monday, November 17, 2008	

Page 104 of 353

HI5INTRB

HI5INTRB

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

MCAIDINTB

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2440

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:

SHOW CARD HI4

Question Text:

Some people receive their Medicaid benefits from plans that have
names like those listed on this card.

Int. Instr II:
INPUT FIELDS / ROUTING

1:43:58 PM Monday, November 17, 2008

Page 105 of 353

HI5INTRB
MCAIDINTB

Field1:
Cheshire Name:

( HIQ4741 )

TEMP

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TContinueEMPTY
1
No
No

Number Label
1 Continue

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI5 - AIDCOVER ( HIQ4750 )

English text: CONTINUE
Attribute
Empty

Route
HI5 - AIDCOVER ( HIQ4750 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:44:00 PM Monday, November 17, 2008

Page 106 of 353

HI5

HI5

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

AIDCOVER

Enable Functions:	

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2450

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If SP is deceased or institutionalized, display "was SP".
Else display "(have you/has SP) been".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

At any time [since (REFERENCE DATE)/between (REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], [(have you/has SP) been/was SP]
covered by Medicaid?

Int. Instr II:

INPUT FIELDS / ROUTING


1:44:01 PM Monday, November 17, 2008	

Page 107 of 353

HI5
AIDCOVER

Field1:
Cheshire Name:

( HIQ4750 )

HRND.AIDCOVER

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI6 - COVTIME ( HIQ4770 )

English text: YES
No

BOX HIT1 - (HIQ5310 )

English text: NO
Attribute
Don't know

Route
BOX HIT1 - (HIQ5310 )

Refusal

BOX HIT1 - (HIQ5310 )

BACKGROUND VARIABLE ASSIGNMENTS
HI5 is asking if SP was covered by Medicaid anytime since the previous round interview
date.
If AIDCOVER=1/Yes, then
If there is a PLAN where PLAN.PLANTYPE=2/Medicaid, regardless if
PLAN.PLANDFLG=1/Yes or LOSEPLFG ^= empty, this stopped Medicaid plan will be
restarted. See detailed instructions below.
Else if there is no PLAN where PLAN.PLANTYPE=2/Medicaid, create a new PLAN
where PLAN.PLANNUM equals the next sequential plan number.
PLAN KEY= PLAN.PLANBASE + PLAN.PLANNUM.

To set current round status of this plan, create a current round PLRO where

PLRO.PLROPLAN = this PLAN.PLANNUM.

PLRO KEY = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
See detailed instructions below:

1:44:04 PM Monday, November 17, 2008

Page 108 of 353

HI5
PLANNUM

If creating new plan, set PLAN.PLANNUM = highest
PLAN.PLANNUM + 01.

PLANRNDC

If creating new plan, set PLAN.PLANRNDC = current
round.

PLANTYPE

If creating a new plan, set PLAN.PLANTYPE =
2/Medicaid.

PLNAME

If creating a new plan, set PLAN.PLNAME =
"MEDICAID".

PLANDFLG

If restarting an existing Medicaid plan and
PLAN.PLANDFLG=1/Yes, update PLAN.PLANDFLG
= empty (-1).

LOSEPLFG

If restarting an existing Medicaid plan and
PLAN.LOSEPLFG ^= empty (-1), update
PLAN.LOSEPLFG = empty (-1).

PLROPLAN

PLRO.PLROPLAN = this PLAN.PLANNUM.

PLRORND

PLRO.PLRORND=current round.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:44:04 PM Monday, November 17, 2008

Page 109 of 353

HI6

HI6

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

COVTIME

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2470

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:	

If Medicaid plan was "current" at the time of the previous round
interview and the Medicaid program is known by a name other than
"Medicaid" in the state where the SP currently lives, display context
header. Display SP's state name for Medicaid. If there is more than
one name, separate them by commas and insert "or" as appropriate
(e.g., NAME1, NAME2, or NAME3).
Else do not display.
A list of Medicaid Program names is shown in Attachment HI1 in the
general specifications.

Question display:

If Medicaid plan was "current" at the time of the previous round
interview then
Display first sentence "At the time of the last interview (you
were/SP was) covered by Medicaid".
If the Medicaid program is known by a name other than
"Medicaid" in the state where SP currently lives, display ",also
known as [READ FROM ABOVE]".
Else do not display.
Else do not display first sentence.
-

Multi Field display:

Roster/Grid Instructions:

1:44:05 PM Monday, November 17, 2008	

Page 110 of 353

HI6
Roster/Grid display:
Report display:

TEXT:
[MEDICAID PROGRAM NAME]

Context Header:
Int. Instr I:

(At the time of the last interview (you were/SP was) covered by
Medicaid, (also known as [READ FROM ABOVE].) (Were you/Was
SP) covered by Medicaid the whole time between (REFERENCE
DATE) and (today/DATE OF DEATH/DATE OF
INSTITUTIONALIZATION), or only part of the time?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING
COVTIME

Field1:
Cheshire Name:

( HIQ4770 )

PLRO.COVTIME

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TCovtime
1
No
No

Number Label
1 WholeTime
2

English text: THE WHOLE TIME
PartOfTime

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI5A - (HIQ4840 )
HI7 - COVNOW ( HIQ4790 )

English text: PART OF THE TIME
Attribute
Don't know

Route
HI7 - COVNOW ( HIQ4790 )

Refusal

HI7 - COVNOW ( HIQ4790 )

BACKGROUND VARIABLE ASSIGNMENTS

1:44:08 PM Monday, November 17, 2008

Page 111 of 353

HI6

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

67

MedicaidCurrentPrevRn
d

Medicaid "current" at the time of the previous round
interview =
There is a PLAN where PLAN.PLANTYPE=2/Medicaid
and PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=previous round & (COVTIME=1/WholeTime
or COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES
HI6 is called from ST, NS, CPS when a Medicaid plan is added at the
Source of Payment roster.

1:44:08 PM Monday, November 17, 2008

Page 112 of 353

HI7

HI7

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

COVNOW

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2490

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If SP is deceased or intitutionalized, display second sentence: "Was
SP covered by...".
Else display first sentence: "(Are you/Is SP) now...".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

[(Are you/Is SP) now covered by Medicaid?] [Was SP covered by
Medicaid on (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)?]

Int. Instr II:

INPUT FIELDS / ROUTING


1:44:10 PM Monday, November 17, 2008	

Page 113 of 353

HI7
( HIQ4790 )

COVNOW

Field1:
Cheshire Name:

PLRO.COVNOW

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI4 - (HIQ4800 )

English text: YES
No

HI9 - COVENDMM ( HIQ4860 )

English text: NO
Attribute
Don't know

Route
BOX HI5A - (HIQ4840 )

Refusal

HI10A - MCAIDHMO ( HIQ4980 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =

1:44:12 PM Monday, November 17, 2008

Page 114 of 353

HI7
MRES.SPALIVE=3/Deceased.
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

1:44:12 PM Monday, November 17, 2008

Page 115 of 353

BOX HI4

BOX HI4

Page Order # :

2500

BOX INSTRUCTIONS
( HIQ4800 )

IF THIS MEDICAID PLAN WAS "CURRENT" AT THE TIME OF THE
PREVIOUS ROUND INTERVIEW, GO TO BOX HI5A - (HIQ4840 ).
ELSE GO TO HI8 - COVBEGMM ( HIQ4810 ).

ASSIGNMENTS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

63

ThisPlanCurrentPrevRn
d

This Plan was "current" at the time of the previous round
interview =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:44:13 PM Monday, November 17, 2008

Page 116 of 353

HI8

HI8

Page Order # :

Design Screen Type:

Date

Fields:

Field 1:

COVBEGMM

Field 2:

COVBEGDD

Field 3:

COVBEGYY

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

2510

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

On what date did (your/SP’s) Medicaid start between (REFERENCE
	
DATE) and (today/DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)?

Int. Instr II:

INPUT FIELDS / ROUTING


1:44:14 PM Monday, November 17, 2008

Page 117 of 353

HI8
COVBEGMM

Field1:
Cheshire Name:

( HIQ4810 )

PLRO.COVBEGMM

Item Text display:
Item Text:
Label:
Label Position:

MM
Under

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer
TMonthInt
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HI8 - COVBEGDD ( HIQ4820 )

Refusal

HI8 - COVBEGDD ( HIQ4820 )

1:44:18 PM Monday, November 17, 2008

FieldSize:
Min Value:
Max Value:
Mask:

2
01
12

Route
HI8 - COVBEGDD ( HIQ4820 )

Page 118 of 353

HI8
COVBEGDD

Field2:
Cheshire Name:

( HIQ4820 )

PLRO.COVBEGDD

Item Text display:
Item Text:
Label:
Label Position:

DD
Under

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer
TDayDKRF
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HI8 - COVBEGYY ( HIQ4830 )

Refusal

HI8 - COVBEGYY ( HIQ4830 )

1:44:22 PM Monday, November 17, 2008

FieldSize:
Min Value:
Max Value:
Mask:

2
1
31

Route
HI8 - COVBEGYY ( HIQ4830 )

Page 119 of 353

HI8
( HIQ4830 )

COVBEGYY

Field3:
Cheshire Name:

PLRO.COVBEGYY

Item Text display:
Item Text:
Label:
Label Position:

YY
Under

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer
TMcyear

FieldSize:

Min Value:
Max Value:
Mask:


1
No
No

Number Label
1 [Continuous answer.]

0

99


Route
BOX HI5A - (HIQ4840 )

Attribute
Don't know

Route
BOX HI5A - (HIQ4840 )

Refusal

BOX HI5A - (HIQ4840 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
Edit #1

PLAN BEGIN DATE, COVBEGMM/COVBEGDD/COVBEGYY,

should be on or between (REFERENCE DATE) and (REFERENCE

PERIOD END DATE).

If not true, display message: "DATE MUST BE ON OR BETWEEN

(REFERENCE DATE) AND (REFERENCE PERIOD END DATE).

PLEASE REENTER.".

TECHNICAL NOTES
114

CoverageStartDate

Health Insurance Plan coverage start date =
PLRO.COVBEGMM / PLRO.COVBEGDD /
PLRO.COVBEGYY.
Check PLRO where PLRO.PLROPLAN =
PLAN.PLANNUM and PLRO.PLRORND = round #
checking.

DESIGN NOTES
1:44:23 PM Monday, November 17, 2008

Page 120 of 353

HI8

1:44:23 PM Monday, November 17, 2008

Page 121 of 353


BOX HI5A

BOX HI5A

Page Order # :

2520

BOX INSTRUCTIONS
( HIQ4840 )

GO TO HI10A - MCAIDHMO ( HIQ4980 ).

ASSIGNMENTS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

DESIGN NOTES

1:44:23 PM Monday, November 17, 2008

Page 122 of 353

HI9

HI9

Page Order # :

Design Screen Type:

Date

Fields:

Field 1:

COVENDMM

Field 2:

COVENDDD

Field 3:

COVENDYY

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

2540

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is deceased or institutionalized, display "between (PREVIOUS
ROUND INTERVIEW DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)" and "last".
Else display "since (REFERENCE DATE)" and "most recently".

Multi Field display:
Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

On what date [since (REFERENCE DATE)/between (REFERENCE
DATE) and (DATE OF DEATH/
DATE OF INSTITUTIONALIZATION)], did (your/SP’s) Medicaid
coverage (most recently/last) stop?

1:44:25 PM Monday, November 17, 2008	

Page 123 of 353

HI9
Int. Instr II:

INPUT FIELDS / ROUTING

COVENDMM

Field1:
Cheshire Name:

( HIQ4860 )

PLRO.COVENDMM

Item Text display:
Item Text:
Label:
Label Position:

MM
Under

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer
TMonthInt
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HI9 - COVENDDD ( HIQ4870 )

Refusal

HI9 - COVENDDD ( HIQ4870 )

1:44:29 PM Monday, November 17, 2008

FieldSize:
Min Value:
Max Value:
Mask:

2
01
12

Route
HI9 - COVENDDD ( HIQ4870 )

Page 124 of 353

HI9
COVENDDD

Field2:
Cheshire Name:

( HIQ4870 )

PLRO.COVENDDD

Item Text display:
Item Text:
Label:
Label Position:

DD
Under

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer
TDayDKRF
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HI9 - COVENDYY ( HIQ4880 )

Refusal

HI9 - COVENDYY ( HIQ4880 )

1:44:33 PM Monday, November 17, 2008

FieldSize:
Min Value:
Max Value:
Mask:

2
1
31

Route
HI9 - COVENDYY ( HIQ4880 )

Page 125 of 353

HI9
( HIQ4880 )

COVENDYY

Field3:
Cheshire Name:

PLRO.COVENDYY

Item Text display:
Item Text:
Label:
Label Position:

YY
Under

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer
TMcyear

FieldSize:

Min Value:
Max Value:
Mask:


1
No
No

Number Label
1 [Continuous answer.]

0

99


Route
HI10A - MCAIDHMO ( HIQ4980 )

Attribute
Don't know

Route
HI10A - MCAIDHMO ( HIQ4980 )

Refusal

HI10A - MCAIDHMO ( HIQ4980 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
Edit #1
PLAN END DATE, COVENDMM/COVENDDD/COVENDYY, should
be on or betwee (REFERENCE DATE) and (REFERENCE PERIOD
END DATE).
If not true, display error message "DATE MUST BE ON OR
BETWEEN (REFERENCE DATE) AND (REFERENCE PERIOD
END DATE). PLEASE REENTER.".
TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute

1:44:34 PM Monday, November 17, 2008

Page 126 of 353

HI9
SP is Deceased =
MRES.SPALIVE=3/Deceased.
115

CoverageStopDate	

Health Insurance Plan coverage stop date =
PLRO.COVENDMM / PLRO.COVENDDD /
PLRO.COVENDYY.
Check PLRO where PLRO.PLROPLAN =
PLAN.PLANNUM and PLRO.PLRORND = round #
checking.

DESIGN NOTES

1:44:34 PM Monday, November 17, 2008	

Page 127 of 353

HI10A

HI10A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

MCAIDHMO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2580

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If this Medicaid plan was "current" at the time of the previous round
interview and SP reported this Medicaid plan was a Medicaid
Managed Care plan in the previous round, display sentence "At the
time of the last interview…".
Else display sentence "Some states now use managed care
plans…" and display "(Health Maintenance Organizations)".
If (this Medicaid plan is "current") and (SP is alive and not

institutionalized), display "(Are you now/Is SP now)".

Else display "(Were you/Was SP)".

If SP is deceased, display "as of (DATE OF DEATH)".

Else if SP is institutionalized, display "as of (DATE OF

INSTITUTIONALIZATION)".

Else if this Medicaid plan is not "current" and the plan coverage stop

date does not = DK or RF, display "as of (MEDICAID COVERAGE

STOP DATE)".

Else if this Medicaid plan is not "current" and the plan coverage stop

date = DK or RF, display "as of the date (your/SP's) Medicaid

coverage stopped".

Else do not display.


Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:

1:44:36 PM Monday, November 17, 2008

Page 128 of 353

HI10A
Report display:

TEXT:
Context Header:
Int. Instr I:
[Some states now use managed care plans, such as HMOs (Health
Maintenance Organizations), to provide some or all health care for
Medicaid beneficiaries.] [At the time of the last interview (you
were/SP was) enrolled in a Medicaid Managed Care Plan.] (Are you
now/Is SP now/Were you/Was SP) enrolled in a Medicaid Managed
Care Plan [as of (DATE OF DEATH)/(DATE OF
INSTITUTIONALIZATION)/(MEDICAID COVERAGE STOP
DATE)/the date (your/SP’s) Medicaid coverage stopped]?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING
MCAIDHMO

Field1:
Cheshire Name:

( HIQ4980 )

PLRO.MCAIDHMO

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI5B - (HIQ4990 )

English text: YES
No

BOX HI5C - (HIQ5000 )

English text: NO
Attribute
Don't know

Route
BOX HI5D - (HIQ5050 )

Refusal

BOX HI5D - (HIQ5050 )

BACKGROUND VARIABLE ASSIGNMENTS
1:44:39 PM Monday, November 17, 2008

Page 129 of 353

HI10A

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
71

ThisPlanCurrent

This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

69

ThisPlanMedicaidHMO

SP reported this Medicaid plan was a Medicaid Managed
Care plan in previous round =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.MCAIDHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.

52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

115

CoverageStopDate

Health Insurance Plan coverage stop date =
PLRO.COVENDMM / PLRO.COVENDDD /
PLRO.COVENDYY.
Check PLRO where PLRO.PLROPLAN =
PLAN.PLANNUM and PLRO.PLRORND = round #
checking.

63

ThisPlanCurrentPrevRn
d

This Plan was "current" at the time of the previous round
interview =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

DESIGN NOTES

1:44:39 PM Monday, November 17, 2008

Page 130 of 353

BOX HI5B

BOX HI5B

Page Order # :

2590

BOX INSTRUCTIONS
( HIQ4990 )	

IF (SP REPORTED THIS MEDICAID PLAN WAS A MEDICAID MANAGED
CARE PLAN IN THE PREVIOUS ROUND) AND (THIS MEDICAID PLAN WAS
"CURRENT" AT THE TIME OF THE PREVIOUS ROUND INTERVIEW), GO
TO BOX HI5D - (HIQ5050 ).
ELSE GO TO HI10B - CHOICHMO ( HIQ5010 ).

ASSIGNMENTS

TECHNICAL NOTES
69

ThisPlanMedicaidHMO

SP reported this Medicaid plan was a Medicaid Managed
Care plan in previous round =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.MCAIDHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.

63

ThisPlanCurrentPrevRn
d

This Plan was "current" at the time of the previous round
interview =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:44:39 PM Monday, November 17, 2008	

Page 131 of 353

BOX HI5C

BOX HI5C

Page Order # :

2600

BOX INSTRUCTIONS
( HIQ5000 )	

IF (SP REPORTED THIS MEDICAID PLAN WAS A MEDICAID MANAGED
CARE PLAN IN THE PREVIOUS ROUND) AND (THIS MEDICAID PLAN WAS
"CURRENT" AT THE TIME OF THE PREVIOUS ROUND INTERVIEW) AND
(HI6 - COVTIME=1/WholeTime), GO TO HI10C - MCAIDVB ( HIQ5020 ).
ELSE GO TO BOX HI5D - (HIQ5050 ).

ASSIGNMENTS

TECHNICAL NOTES
69

ThisPlanMedicaidHMO

SP reported this Medicaid plan was a Medicaid Managed
Care plan in previous round =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.MCAIDHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.

63

ThisPlanCurrentPrevRn
d

This Plan was "current" at the time of the previous round
interview =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:44:39 PM Monday, November 17, 2008	

Page 132 of 353

HI10B

HI10B

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

CHOICHMO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2610

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:	

As far as you can recall, (were you/was SP) given a choice to enroll
in a Medicaid Managed Care Plan, or did (you/he/she) have to enroll
to receive Medicaid benefits?

Int. Instr II:
INPUT FIELDS / ROUTING

1:44:40 PM Monday, November 17, 2008	

Page 133 of 353

HI10B
CHOICHMO

Field1:
Cheshire Name:

( HIQ5010 )

PLRO.CHOICHMO

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TChoichmo
1
No
No

Number Label
1 GivenChoice

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI5D - (HIQ5050 )

2

English text: GIVEN A CHOICE TO ENROLL
HadToEnroll
BOX HI5D - (HIQ5050 )

3

English text: HAD TO ENROLL
DoesntRemember

BOX HI5D - (HIQ5050 )

English text: DOESN'T REMEMBER
Attribute
Refusal

Route
BOX HI5D - (HIQ5050 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:44:43 PM Monday, November 17, 2008

Page 134 of 353

HI10C

HI10C

Page Order # :

Design Screen Type:

Verbatim Text

Fields:

Field 1:

MCAIDVB

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2620

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Why (do you/does SP) no longer receive (your/his/her) Medicaid

benefits through a managed care plan?

Int. Instr II:

RECORD VERBATIM.

INPUT FIELDS / ROUTING

1:44:43 PM Monday, November 17, 2008

Page 135 of 353

HI10C

Field1:
Cheshire Name:

MCAIDVB

( HIQ5020 )

NONE
REPLACES CHESHIRE VARIABLES:
PLRO.MCAIDVB1
PLRO.MCAIDVB2
PLRO.MCAIDVB3

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Open
TOpen270
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

135

Route
BOX HI5D - (HIQ5050 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:44:44 PM Monday, November 17, 2008

Page 136 of 353

BOX HI5D

BOX HI5D

Page Order # :

2630

BOX INSTRUCTIONS
( HIQ5050 )	

IF ((ADMINISTERING ST, NS OR CPS) AND SP WAS COVERED BY A
MEDICARE PRESCRIPTION DRUG PLAN ANYTIME DURING THE
CURRENT ROUND) OR (ADMINSTERING HI AND THERE WAS A
MEDICARE PRESCRIPTION DRUG PLAN THAT WAS "CURRENT" AT THE
TIME OF THE PREVIOUS ROUND INTERVIEW), GO TO BOX HIT1 ­
(HIQ5310 ).
ELSE IF (ADMINISTERING ST, NS OR CPS) AND SP WAS NOT COVERED
BY A MEDICARE PRESCRIPTION DRUG PLAN ANYTIME DURING THE
CURRENT ROUND, GO TO HI10D - MCDRXCOV ( HIQ5060 ).
ELSE GO TO HI10C1 - MPDCOVER ( HIQ5051 ).

ASSIGNMENTS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

351

MPDPAnytimeCurrRnd

SP covered by an MPDP plan anytime during current
round =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.

343

MPDPCurrPrevRnd

Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:44:44 PM Monday, November 17, 2008	

Page 137 of 353

HI10C1

HI10C1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

MPDCOVER

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2635

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If no Medicare Prescription Drug plan ever reported in any round,
display "Some people who receive Medicaid...".
Else do not display.
If SP is deceased or institutionalized, display "covered".
Else display "covers".
If SP is deceased or institutionalized, display "was (SP)".
Else if SP is respondent, display "have you been".
Else display "has (SP) been".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

1:44:45 PM Monday, November 17, 2008

(Some people who receive Medicaid benefits are also enrolled in a

Medicare Prescription Drug plan, or Medicare Part D plan, that pays
Page 138 of 353

HI10C1
for some or all of their prescribed medicines. The Medicare program
automatically enrolls such beneficiaries into a Medicare Prescription
Drug plan, although the beneficiary may choose to switch to a
different prescription plan.)
At any time [since (REFERENCE DATE)/between (REFERENCE
DATE) AND (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], [have you been/has (SP) been/was
(SP)] enrolled in a Medicare Prescription Drug plan that
(covers/covered) medicines prescribed by a doctor?
Int. Instr II:

INPUT FIELDS / ROUTING

MPDCOVER

Field1:
Cheshire Name:

( HIQ5051 )

HRND.MPDCOVER

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI10C2 - PDPCURR ( HIQ5052 )

English text: YES
No

HI10D - MCDRXCOV ( HIQ5060 )

English text: NO
Attribute
Don't know

Route
HI10D - MCDRXCOV ( HIQ5060 )

Refusal

HI10D - MCDRXCOV ( HIQ5060 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

1:44:49 PM Monday, November 17, 2008

Page 139 of 353

HI10C1
HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

341

NeverMedicarePresDru
gPlan

No Medicare Prescription Drug plan ever reported in any
round =
There is no PLAN where PLAN.PLANTYPE = 7/MPDP.
Exclude Deleted Plans. See T.N. 52.

59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

DESIGN NOTES

1:44:49 PM Monday, November 17, 2008

Page 140 of 353

HI10C2

HI10C2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDPCURR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2645

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is alive and not institutionalized, display "currently".
Else do not display.
If SP is deceased, display "on (DATE OF DEATH)".
Else if SP is institutionalized, display "on (DATE OF
INSTITUTIONALIZATION)".
Else do not display.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

[Are you/Is (SP)/Was (SP)] (currently) covered by or enrolled in a
Medicare Prescription Drug plan [on (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]?

Int. Instr II:
1:44:50 PM Monday, November 17, 2008	

Page 141 of 353

HI10C2
INPUT FIELDS / ROUTING
( HIQ5052 )

PDPCURR

Field1:
Cheshire Name:

HRND.PDPCURR

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI10C3 - PLAN_CAIDMPDP ( HIQ5053 )

English text: YES
No
English text: NO

HI10C5 - PLAN_CAIDMPDPOTHR ( HIQ5056 )

Attribute
Don't know

Route
HI10C5 - PLAN_CAIDMPDPOTHR ( HIQ5056 )

Refusal

HI10C5 - PLAN_CAIDMPDPOTHR ( HIQ5056 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =

1:44:53 PM Monday, November 17, 2008

Page 142 of 353

HI10C2
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES

1:44:53 PM Monday, November 17, 2008

Page 143 of 353

HI10C3

HI10C3

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PLAN_CAIDMPDP

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Name:

Plan Roster

Roster Type:

Single Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

2655

Display as ' Add a Plan '
Display as ' Edit a Plan '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Always display brackets around question text.
If SP is deceased, display "on (DATE OF DEATH)".

Else if SP is institutionalized, display "on (DATE OF

INSTITUTIONALIZATION)" .

Else do not display.

If SP is deceased or institutionalized, display "covered".

Else display "covers".


Multi Field display:

Roster/Grid Instructions:

Display all health insurance plans from the Plan Roster.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare plan
Medicare Managed Care Plans
Medicaid
Tricare
Public Plans
Private Plans
Medicare Prescription Drug plan if "current" at the time of the
previous round interview

Roster/Grid display:

COL #
1

1:44:53 PM Monday, November 17, 2008

HEADER
Plan Name

INSTRUCTIONS
Display PLAN.PLNAME.
Page 144 of 353

HI10C3
2

Plan Type

Display PLAN.PLANTYPE:
1/Medicare, display "(MCAR)"
2/Medicaid, display "(MCAD)"
3/PublicPlan, display "(PUBL)"
4/PrivatePlan, display "(PRIV)"
5/MHMO, display "(MHMO)"
6/Tricare, display "(TRIC)"
7/MPDP, display "(MPDP)"

3

Plan Status

Display CURRENT ROUND PLAN
STATUS.

Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

[What is the name of the Medicare Prescription Drug plan that
(currently covers/covered) [you/(SP)] [on (DATE OF DEATH)/(DATE
OF INSTITUTIONALIZATION)]?]

Int. Instr II:

SELECT OR ADD ONLY ONE MEDICARE PRESCRIPTION DRUG
PLAN AT THIS ROSTER.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PLAN_CAIDMPDP

( HIQ5053 )

TEMP

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:


String
TPlanPick32
1

No
No


Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:


32

Route
HI10C4 - PDPMORE ( HIQ5055 )

BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:

1:44:54 PM Monday, November 17, 2008

Page 145 of 353

HI10C3
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at HI10C3.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HI10C3.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
The plan selected at HI10C3 is the SP's current Medicare Prescription Drug plan for the
current round.
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
COVANYTM	

Set PLRO.COVANYTM=1/Yes for plan selected at
HI10C3.

COVCURNT	

Set PLRO.COVCURNT=1/Yes for plan selected at
HI10C3.

PLANTYPE	

If PLAN added to roster, set
PLAN.PLANTYPE=7/MPDP.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
95

PlanIsCurrent

If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

1:44:54 PM Monday, November 17, 2008	

Page 146 of 353

HI10C3
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

53

PlanTypes

Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Managed Care: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.

343

MPDPCurrPrevRnd

Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:44:54 PM Monday, November 17, 2008

Page 147 of 353

HI10C4

HI10C4

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDPMORE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2665

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is deceased or institutionalized, display "had (SP)".
Else display "(have you/has SP)".
Display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/INSTITUTIONALIZATION)], (have you/has
SP/had SP) been covered by any other Medicare Prescription Drug
plans besides (CURRENT MEDICARE PRESCRIPTION DRUG
PLAN)?
[PROBE IF NECESSARY: Please include Medicare Prescription

1:44:56 PM Monday, November 17, 2008

Page 148 of 353

HI10C4
Drug plans (you were/SP was) automatically enrolled in through
Medicaid as well as any (you/he/she) enrolled in on (your/his/her)
own.]
Int. Instr II:
INPUT FIELDS / ROUTING
( HIQ5055 )

PDPMORE

Field1:
Cheshire Name:

HRND.PDPMORE

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI10C5 - PLAN_CAIDMPDPOTHR ( HIQ5056 )

English text: YES
No

BOX HIT1 - (HIQ5310 )

English text: NO
Attribute
Don't know

Route
BOX HIT1 - (HIQ5310 )

Refusal

BOX HIT1 - (HIQ5310 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

1:44:59 PM Monday, November 17, 2008

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
Page 149 of 353

HI10C4
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

DESIGN NOTES

1:44:59 PM Monday, November 17, 2008

Page 150 of 353

HI10C5

HI10C5

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PLAN_CAIDMPDPOTH
R

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Name:

Plan Roster

Roster Type:

Multiple Item Select

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No

Yes


Grid Functions:	

Add Line
Delete Line

No
No

2675

Display as ' Add a Plan '

Display as ' Edit a Plan '


DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has a "current" Medicare Prescription Drug plan, then display
"the other".
Else display "all".
If SP has a "current" Medicare Prescription Drug plan, then display
"besides (CURRENT MEDICARE PRESCRIPTION DRUG PLAN)"
and the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else do not display.

Multi Field display:

Roster/Grid Instructions:

Display all health insurance plans from the Plan Roster.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare plan
Medicare Managed Care Plans
Medicaid
Tricare
Public Plans
Private Plans
Medicare Prescription Drug plan if "current" at the time of the
previous round interview
Medicare Prescription Drug plan if "current" in the current round

1:44:59 PM Monday, November 17, 2008	

Page 151 of 353

HI10C5
Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

Plan Name

Display PLAN.PLNAME.

2

Plan Type

Display PLAN.PLANTYPE:
1/Medicare, display "(MCAR)"
2/Medicaid, display "(MCAD)"
3/PublicPlan, display "(PUBL)"
4/PrivatePlan, display "(PRIV)"
5/MHMO, display "(MHMO)"
6/Tricare, display "(TRIC)"
7/MPDP, display "(MPDP)"

3

Plan Status

Display CURRENT ROUND PLAN
STATUS.

Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

Please tell me the names of (the other/all) Medicare Prescription
Drug plans that (you have/he has/she has) been enrolled in since
(REFERENCE DATE) [besides (CURRENT MEDICARE
PRESCRIPTION DRUG PLAN)].
[PROBE IF NECESSARY: Please include Medicare Prescription
Drug plans (you were/SP was) automatically enrolled in through
Medicaid as well as any (you/he/she) enrolled in on (your/his/her)
own.]

Int. Instr II:

SELECT OR ADD MEDICARE PRESCRIPTION DRUG PLAN
NAMES AT THIS ROSTER.

INPUT FIELDS / ROUTING

1:45:00 PM Monday, November 17, 2008

Page 152 of 353

HI10C5

Field1:	

Cheshire Name:

PLAN_CAIDMPDPOTH ( HIQ5056 )

R


TEMP

Item Text display:
Item Text:
Label:

Label Position:

Field Type:	
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:


String
TPlanPick30
1

No
No


Number Label	
1 [Continuous answer.]	

FieldSize:
Min Value:

Max Value:

Mask:


30

Route
BOX HIT1 - (HIQ5310 )

BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at HI10C5.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HI10C5.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
Plans selected at HI10C5 are Medicare Prescription Drug plans that the SP was enrolled in
for some time in the current round but are not the SP's current Medicare Prescription Drug
plan.
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
COVANYTM	

Set PLRO.COVANYTM = 1/Yes for all plan selected
at HI10C5.

COVCURNT	

Set PLRO.COVCURNT = 2/No for all plan selected
at HI10C5.

1:45:01 PM Monday, November 17, 2008	

Page 153 of 353

HI10C5
If PLAN added to roster, set
PLAN.PLANTYPE=7/MPDP.

PLANTYPE
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
343

MPDPCurrPrevRnd

Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

95

PlanIsCurrent

If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

53

PlanTypes

Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Managed Care: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:45:01 PM Monday, November 17, 2008

Page 154 of 353

HI10D

HI10D

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

MCDRXCOV

Enable Functions:	

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2685

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (this Medicaid plan is not "current") or (SP is deceased or
institutionalized), display "Did".
Else display "Does".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

(Does/Did) (your/SP’s) Medicaid plan cover medicines prescribed by
	
a doctor?

Int. Instr II:

INPUT FIELDS / ROUTING


1:45:02 PM Monday, November 17, 2008	

Page 155 of 353

HI10D
MCDRXCOV

Field1:
Cheshire Name:

( HIQ5060 )

PLRO.MCDRXCOV

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HIT1 - (HIQ5310 )

English text: YES
No

BOX HIT1 - (HIQ5310 )

English text: NO
Attribute
Don't know

Route
BOX HIT1 - (HIQ5310 )

Refusal

BOX HIT1 - (HIQ5310 )

BACKGROUND VARIABLE ASSIGNMENTS
HI10D is a plan detail for the SP's Medicaid plan.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus	

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =

MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY

SP is Institutionalized =

MRES.SPALIVE=2/AliveAndInstitute


1:45:05 PM Monday, November 17, 2008	

Page 156 of 353

HI10D
SP is Deceased =
MRES.SPALIVE=3/Deceased.
71

ThisPlanCurrent

This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:45:06 PM Monday, November 17, 2008

Page 157 of 353

BOX HIT1

BOX HIT1

Page Order # :

2790

BOX INSTRUCTIONS
( HIQ5310 )

IF ADMINISTERING ST, GO TO BOX ST69A - (STQ2825 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS69A - (NSQ2825 ).
ELSE IF ADMINISTERIGN CPS, GO TO BOX CPS29A - (CPS1710 ).
ELSE IF A TRICARE PLAN WAS "CURRENT" AT THE TIME OF THE
PREVIOUS ROUND INTERVIEW, GO TO HIT2 - COVTIME ( HIQ5330 ).
ELSE GO TO HIT1 - TRICOVER ( HIQ5320 ).

ASSIGNMENTS
If Tricare was current at the time of the previous round interview, then the SP was also

covered by Tricare for some time during the current round.

If Tricare was current at the time of the previous round interview, current round plan details

will be collected on PLAN and PLRO:

PLAN key = PLAN.PLANBASE + PLAN.PLANNUM

PLAN.PLANNUM = Number of Tricare plan.

PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND

PLRO.PLROPLAN = PLAN.PLANNUM of Tricare plan.

PLRO.PLRORND = current round.

To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this

PLAN.PLANNUM and PLRO.PLRORND = current round.

See detailed instructions below.

PLROPLAN

PLRO.PLROPLAN = PLAN.PLANNUM of Tricare
Plan current at time of previous round.

PLRORND

PLRO.PLRORND = current round.

TECHNICAL NOTES
52

DeletedPlans	

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

76

TricareCurrentPrevRnd	

Tricare "current" at the time of previous round interview =
MRES.INTTYPE ^= 2,5,6 and there is ((a PLAN where
PLAN.PLANTYPE=6/Tricare) and a PLRO where
(PLROPLAN=this PLAN.PLANNUM and
PLRORND=previous round and
(COVTIME=1/WholeTime or COVNOW=1/Yes))).

DESIGN NOTES
If administering ST, NS, CPS, you have completed the Medicaid detail

questions for the Medicaid plan added at the Source of Payment roster.

Return to the section being administered as specified above.


1:45:06 PM Monday, November 17, 2008	

Page 158 of 353

HIT1

HIT1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

TRICOVER

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2800

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Always display "(may)" in parenthesis.

If SP is deceased or institutionalized, display "was SP".

Else display "(have you/has SP) been".

Always display "(BACK OF SHOWCARD HIT1)" in parenthesis.


Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:

SHOW CARD HIT1

Question Text:

As you (may) know, the Department of Defense sponsors a
regionally managed health care program called TRICARE for active
duty and retired members of the uniformed Armed Forces, their
families, and survivors.
Please look at this card. At any time [since (REFERENCE DATE)/

1:45:07 PM Monday, November 17, 2008

Page 159 of 353

HIT1
between (PREVIOUS ROUND INTERVIEW DATE) and (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)], [(have you/has SP)
been/was SP] enrolled in or covered by any of these TRICARE
plans?
[EXPLAIN IF NECESSARY: You may have received a reference
card that looks like this (BACK OF SHOWCARD HIT1).]
Int. Instr II:
INPUT FIELDS / ROUTING
TRICOVER

Field1:
Cheshire Name:

( HIQ5320 )

HRND.TRICOVER

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HIT2 - COVTIME ( HIQ5330 )

English text: YES
No

BOX HIT3 - (HIQ5700 )

English text: NO
Attribute
Don't know

Route
BOX HIT3 - (HIQ5700 )

Refusal

BOX HIT3 - (HIQ5700 )

BACKGROUND VARIABLE ASSIGNMENTS
HIT1 is asking if SP was covered by Tricare anytime since the previous round interview

date.

If TRICOVER=1/Yes, then
If there is a PLAN where PLAN.PLANTYPE=6/Tricare, regardless if
PLAN.PLANDFLG=1/Yes or LOSEPLFG ^= empty, this stopped Tricare plan will be
restarted. See detailed instructions below.

1:45:10 PM Monday, November 17, 2008

Page 160 of 353

HIT1
Else if there is no PLAN where PLAN.PLANTYPE=6/Tricare, create a new PLAN where
PLAN.PLANNUM equals the next sequential plan number.
PLAN KEY= PLAN.PLANBASE + PLAN.PLANNUM.
To set current round status of this plan, create a current round PLRO where
PLRO.PLROPLAN = this PLAN.PLANNUM.
PLRO KEY = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
See detailed instructions below:
PLANNUM	

If creating new plan, set PLAN.PLANNUM = highest
PLAN.PLANNUM + 01.

PLANRNDC	

If creating new plan, set PLAN.PLANRNDC = current
round.

PLANTYPE	

If creating a new plan, set PLAN.PLANTYPE =
6/Tricare.

PLNAME	

If creating a new plan, set PLAN.PLNAME =
"TRICARE".

PLANDFLG	

If restarting an existing Tricare plan and
PLAN.PLANDFLG=1/Yes, update PLAN.PLANDFLG
= empty (-1).

LOSEPLFG	

If restarting an existing Tricare plan and
PLAN.LOSEPLFG ^= empty (-1), update
PLAN.LOSEPLFG = empty (-1).

PLROPLAN	

PLRO.PLROPLAN = this PLAN.PLANNUM.

PLRORND	

PLRO.PLRORND = current round.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

DESIGN NOTES

1:45:10 PM Monday, November 17, 2008	

Page 161 of 353

HIT2

HIT2

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

COVTIME

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2810

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If Tricare plan was "current" at the time of the previous round
interview, display first sentence: "At the time...".
Else do not display.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

[At the time of the last interview (you were/SP was) covered by
TRICARE.] (Were you/Was SP) covered by TRICARE the whole
time between (REFERENCE DATE) and (today/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION), or only part of the
time?

Int. Instr II:

1:45:11 PM Monday, November 17, 2008	

Page 162 of 353

HIT2
INPUT FIELDS / ROUTING
( HIQ5330 )

COVTIME

Field1:
Cheshire Name:

PLRO.COVTIME

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TCovtime

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 WholeTime
2

Route
HIT4 - TRIRXCOV ( HIQ5360 )

English text: THE WHOLE TIME
PartOfTime
English text: PART OF THE TIME

Attribute
Don't know

Route
HIT3 - COVNOW ( HIQ5340 )

Refusal

HIT3 - COVNOW ( HIQ5340 )

HIT3 - COVNOW ( HIQ5340 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans	

1:45:14 PM Monday, November 17, 2008	

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

Page 163 of 353

HIT2
76

TricareCurrentPrevRnd	

Tricare "current" at the time of previous round interview =
MRES.INTTYPE ^= 2,5,6 and there is ((a PLAN where
PLAN.PLANTYPE=6/Tricare) and a PLRO where
(PLROPLAN=this PLAN.PLANNUM and
PLRORND=previous round and
(COVTIME=1/WholeTime or COVNOW=1/Yes))).

DESIGN NOTES
HIT2 is called from ST, NS, CPS if Tricare was added at the Source of
Payment roster.

1:45:14 PM Monday, November 17, 2008	

Page 164 of 353

HIT3

HIT3

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

COVNOW

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2820

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If SP is deceased or institutionalized, display second sentence:
"Was SP covered by ...".
Else display first sentence: "(Are you/Is SP) now covered by
TRICARE?".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

[(Are you/Is SP) now covered by TRICARE?] [Was SP covered by
TRICARE on (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION?]

Int. Instr II:
INPUT FIELDS / ROUTING

1:45:15 PM Monday, November 17, 2008	

Page 165 of 353

HIT3
( HIQ5340 )

COVNOW

Field1:
Cheshire Name:

PLRO.COVNOW

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HIT4 - TRIRXCOV ( HIQ5360 )

English text: YES
No

HIT4 - TRIRXCOV ( HIQ5360 )

English text: NO
Attribute
Don't know

Route
HIT4 - TRIRXCOV ( HIQ5360 )

Refusal

HIT4 - TRIRXCOV ( HIQ5360 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =

1:45:18 PM Monday, November 17, 2008

Page 166 of 353

HIT3
MRES.SPALIVE=3/Deceased.
DESIGN NOTES

1:45:18 PM Monday, November 17, 2008

Page 167 of 353

HIT4

HIT4

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

TRIRXCOV

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2840

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (Tricare plan is not "current") or (if SP is deceased or
institutionalized), display "Did".
Else display "Does".
If SP is respondent, display "you personally have".
Else display "(SP) personally has".
Display "you" or "(SP)" in "(you personally have/SP personally has)"
in bold.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

1:45:20 PM Monday, November 17, 2008

(Does/Did) (your/SP’s) TRICARE plan cover medicines prescribed
	
by a doctor?

Page 168 of 353

HIT4
[PROBE: I am asking about the type of insurance coverage that
(you personally have/SP personally has), not what the plan offers
everyone.]
Int. Instr II:
INPUT FIELDS / ROUTING
( HIQ5360 )

TRIRXCOV

Field1:
Cheshire Name:

PLRO.TRIRXCOV

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HIT4A1 - TRIMEDS ( HIQ5363 )

English text: YES
No

BOX HIT3 - (HIQ5700 )

English text: NO
Attribute
Don't know

Route
BOX HIT3 - (HIQ5700 )

Refusal

BOX HIT3 - (HIQ5700 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

1:45:22 PM Monday, November 17, 2008

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
Page 169 of 353

HIT4
SP is Alive =

MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY

SP is Institutionalized =

MRES.SPALIVE=2/AliveAndInstitute

SP is Deceased =

MRES.SPALIVE=3/Deceased.

71

ThisPlanCurrent	

This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

DESIGN NOTES

1:45:22 PM Monday, November 17, 2008	

Page 170 of 353

HIT4A1

HIT4A1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

TRIMEDS

Field 2:

TRIMEDOS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

2845

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If ((this Tricare plan is not "current") and (proxy is respondent)) or
(SP is deceased or institutionalized), display "did SP" and "Did SP".
Else if this Tricare plan is not "current" and SP is respondent,
display "did you" and "Did you".
Else if this Tricare plan is "current" and SP is respondent, display
"do you" and "Do you".
Else display "does SP" and "Does SP".
Display the first instance of "usually" in BOLD.
Always display "(TMOP)", "(TRRx)", and "(MTF)" in parenthesis.

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
1:45:25 PM Monday, November 17, 2008

SHOW CARD HIT2
Page 171 of 353

HIT4A1
Where (do you/does SP/did you/did SP) usually obtain (your/his/her)
medicines? (Do you/Does SP/Did you/Did SP) usually obtain them at
a TRICARE mail order pharmacy (TMOP), a TRICARE retail
pharmacy network pharmacy (TRRx), a military treatment facility
pharmacy (MTF), a non-network retail pharmacy, or somewhere
else?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING
TRIMEDS

Field1:
Cheshire Name:

( HIQ5363 )

PLRO.TRIMEDS

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
Ttrimeds
1
No
No

Number Label
1 TMOP

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HIT3 - (HIQ5700 )

2

English text: A TRICARE MAIL ORDER PHARMACY (TMOP)
TRRX
BOX HIT3 - (HIQ5700 )

3

English text: A TRICARE RETAIL PHARMACY NETWORK PHARMACY (TRRX)
MTF
BOX HIT3 - (HIQ5700 )

4

English text: A MILITARY TREATMENT FACILITY PHARMACY (MTF)
NonNetworkRetail
BOX HIT3 - (HIQ5700 )

91

English text: A NON-NETWORK RETAIL PHARMACY
Other
HIT4A1 - TRIMEDOS ( HIQ5365 )
English text: SOMEWHERE ELSE

Attribute
Don't know

Route
BOX HIT3 - (HIQ5700 )

Refusal

BOX HIT3 - (HIQ5700 )

1:45:30 PM Monday, November 17, 2008

Page 172 of 353

HIT4A1
( HIQ5365 )

TRIMEDOS

Field2:
Cheshire Name:

PLRO.TRIMEDOS

Item Text display:

Display "(SPECIFY)" in same blue font used for interviewer

instructions.


Item Text:

SOMEWHERE ELSE (SPECIFY)


Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


String

TOthrspec

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]

30

Route
BOX HIT3 - (HIQ5700 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

71

ThisPlanCurrent

1:45:31 PM Monday, November 17, 2008

This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

Page 173 of 353

HIT4A1
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

DESIGN NOTES

1:45:31 PM Monday, November 17, 2008

Page 174 of 353

BOX HIT3

BOX HIT3

1:45:31 PM Monday, November 17, 2008

Page Order # :

3060


Page 175 of 353


BOX HIT3
BOX INSTRUCTIONS
( HIQ5700 )

IF ADMINISTERING ST, GO TO BOX ST69A - (STQ2825 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS69A - (NSQ2825 ).
ELSE IF ADMINISTERING CPS, GO BOX CPS29A - (CPS1710 ).
ELSE IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO BOX HI7 ­
(HIQ5740 ).
ELSE IF ((SP DID NOT REPORT RECEIVING HEALTH CARE SERVICES
FROM M.T.F IN THE PREVIOUS ROUND) AND ((SP WAS COVERED BY
TRICARE IN THE CURRENT OR PREVIOUS ROUND) OR (SP SERVED IN
THE ARMED FORCES)), GO TO HIT11 - MTFCOVER ( HIQ5710 ).
ELSE GO TO BOX HI20 - (HIQ5720 ).

ASSIGNMENTS
If HRND.MTFCOVER=1/Yes in the previous round, the interviewer will not ask HIT11 in the
current round. However, the response from the previous round will get copied to the
current round HRND. See detailed instructions below.
MTFCOVER	

If previous round HRND.MTFCOVER=1/Yes, set
current round HRND.MTFCOVER=1/Yes.

TECHNICAL NOTES
92

HIT11NotYes	

SP did not report receiving health care servces from
M.T.F in the previous round =
HRND.MTFCOVER^=1/Yes on HRND where
HRND.HRNDRND=previous round.

9

SuppORD	

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

52

DeletedPlans	

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

77

TricareCurrOrPrevRnd	

SP was covered by Tricare in the current or previous
round =
There is a PLAN where PLAN.PLANTYPE=6/Tricare &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
(PLRO.PLRORND=current round or previous round) &
COVTIME^=empty).
Exclude Deleted Plans. See T.N. 52.

78

SPServedArmedForces	

SP served in the armed forces =
HOME.SPAFEVER=1/Yes or HOME.SPNGEVER =
1/Yes.

DESIGN NOTES
If administering ST, NS, CPS, you have completed the Tricare detail

questions for the Tricare plan added at the Source of Payment roster.

Return to the section being administered as specified above.


1:45:31 PM Monday, November 17, 2008	

Page 176 of 353

HIT11

HIT11

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

MTFCOVER

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3070

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (SP served in the Armed Forces) and (SP is not covered by
Tricare in the current or the previous round), display "We recorded
that (you/SP) served in the Armed Forces of the United States.".
Else do not display.
If SP deceased or institutionalized, display "did SP receive".
Else display "(have you/has SP) received".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

[We recorded that (you/SP) served in the Armed Forces of the
United States.] Since (REFERENCE DATE), [(have you/has SP)
received/did SP receive] health care or health services or prescribed
medicines at a Military Treatment Facility or MTF?

1:45:32 PM Monday, November 17, 2008	

Page 177 of 353

HIT11
[EXPLAIN IF NECESSARY: A Military Treatment Facility is any
military hospital, clinic, or NAVCARE clinic.]
Int. Instr II:

INPUT FIELDS / ROUTING

( HIQ5710 )

MTFCOVER

Field1:
Cheshire Name:

HRND.MTFCOVER

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI20 - (HIQ5720 )

English text: YES
No

BOX HI20 - (HIQ5720 )

English text: NO
Attribute
Don't know

Route
BOX HI20 - (HIQ5720 )

Refusal

BOX HI20 - (HIQ5720 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
78

SPServedArmedForces

1:45:35 PM Monday, November 17, 2008

SP served in the armed forces =
HOME.SPAFEVER=1/Yes or HOME.SPNGEVER =
1/Yes.
Page 178 of 353

HIT11
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

77

TricareCurrOrPrevRnd

SP was covered by Tricare in the current or previous
round =
There is a PLAN where PLAN.PLANTYPE=6/Tricare &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
(PLRO.PLRORND=current round or previous round) &
COVTIME^=empty).
Exclude Deleted Plans. See T.N. 52.

59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

DESIGN NOTES

1:45:35 PM Monday, November 17, 2008

Page 179 of 353

BOX HI20

BOX HI20

Page Order # :

3080

BOX INSTRUCTIONS
( HIQ5720 )

IF (SP DID NOT REPORT RECEIVING HEALTH CARE SERVICES
THROUGH V.A. IN THE PREVIOUS ROUND) AND (SP SERVED IN THE
ARMED FORCES), GO TO HI36 - VACOVER ( HIQ5730 ).
ELSE GO TO BOX HI7 - (HIQ5740 ).

ASSIGNMENTS
If HRND.VACOVER=1/Yes in the previous round, the interviewer will not ask HI36 in the
current round. However, the response from the previous round will get copied to the
current round HRND. See detailed instructions below.
If previous round HRND.VACOVER=1/Yes, set
current round HRND.VACOVER=1/Yes.

VACOVER	

TECHNICAL NOTES
132

HI36NotYes

SP did not report receiving health care services through
V.A.in the previous round =
HRND.VACOVER ^= 1/Yes on HRND where
HRND.HRNDRND=previous round.

78

SPServedArmedForces

SP served in the armed forces =
HOME.SPAFEVER=1/Yes or HOME.SPNGEVER =
1/Yes.

DESIGN NOTES

1:45:35 PM Monday, November 17, 2008	

Page 180 of 353

HI36

HI36

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

VACOVER

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3090

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

NOTE: The first sentence in Question text will only be displayed if
we did not ask HIT11 in the current round.
If HIT11 - MTFCOVER not asked in the current round, display first
sentence "We recorded that…".
Else do not display.
If SP is deceased or institutionalized. display "did SP receive".
Else display "(have you/has SP) received".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

[We recorded that (you/SP) served in the Armed Forces of the
United States.] Since (REFERENCE DATE), [(have you/has SP)
received/did SP receive] health care or health services or prescribed

1:45:37 PM Monday, November 17, 2008	

Page 181 of 353

HI36
medicines through the Department of Veterans Affairs or V.A.?
Int. Instr II:

INPUT FIELDS / ROUTING

( HIQ5730 )

VACOVER

Field1:
Cheshire Name:

HRND.VACOVER

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI7 - (HIQ5740 )

English text: YES
No

BOX HI7 - (HIQ5740 )

English text: NO
Attribute
Don't know

Route
BOX HI7 - (HIQ5740 )

Refusal

BOX HI7 - (HIQ5740 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =

1:45:40 PM Monday, November 17, 2008

Page 182 of 353

HI36
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES

1:45:40 PM Monday, November 17, 2008

Page 183 of 353

BOX HI7

BOX HI7

Page Order # :

3100

BOX INSTRUCTIONS
( HIQ5740 )	

IF AT LEAST ONE PUBLIC PLAN WAS "CURRENT" AT THE TIME OF THE
PREVIOUS ROUND INTERVIEW, GO TO HI11PREV - PUBINTRO (
HIQ5743 ).
ELSE GO TO HI11 - PUBCOVER ( HIQ5750 ).

ASSIGNMENTS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

80

PublicCurrentPrevRnd

Public plan "current" at the time of previous round
interview =
There is a PLAN where PLAN.PLANTYPE=3/PublicPlan
& PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=previous round & (COVTIME=1/WholeTime
or COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:45:40 PM Monday, November 17, 2008	

Page 184 of 353

HI11PREV

HI11PREV

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

PUBINTRO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3103

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

The next questions are about public plans [you were/(SP) was]

covered by as of (REFERENCE DATE).

Int. Instr II:
INPUT FIELDS / ROUTING

1:45:41 PM Monday, November 17, 2008

Page 185 of 353

HI11PREV
PUBINTRO

Field1:
Cheshire Name:

( HIQ5743 )

TEMP

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TContinueEMPTY
1
No
No

Number Label
1 Continue

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI11PREV_IN - NAVIGATOR ( HIQ5744 )

English text: CONTINUE
Attribute
Empty

Route
HI11PREV_IN - NAVIGATOR ( HIQ5744 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:45:42 PM Monday, November 17, 2008

Page 186 of 353

HI11PREV_IN

HI11PREV_IN

Page Order # :

Design Screen Type:

Instance Navigator

Fields:

Field 0:

NAVIGATOR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

3104

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display all public plans that were "current" at the time of the
previous round interview.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING

1:45:43 PM Monday, November 17, 2008

Page 187 of 353

HI11PREV_IN
NAVIGATOR

Field0:
Cheshire Name:

( HIQ5744 )

N/A

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TInstanceNavigator
1
No
No

Number Label
1 SelectItemInList	
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI7A - (HIQ5745 )

English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview	
HI11 - PUBCOVER ( HIQ5750 )
English text: CONTINUE INTERVIEW SELECTED

BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:

PLAN key = PLAN.PLANBASE + PLAN.PLANNUM

PLAN.PLANNUM = Number of public plan being asked about from the previous round.

PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND

PLRO.PLROPLAN = PLAN.PLANNUM of public plan being asked about from the previous

round.

PLRO.PLRORND = current round.


SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans	

1:45:45 PM Monday, November 17, 2008	

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

Page 188 of 353

HI11PREV_IN
80

PublicCurrentPrevRnd

Public plan "current" at the time of previous round
interview =
There is a PLAN where PLAN.PLANTYPE=3/PublicPlan
& PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=previous round & (COVTIME=1/WholeTime
or COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:45:45 PM Monday, November 17, 2008

Page 189 of 353

BOX HI7A

BOX HI7A

Page Order # :

3105

BOX INSTRUCTIONS
( HIQ5745 )

CREATE CURRENT ROUND PLRO FOR PUBLIC PLAN .
GO TO HI13 - COVTIME ( HIQ5780 ).

ASSIGNMENTS
If Public plan was current at the time of the previous round interview, then the SP was also

covered by the Public plan for some time during the current round.

Create a current round PLRO to store the status of this public plan in the current round.

PLRO KEY = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND

See detailed instructions below.

PLROPLAN

PLRO.PLROPLAN = PLAN.PLANNUM of Public
Plan current at time of previous round.

PLRORND

PLRO.PLRORND = current round.

TECHNICAL NOTES

DESIGN NOTES

1:45:45 PM Monday, November 17, 2008

Page 190 of 353

HI11

HI11

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PUBCOVER

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3110

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is deceased or institutionalized, display "was SP".
Else display "(have you/has SP) been".
If state where SP currently lives has no State Pharmaceutical
Assistance programs, display first phrase: "[for example, a public
program that pays for prescribed medicines]?".
Else if state where SP currently lives has one State Pharmaceutical
Assistance program, display second phrase: "[for example (STATE
PHARMACEUTICAL ASSISTANCE PROGRAM), a public program
that pays for prescribed medicines]?".
Else if state where SP currently lives has two State Pharmaceutical
Assistance programs, display third phrase: "[for example (STATE
PHARMACEUTICAL ASSISTANCE PROGRAM1) or (STATE
PHARMACEUTICAL ASSISTANCE PROGRAM2), public programs
that pay for prescribed medicines]?".
Else display fourth phrase "[for example (STATE
PHARMACEUTICAL ASSISTANCE PROGRAM1), (STATE
PHARMACEUTICAL ASSISTANCE PROGRAM2), or (STATE
PHARMACEUTICAL ASSISTANCE PROGRAM3), public programs
that pay for prescribed medicines]?".
Always display "[for example…]" in brackets.
See Attachment HI2 in General Specifications for a list of State
Pharmaceutical Assistance programs.

Multi Field display:

1:45:47 PM Monday, November 17, 2008

Page 191 of 353

HI11
Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

At any time [since (REFERENCE DATE)/between (PREVIOUS
ROUND INTERVIEW DATE) and (DATE OF DEATH/
DATE OF INSTITUTIONALIZATION)], [(have you/has SP) been/was
SP] covered by any public program other than Medicaid that pays for
medical care [for example, a public program that pays for prescribed
medicines/for example (STATE PHARMACEUTICAL ASSISTANCE
PROGRAM), a public program that pays for prescribed medicines/
for example (STATE PHARMACEUTICAL ASSISTANCE
PROGRAM1) or (STATE PHARMACEUTICAL ASSISTANCE
PROGRAM2)/for example (STATE PHARMACEUTICAL
ASSISTANCE PROGRAM1), (STATE PHARMACEUTICAL
ASSISTANCE PROGRAM2), or (STATE PHARMACEUTICAL
ASSISTANCE PROGRAM3), public programs that pay for
prescribed medicines]?

Int. Instr II:
INPUT FIELDS / ROUTING

1:45:50 PM Monday, November 17, 2008

Page 192 of 353

HI11
PUBCOVER

Field1:
Cheshire Name:

( HIQ5750 )

HRND.PUBCOVER

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI12 - PLAN_PUBLIC ( HIQ5770 )

English text: YES
No

BOX HI12AA - (HIQ6155 )

English text: NO
Attribute
Don't know

Route
BOX HI12AA - (HIQ6155 )

Refusal

BOX HI12AA - (HIQ6155 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus	

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =

MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY

SP is Institutionalized =

MRES.SPALIVE=2/AliveAndInstitute

SP is Deceased =


1:45:53 PM Monday, November 17, 2008	

Page 193 of 353

HI11
MRES.SPALIVE=3/Deceased.
DESIGN NOTES

1:45:53 PM Monday, November 17, 2008

Page 194 of 353

HI12

HI12

Page Order # :

Design Screen Type:	

Roster

Fields:	

Field 1:

PLAN_PUBLIC

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Name:

Plan Roster

Roster Type:

Multiple Item Select

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
Yes

Grid Functions:	

Add Line
Delete Line

No
No

3130

Display as ' Add a Plan '
Display as ' Edit a Plan '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Roster/Grid Instructions:

Display all health insurance plans from the Plan Roster.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare
Medicare Managed Care plans.
Medicaid
Tricare
Private plans
Public plans that SP has already reported being covered by during
the current round, this includes plans that are current or have
stopped in current round.
Medicare Prescription Drug Plans

Roster/Grid display:

COL #
1

1:45:54 PM Monday, November 17, 2008	

HEADER	
Plan Name

INSTRUCTIONS
Display PLAN.PLNAME.

Page 195 of 353

HI12
2

Plan Type

Display PLAN.PLANTYPE:
1/Medicare, display "(MCAR)"
2/Medicaid, display "(MCAD)"
3/PublicPlan, display "(PUBL)"
4/PrivatePlan, display "(PRIV)"
5/MHMO, display "(MHMO)"
6/Tricare, display "(TRIC)"
7/MPDP, display "(MPDP)"

3

Plan Status

Display CURRENT ROUND PLAN
STATUS.

Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

What is the name of each of the public programs other than
Medicaid that covered (you/SP)?

Int. Instr II:

SELECT OR ADD ALL PUBLIC PROGRAM NAMES AT THIS
ROSTER.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PLAN_PUBLIC

( HIQ5770 )

TEMP

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:


String
TPlanPick32
1

No
No


Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:


32

Route
HI12_IN - NAVIGATOR ( HIQ5775 )

BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:

PLAN key = PLAN.PLANBASE + PLAN.PLANNUM


1:45:54 PM Monday, November 17, 2008

Page 196 of 353

HI12
PLAN.PLANNUM = Number of plan selected at HI12.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HI12.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
Plans selected at HI12 are Public plans that the SP was enrolled in for some time in the
current round.
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
PLROPLAN

PLRO.PLROPLAN = this PLAN.PLANNUM.

PLRORND

PLRO.PLRORND=current round.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

53

PlanTypes

Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Managed Care: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.

93

AnyPlansCurrentRnd

SP reported being covered by any plans during the
current round =
There is PLAN & PLRO where (PLRO.PLROPLAN =
PLAN.PLANNUM & PLRO.PLRORND = current round &
(PLRO.COVTIME ^= empty or PLRO.COVANYTIM =
1/Yes)).
Exclude Deleted Plans. See T.N. 52.

95

PlanIsCurrent

If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

1:45:55 PM Monday, November 17, 2008

Page 197 of 353

HI12
DESIGN NOTES

1:45:55 PM Monday, November 17, 2008

Page 198 of 353


HI12_IN

HI12_IN

Page Order # :

Design Screen Type:

Instance Navigator

Fields:

Field 1:

NAVIGATOR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

3135

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display all plans selected at HI12.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING

1:45:55 PM Monday, November 17, 2008

Page 199 of 353

HI12_IN
NAVIGATOR

Field1:
Cheshire Name:

( HIQ5775 )

N/A

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TInstanceNavigator
1
No
No

Number Label
1 SelectItemInList
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI13 - COVTIME ( HIQ5780 )

English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
BOX HI12AA - (HIQ6155 )
English text: CONTINUE INTERVIEW SELECTED

BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at HI12.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HI12.
PLRO.PLRORND = current round.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:45:57 PM Monday, November 17, 2008

Page 200 of 353

HI13

HI13

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

COVTIME

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3140

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display plan name for the public plan being asked about,
PLAN.PLNAME.

Question display:

If public plan was "current" at the time of the previous round
interview, display first sentence: "At the time of the last interview...".
Else do not display.
Display plan name for the public plan being asked about,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

OTHER PUBLIC PROGRAM = (PUBLIC PLAN NAME)

Int. Instr I:
Question Text:

1:46:00 PM Monday, November 17, 2008

[At the time of the last interview (you were/SP was) covered by
(PUBLIC PLAN NAME).] (Were you/Was SP) covered by (PUBLIC
PLAN NAME) the whole time between (REFERENCE DATE) and
(today/DATE OF DEATH/DATE OF INSTITUTIONALIZATION), or
only part of the time?
Page 201 of 353

HI13
Int. Instr II:
INPUT FIELDS / ROUTING
( HIQ5780 )

COVTIME

Field1:
Cheshire Name:

PLRO.COVTIME

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TCovtime

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 WholeTime
2

Route
HI16A - PUBRXCOV ( HIQ5900 )

English text: THE WHOLE TIME
PartOfTime

HI14 - COVNOW ( HIQ5800 )

English text: PART OF THE TIME
Attribute
Don't know

Route
HI14 - COVNOW ( HIQ5800 )

Refusal

HI14 - COVNOW ( HIQ5800 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

1:46:03 PM Monday, November 17, 2008

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

Page 202 of 353

HI13
63

ThisPlanCurrentPrevRn	
d	

This Plan was "current" at the time of the previous round
interview =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES
HI13 is called from ST, NS, CPS when a public plan is added at the Source
of Payment roster.

1:46:03 PM Monday, November 17, 2008	

Page 203 of 353

HI14

HI14

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

COVNOW

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3160

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is deceased or institutionalized, display second sentence:
"Was SP covered by...".
Else display first sentence "(Are you/Is SP) now covered...".
Display plan name for the public plan being asked about,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

[(Are you/Is SP) now covered by (PUBLIC PLAN NAME)?] [Was SP
covered by (PUBLIC PLAN NAME) on (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)?]

Int. Instr II:

1:46:04 PM Monday, November 17, 2008	

Page 204 of 353

HI14
INPUT FIELDS / ROUTING
( HIQ5800 )

COVNOW

Field1:
Cheshire Name:

PLRO.COVNOW

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI10 - (HIQ5810 )

English text: YES
No
English text: NO

HI16 - COVENDMM ( HIQ5860 )

Attribute
Don't know

Route
HI16A - PUBRXCOV ( HIQ5900 )

Refusal

HI16A - PUBRXCOV ( HIQ5900 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute

1:46:07 PM Monday, November 17, 2008

Page 205 of 353

HI14
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES

1:46:07 PM Monday, November 17, 2008

Page 206 of 353

BOX HI10

BOX HI10

Page Order # :

3170

BOX INSTRUCTIONS
( HIQ5810 )	

IF THIS PUBLIC PLAN WAS "CURRENT" AT THE TIME OF THE PREVIOUS
ROUND INTERVIEW, GO TO HI16A - PUBRXCOV ( HIQ5900 ).
ELSE GO TO HI15 - COVBEGMM ( HIQ5820 ).

ASSIGNMENTS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

63

ThisPlanCurrentPrevRn
d

This Plan was "current" at the time of the previous round
interview =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:46:07 PM Monday, November 17, 2008	

Page 207 of 353

HI15

HI15

Page Order # :

Design Screen Type:

Date

Fields:

Field 1:

COVBEGMM

Field 2:

COVBEGDD

Field 3:

COVBEGYY

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

3180

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display plan name for the public plan being asked about,
PLAN.PLNAME.

Multi Field display:
Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

On what date did (your/SP’s) (PUBLIC PLAN NAME) coverage start
	
between (REFERENCE DATE) and (today/DATE OF DEATH/DATE
OF INSTITUTIONALIZATION)?

Int. Instr II:

1:46:09 PM Monday, November 17, 2008

Page 208 of 353

HI15
INPUT FIELDS / ROUTING
COVBEGMM

Field1:
Cheshire Name:

( HIQ5820 )

PLRO.COVBEGMM

Item Text display:
Item Text:
Label:

Label Position:


MM
Under

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Integer
TMonthInt
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HI15 - COVBEGDD ( HIQ5830 )

Refusal

HI15 - COVBEGDD ( HIQ5830 )

1:46:12 PM Monday, November 17, 2008

FieldSize:
Min Value:
Max Value:
Mask:

2
01
12

Route
HI15 - COVBEGDD ( HIQ5830 )

Page 209 of 353

HI15
COVBEGDD

Field2:
Cheshire Name:

( HIQ5830 )

PLRO.COVBEGDD

Item Text display:
Item Text:
Label:
Label Position:

DD
Under

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer
TDayDKRF
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HI15 - COVBEGYY ( HIQ5840 )

Refusal

HI15 - COVBEGYY ( HIQ5840 )

1:46:16 PM Monday, November 17, 2008

FieldSize:
Min Value:
Max Value:
Mask:

2
1
31

Route
HI15 - COVBEGYY ( HIQ5840 )

Page 210 of 353

HI15
( HIQ5840 )

COVBEGYY

Field3:
Cheshire Name:

PLRO.COVBEGYY

Item Text display:
Item Text:
Label:
Label Position:

YY
Under

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer
TMcyear

FieldSize:

Min Value:
Max Value:
Mask:


1
No
No

Number Label
1 [Continuous answer.]

0

99


Route
HI16A - PUBRXCOV ( HIQ5900 )

Attribute
Don't know

Route
HI16A - PUBRXCOV ( HIQ5900 )

Refusal

HI16A - PUBRXCOV ( HIQ5900 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
Edit #1

PLAN BEGIN DATE, COVBEGMM/COVBEGDD/COVBEGYY,

should be on or between (REFERENCE DATE) and (REFERENCE

PERIOD END DATE).

If not true, display message: "DATE MUST BE ON OR BETWEEN

(REFERENCE DATE) AND (REFERENCE PERIOD END DATE).

PLEASE REENTER.".

TECHNICAL NOTES
114

CoverageStartDate

Health Insurance Plan coverage start date =
PLRO.COVBEGMM / PLRO.COVBEGDD /
PLRO.COVBEGYY.
Check PLRO where PLRO.PLROPLAN =
PLAN.PLANNUM and PLRO.PLRORND = round #
checking.

DESIGN NOTES
1:46:18 PM Monday, November 17, 2008

Page 211 of 353

HI15

1:46:18 PM Monday, November 17, 2008

Page 212 of 353


HI16

HI16

Page Order # :

Design Screen Type:

Date

Fields:

Field 1:

COVENDMM

Field 2:

COVENDDD

Field 3:

COVENDYY

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

3200

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display plan name for the public plan being asked about,
PLAN.PLNAME.
If SP is deceased or institutionalized, display "last".
Else display "most recently".

Multi Field display:
Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

On what date [since (REFERENCE DATE)/between (PREVIOUS
ROUND INTERVIEW DATE) and (DATE OF DEATH/
DATE OF INSTITUTIONALIZATION)] did (your/SP’s) (PUBLIC PLAN
NAME) coverage (most recently/last) stop?

1:46:20 PM Monday, November 17, 2008	

Page 213 of 353

HI16
Int. Instr II:

INPUT FIELDS / ROUTING

COVENDMM

Field1:
Cheshire Name:

( HIQ5860 )

PLRO.COVENDMM

Item Text display:
Item Text:
Label:

Label Position:


MM
Under

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Integer
TMonthInt
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HI16 - COVENDDD ( HIQ5870 )

Refusal

HI16 - COVENDDD ( HIQ5870 )

1:46:23 PM Monday, November 17, 2008

FieldSize:
Min Value:
Max Value:
Mask:

2
01
12

Route
HI16 - COVENDDD ( HIQ5870 )

Page 214 of 353

HI16
COVENDDD

Field2:
Cheshire Name:

( HIQ5870 )

PLRO.COVENDDD

Item Text display:
Item Text:
Label:
Label Position:

DD
Under

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer
TDayDKRF
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HI16 - COVENDYY ( HIQ5880 )

Refusal

HI16 - COVENDYY ( HIQ5880 )

1:46:27 PM Monday, November 17, 2008

FieldSize:
Min Value:
Max Value:
Mask:

2
1
31

Route
HI16 - COVENDYY ( HIQ5880 )

Page 215 of 353

HI16
( HIQ5880 )

COVENDYY

Field3:
Cheshire Name:

PLRO.COVENDYY

Item Text display:
Item Text:
Label:
Label Position:

YY
Under

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer
TMcyear

FieldSize:

Min Value:
Max Value:
Mask:


1
No
No

Number Label
1 [Continuous answer.]

0

99


Route
HI16A - PUBRXCOV ( HIQ5900 )

Attribute
Don't know

Route
HI16A - PUBRXCOV ( HIQ5900 )

Refusal

HI16A - PUBRXCOV ( HIQ5900 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
EDIT #1

PLAN END DATE, COVENDMM/COVENDDD/COVENDYY, should

be on or between (REFERENCE DATE) and (REFERENCE

PERIOD END DATE).

If not true, display message: "DATE MUST BE ON OR BETWEEN

(REFERENCE DATE) AND (REFERENCE PERIOD END DATE).

PLEASE REENTER.".

TECHNICAL NOTES
115

CoverageStopDate

1:46:29 PM Monday, November 17, 2008

Health Insurance Plan coverage stop date =
PLRO.COVENDMM / PLRO.COVENDDD /
PLRO.COVENDYY.
Check PLRO where PLRO.PLROPLAN =
PLAN.PLANNUM and PLRO.PLRORND = round #
checking.

Page 216 of 353

HI16
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

DESIGN NOTES

1:46:29 PM Monday, November 17, 2008

Page 217 of 353

HI16A

HI16A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PUBRXCOV

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3202

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (this public plan is not "current") or (SP is deceased or
institutionalized), display "Did".
Else display "Does".
Display plan name for the public plan being asked about,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

(Does/Did) (your/SP’s) (PUBLIC PLAN NAME) plan cover medicines
	
prescribed by a doctor?

Int. Instr II:

1:46:31 PM Monday, November 17, 2008

Page 218 of 353

HI16A
INPUT FIELDS / ROUTING
( HIQ5900 )

PUBRXCOV

Field1:
Cheshire Name:

PLRO.PUBRXCOV

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI12 - (HIQ6150 )

English text: YES
No
English text: NO

BOX HI12 - (HIQ6150 )

Attribute
Don't know

Route
BOX HI12 - (HIQ6150 )

Refusal

BOX HI12 - (HIQ6150 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute

1:46:34 PM Monday, November 17, 2008

Page 219 of 353

HI16A
SP is Deceased =
MRES.SPALIVE=3/Deceased.
71

ThisPlanCurrent

This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:46:34 PM Monday, November 17, 2008

Page 220 of 353

BOX HI12

BOX HI12

1:46:34 PM Monday, November 17, 2008

Page Order # :

3213


Page 221 of 353


BOX HI12
BOX INSTRUCTIONS
( HIQ6150 )	

IF ADMINISTERING ST, GO TO BOX ST69A - (STQ2825 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS69A - (NSQ2825 ).
ELSE IF ADMINISTERIGN CPS, GO TO BOX CPS29A - (CPS1710 ).
ELSE IF REVIEWING PUBLIC PLANS THAT WERE "CURRENT" AT THE
TIME OF THE PREVIOUS ROUND INTERVIEW, GO TO HI11PREV_IN ­
NAVIGATOR ( HIQ5744 ).
ELSE GO TO HI12_IN - NAVIGATOR ( HIQ5775 ).

ASSIGNMENTS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

80

PublicCurrentPrevRnd

Public plan "current" at the time of previous round
interview =
There is a PLAN where PLAN.PLANTYPE=3/PublicPlan
& PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=previous round & (COVTIME=1/WholeTime
or COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

85

PublicNew

Public Plan is new =
PLAN.PLANTYPE=3/PublicPlan and PLAN.PLANRNDC
= current round and PLAN.PLANSUMM ^= 1/Yes.
Exclude Deleted Plans. See T.N. 52.

86

PublicRestarted

Public Plan has been restarted =
For this PLAN, there is no PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND = previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES
If administering ST, NS, CPS, you have completed the Public plan detail

questions for the Public plan(s) added at the Source of Payment roster.

Return to the section being administered as specified above.

NOTE ON ELSE CONDITION:

ASKING ABOUT PREVIOUS ROUND PLANS:

Once all items at HI11PREV_IN Instance Navigator screen are DONE,

routing will return to HI11PREV_IN until Interviewer selects CONTINUE 

INTERVIEW. 

ASKING ABOUT CURRENT ROUND PLANS:

Once all items at HI12_IN Instance Navigator screen are DONE, routing


1:46:34 PM Monday, November 17, 2008	

Page 222 of 353

BOX HI12
will return to HI12_IN until Interviewer selects CONTINUE INTERVIEW.

1:46:34 PM Monday, November 17, 2008

Page 223 of 353


BOX HI12AA

BOX HI12AA

Page Order # :

3218

BOX INSTRUCTIONS
( HIQ6155 )	

IF (SP HAS A MEDICARE PRESCRIPTION DRUG PLAN THAT WAS
"CURRENT" AT THE TIME OF THE PREVIOUS ROUND INTERVIEW), GO
TO HI16AB - PDPSAME ( HIQ6157 ).
ELSE IF ((SP DOES NOT HAVE A MEDICARE PRESCRIPTION DRUG PLAN
THAT WAS "CURRENT" AT THE TIME OF THE PREVIOUS ROUND
INTERVIEW) AND (SP DOES NOT HAVE A "CURRENT" MEDICARE
MANAGED CARE PLAN WITH RX COVERAGE) AND (HI10C1 - MPDCOVER
= empty)), GO TO HI16B - PDPCOVER ( HIQ6165 ).
ELSE IF ((SP DOES NOT HAVE A MEDICARE PRESCRIPTION DRUG PLAN
THAT WAS "CURRENT" AT THE TIME OF THE PREVIOUS ROUND
INTERVIEW) AND (SP DOES NOT HAVE A "CURRENT" MEDICARE
MANAGED CARE PLAN WITH RX COVERAGE) AND (HI10C1 - MPDCOVER
= 2/No)), GO TO HI16B1 - PDPCOVER ( HIQ6167 ).
ELSE GO TO BOX HI12A - (HIQ6185 ).

ASSIGNMENTS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

343

MPDPCurrPrevRnd

Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

344

MHMOCurrWithRx

SP has a "current" MHMO with RX coverage =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes & PLRO.MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:46:34 PM Monday, November 17, 2008	

Page 224 of 353

HI16AB

HI16AB

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDPSAME

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3323

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display Medicare Prescription Drug plan that was "current' at the
time of the previous round interview, PLAN.PLNAME.

Question display:

Display the name of the Medicare Prescription Drug plan that was
"current' at the time of the previous round interview, PLAN.PLNAME.
If SP is deceased or institutionalized, display "Was (SP) covered
by...".
Else display "(Are you/Is SP) now covered...".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:	

MEDICARE PRESCRIPTION DRUG PLAN = (MEDICARE
PRESCRIPTION DRUG PLAN NAME)

Int. Instr I:
Question Text:	

At the time of the last interview (you were/SP was) covered by
(MEDICARE PRESCRIPTION DRUG PLAN NAME).
[(Are you/Is SP) now covered by (MEDICARE PRESCRIPTION

1:46:35 PM Monday, November 17, 2008	

Page 225 of 353

HI16AB
DRUG PLAN NAME)?] [Was (SP) covered by (MEDICARE
PRESCRIPTION DRUG PLAN NAME) on (DATE OF DEATH/DATE
OF INSTITUTIONALIZATION)?]
Int. Instr II:
INPUT FIELDS / ROUTING
PDPSAME

Field1:
Cheshire Name:

( HIQ6157 )

HRND.PDPSAME

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI12A - (HIQ6185 )

English text: YES
No

HI16AC - PDPYSTOP ( HIQ6159 )

English text: NO
Attribute
Don't know

Route
BOX HI12A - (HIQ6185 )

Refusal

HI16AD - PDPOTHER ( HIQ6163 )

BACKGROUND VARIABLE ASSIGNMENTS
The Medicare Prescription Drug plan being asked about at HI16AB was SP's current
Medicare Prescription Drug plan at the time of the previous round interview. This also
means that the SP was covered by this Medicare Prescription Drug plan for some time
during the current round.
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of Medicare Prescription Drug plan
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of Medicare Prescription Drug plan
PLRO.PLRORND = current round
1:46:38 PM Monday, November 17, 2008

Page 226 of 353

HI16AB
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
Based on response to HI16AB, HRND.PDPSAME, set the status of this plan on the current
round PLRO.
See detailed instructions below:
PLROPLAN	

PLRO.PLROPLAN = PLAN.PLANNUM of MPDP
current at time of previous round.

PLRORND	

PLRO.PLRORND = current round.

COVANYTM	

PLRO.COVANYTM = 1/Yes.

COVCURNT	

If HI16AB - PDPSAME = 1/Yes, set
PLRO.COVCURNT = 1/Yes.
Else set PLRO.COVCURNT = 2/No.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

343

MPDPCurrPrevRnd

Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

DESIGN NOTES

1:46:38 PM Monday, November 17, 2008	

Page 227 of 353

HI16AC

HI16AC

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

PDPYSTOP

Field 2:

PDPYSTOS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

3328

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

Display the name of the Medicare Prescription Drug plan that was
"current" at the time of the previous round interview,
PLAN.PLNAME.

Multi Field display:	

Vertical Alignment

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

What is the most important reason (you/SP) stopped the

(MEDICARE PRESCRIPTION DRUG PLAN NAME) coverage?

Int. Instr II:

INPUT FIELDS / ROUTING


1:46:41 PM Monday, November 17, 2008	

Page 228 of 353

HI16AC
PDPYSTOP

Field1:
Cheshire Name:

( HIQ6159 )

PLRO.PDPYSTOP

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TPdpStop
1
No
No

Number Label
1 TooExpensive

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI16AD - PDPOTHER ( HIQ6163 )

2

English text: TOO EXPENSIVE OR COULDN'T AFFORD
DissatisfiedWithCoverage
HI16AD - PDPOTHER ( HIQ6163 )

3

English text: SP DISSATISFIED WITH PLAN'S COVERAGE
GetRxCoverage
HI16AD - PDPOTHER ( HIQ6163 )

4

English text: TO GET RX COVERAGE IN ANOTHER PLAN
DiffHealthCareCov
HI16AD - PDPOTHER ( HIQ6163 )

5

English text: TO GET DIFFERENT HEALTH CARE COVERAGE
NotMedicareRx
HI16AD - PDPOTHER ( HIQ6163 )

6

English text: PLAN NO LONGER CONTRACTS FOR MEDICARE RX COVERAGE
ChangedName
HI16C - PDPCURR ( HIQ6169 )

7

English text: PLAN NAME CHANGED OR PLAN WAS BOUGHT BY/MERGED WITH
ANOTHER PLAN
SPMoved
HI16AD - PDPOTHER ( HIQ6163 )

91

English text: SP MOVED OUT OF PLAN AREA
Other
HI16AC - PDPYSTOS ( HIQ6161 )
English text: OTHER

Attribute
Don't know

Route
HI16AD - PDPOTHER ( HIQ6163 )

Refusal

HI16AD - PDPOTHER ( HIQ6163 )

1:46:48 PM Monday, November 17, 2008

Page 229 of 353

HI16AC
( HIQ6161 )

PDPYSTOS

Field2:
Cheshire Name:

PLRO.PDPYSTOS

Item Text display:

Display "(SPECIFY)" in same blue font used for interviewer

instructions.


Item Text:

OTHER (SPECIFY)


Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


String

TOthrspec

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]

30

Route
HI16AD - PDPOTHER ( HIQ6163 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

343

MPDPCurrPrevRnd

Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:46:49 PM Monday, November 17, 2008

Page 230 of 353

HI16AD

HI16AD

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDPOTHER

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3333

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is deceased or institutionalized, display "had (SP)".
Else display "(have you/has SP)".
Display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/INSTITUTIONALIZATION)], [have you/has
(SP)/had (SP)] been covered by any other Medicare Prescription
Drug plans besides (MEDICARE PRESCRIPTION DRUG PLAN
CURRENT LAST ROUND)?

Int. Instr II:
1:46:50 PM Monday, November 17, 2008

Page 231 of 353

HI16AD
INPUT FIELDS / ROUTING
( HIQ6163 )

PDPOTHER

Field1:
Cheshire Name:

HRND.PDPOTHER

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI16C - PDPCURR ( HIQ6169 )

English text: YES
No
English text: NO

BOX HI12A - (HIQ6185 )

Attribute
Don't know

Route
BOX HI12A - (HIQ6185 )

Refusal

BOX HI12A - (HIQ6185 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =

1:46:53 PM Monday, November 17, 2008

Page 232 of 353

HI16AD
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:46:53 PM Monday, November 17, 2008

Page 233 of 353

HI16B

HI16B

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDPCOVER

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3338

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If no Medicare Prescription Drug plan ever reported in any round,
display "Medicare beneficiaries can receive insurance...".
Else do not display.
If SP is deceased or institutionalized, display "covered".
Else display "covers".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

(Medicare beneficiaries can receive insurance coverage for
prescription drugs through Medicare Prescription Drug plans. These
plans are also called "Medicare Part D" plans.)
At any time since (REFERENCE DATE), (have you/has SP/had SP)
been enrolled in a Medicare Prescription Drug plan that

1:46:54 PM Monday, November 17, 2008	

Page 234 of 353

HI16B
(covers/covered) medicines prescribed by a doctor?
Int. Instr II:

INPUT FIELDS / ROUTING

( HIQ6165 )

PDPCOVER

Field1:
Cheshire Name:

HRND.PDPCOVER

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI16C - PDPCURR ( HIQ6169 )

English text: YES
No

BOX HI12A - (HIQ6185 )

English text: NO
Attribute
Don't know

Route
BOX HI12A - (HIQ6185 )

Refusal

BOX HI12A - (HIQ6185 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =

1:46:57 PM Monday, November 17, 2008

Page 235 of 353

HI16B
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

341

NeverMedicarePresDru
gPlan

No Medicare Prescription Drug plan ever reported in any
round =
There is no PLAN where PLAN.PLANTYPE = 7/MPDP.
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:46:57 PM Monday, November 17, 2008

Page 236 of 353

HI16B1

HI16B1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDPCOVER

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3343

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:

You mentioned that (you have/SP has/SP had) not been enrolled in
a Medicare Prescription Drug plan associated with (your/his/her)
Medicaid coverage.
At any time since (REFERENCE DATE), (have you/has SP/had SP)
been enrolled in a Medicare Prescription Drug plan in any way other
than through Medicaid?

Int. Instr II:

1:46:58 PM Monday, November 17, 2008

Page 237 of 353

HI16B1
INPUT FIELDS / ROUTING
( HIQ6167 )

PDPCOVER

Field1:
Cheshire Name:

HRND.PDPCOVER

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI16C - PDPCURR ( HIQ6169 )

English text: YES
No
English text: NO

BOX HI12A - (HIQ6185 )

Attribute
Don't know

Route
BOX HI12A - (HIQ6185 )

Refusal

BOX HI12A - (HIQ6185 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

341

NeverMedicarePresDru
gPlan

No Medicare Prescription Drug plan ever reported in any
round =
There is no PLAN where PLAN.PLANTYPE = 7/MPDP.
Exclude Deleted Plans. See T.N. 52.

1:47:01 PM Monday, November 17, 2008

Page 238 of 353

HI16B1
DESIGN NOTES

1:47:01 PM Monday, November 17, 2008

Page 239 of 353


HI16C

HI16C

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDPCURR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3348

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is alive and not institutionalized, display "currently".
Else do not display.
If SP is deceased, display "on (DATE OF DEATH)".
Else if SP is institutionalized, display "on (DATE OF
INSTITUTIONALIZATION)".
Else do not display.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

(Are you/Is SP/Was SP) (currently) covered by or enrolled in a
Medicare Prescription Drug plan [on (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]?

Int. Instr II:
1:47:03 PM Monday, November 17, 2008	

Page 240 of 353

HI16C
INPUT FIELDS / ROUTING
( HIQ6169 )

PDPCURR

Field1:
Cheshire Name:

HRND.PDPCURR

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI16E - PLAN_MPDP ( HIQ6171 )

English text: YES
No
English text: NO

HI16G - PLAN_MPDPOTHR ( HIQ6177 )

Attribute
Don't know

Route
HI16G - PLAN_MPDPOTHR ( HIQ6177 )

Refusal

HI16G - PLAN_MPDPOTHR ( HIQ6177 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =

1:47:06 PM Monday, November 17, 2008

Page 241 of 353

HI16C
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES

1:47:06 PM Monday, November 17, 2008

Page 242 of 353

HI16E

HI16E

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PLAN_MPDP

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Name:

Plan Roster

Roster Type:

Single Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

3353

Display as ' Add a Plan '
Display as ' Edit a Plan '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Always display brackets around question text.
If SP is deceased, display "on (DATE OF DEATH)".

Else if SP is institutionalized, display "on (DATE OF

INSTITUTIONALIZATION)" .

Else do not display.

If SP is deceased or institutionalized, display "covered".

Else display "covers".


Multi Field display:

Roster/Grid Instructions:

Display all health insurance plans from the Plan Roster.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare plan
Medicare Managed Care Plans
Medicaid
Tricare
Public Plans
Private Plans
Medicare Prescription Drug plan if "current" at the time of the
previous round interview

Roster/Grid display:

COL #
1

1:47:06 PM Monday, November 17, 2008

HEADER
Plan Name

INSTRUCTIONS
Display PLAN.PLNAME.
Page 243 of 353

HI16E
2

Plan Type

Display PLAN.PLANTYPE:
1/Medicare, display "(MCAR)"
2/Medicaid, display "(MCAD)"
3/PublicPlan, display "(PUBL)"
4/PrivatePlan, display "(PRIV)"
5/MHMO, display "(MHMO)"
6/Tricare, display "(TRIC)"
7/MPDP, display "(MPDP)"

3

Plan Status

Display CURRENT ROUND PLAN
STATUS.

Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

[What is the name of the Medicare Prescription Drug plan that
(currently covers/covered) [you/(SP)] [on (DATE OF DEATH/DATE
OF INSTITUTIONALIZATION)]?]

Int. Instr II:

SELECT OR ADD ONLY ONE MEDICARE PRESCRIPTION DRUG
PLAN AT THIS ROSTER.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PLAN_MPDP

( HIQ6171 )

TEMP

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:


String
TPlanPick32
1

No
No


Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:


32

Route
HI16F - PDPMORE ( HIQ6175 )

BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:

1:47:07 PM Monday, November 17, 2008

Page 244 of 353

HI16E
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at HI16E.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HI16E.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
The plan selected at HI16E is the SP's current Medicare Prescription Drug plan for the
current round.
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
COVANYTM	

Set PLRO.COVANYTM=1/Yes for plan selected at
HI16E.

COVCURNT	

Set PLRO.COVCURNT=1/Yes for plan selected at
HI16E.

PLANTYPE	

If PLAN added to roster, set
PLAN.PLANTYPE=7/MPDP.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
95

PlanIsCurrent

If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

1:47:07 PM Monday, November 17, 2008	

Page 245 of 353

HI16E
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

53

PlanTypes

Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Managed Care: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.

343

MPDPCurrPrevRnd

Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES
HI16E is called from ST, NS, CPS when a Medicare Prescription Drug Plan
is added at the Source of Payment roster and SP has already reported a
current Medicare Prescription Drug plan but has now reported a change
regarding which Medicare Prescription Drug plan is current.

1:47:07 PM Monday, November 17, 2008

Page 246 of 353

HI16F

HI16F

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDPMORE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3363

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is deceased or institutionalized, display "had (SP)".
Else display "(have you/has SP)".
Display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/ INSTITUTIONALIZATION)], [have you/has
(SP)/had (SP)] been covered by any other Medicare Prescription
Drug plans besides (CURRENT MEDICARE PRESCRIPTION DRUG
PLAN)?

Int. Instr II:
1:47:08 PM Monday, November 17, 2008	

Page 247 of 353

HI16F
INPUT FIELDS / ROUTING
( HIQ6175 )

PDPMORE

Field1:
Cheshire Name:

HRND.PDPMORE

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI16G - PLAN_MPDPOTHR ( HIQ6177 )

English text: YES
No
English text: NO

BOX HI12A - (HIQ6185 )

Attribute
Don't know

Route
BOX HI12A - (HIQ6185 )

Refusal

BOX HI12A - (HIQ6185 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =

1:47:11 PM Monday, November 17, 2008

Page 248 of 353

HI16F
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:47:11 PM Monday, November 17, 2008

Page 249 of 353

HI16G

HI16G

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PLAN_MPDPOTHR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Name:

Plan Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No

Yes


Grid Functions:

Add Line
Delete Line

No
No

3368

Display as ' Add a Plan '

Display as ' Edit a Plan '


DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has a "current" Medicare Prescription Drug plan, display
"Besides (CURRENT PRESCRIPTION DRUG PLAN), what other".
Display the name of the Medicare Prescription drug plan that is
"current' in the current round, PLAN.PLNAME
Else if SP had a Medicare Prescription Drug plan was "current" at
the time of the previous round interview, display "Besides
(PREVIOUS ROUND PRESCRPTION DRUG PLAN), what other".
Display the name of the Medicare Prescription drug plan that was
"current" at the time of the previous round interview,
PLAN.PLNAME.
Else display "What".

Multi Field display:

Roster/Grid Instructions:

Display all health insurance plans from the Plan Roster.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare plan
Medicare Managed Care Plans
Medicaid
Tricare
Public Plans
Private Plans

1:47:12 PM Monday, November 17, 2008

Page 250 of 353

HI16G
Medicare Prescription Drug plan if "current" at the time of the
previous round interview
Medicare Prescription Drug plan if "current" in the current round
Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

Plan Name

Display PLAN.PLNAME.

2

Plan Type

Display PLAN.PLANTYPE:
1/Medicare, display "(MCAR)"
2/Medicaid, display "(MCAD)"
3/PublicPlan, display "(PUBL)"
4/PrivatePlan, display "(PRIV)"
5/MHMO, display "(MHMO)"
6/Tricare, display "(TRIC)"
7/MPDP, display "(MPDP)"

3

Plan Status

Display CURRENT ROUND PLAN
STATUS.

Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

[Besides (CURRENT PRESCRIPTION DRUG PLAN), what
other/Besides (PREVIOUS ROUND PRESCRIPTION DRUG PLAN),
what other/What] Medicare Prescription Drug plans covered
[your/(SP’s)] medicines since (REFERENCE DATE)?

Int. Instr II:

SELECT OR ADD MEDICARE PRESCRIPTION DRUG PLAN
NAMES AT THIS ROSTER.

INPUT FIELDS / ROUTING

1:47:13 PM Monday, November 17, 2008

Page 251 of 353

HI16G

Field1:
Cheshire Name:

PLAN_MPDPOTHR

( HIQ6177 )

TEMP

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

String
TPlanPick30
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HI12A - (HIQ6185 )

BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at HI16G.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HI16G.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
Plans selected at HI16G are Medicare Prescription Drug plans that the SP was enrolled in
for some time in the current round but are not the SP's current Medicare Prescription Drug
plan.
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
COVANYTM	

Set PLRO.COVANYTM = 1/Yes for all plan selected
at HI16G.

COVCURNT	

Set PLRO.COVCURNT = 2/No for all plan selected
at HI16G.

1:47:13 PM Monday, November 17, 2008	

Page 252 of 353

HI16G
If PLAN added to roster, set
PLAN.PLANTYPE=7/MPDP.

PLANTYPE
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
343

MPDPCurrPrevRnd

Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

95

PlanIsCurrent

If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

53

PlanTypes

Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Managed Care: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:47:13 PM Monday, November 17, 2008

Page 253 of 353

BOX HI12A

BOX HI12A

Page Order # :

3371

BOX INSTRUCTIONS
( HIQ6185 )	

IF AT LEAST ONE PRIVATE PLAN WAS "CURRENT" AT THE TIME OF THE
PREVIOUS ROUND INTERVIEW, GO TO HI17PREV - PRIVINTRO (
HIQ6190 ).
ELSE GO TO HI17 - PRVCOVER ( HIQ6205 ).

ASSIGNMENTS
If a private plan was current at the time of the previous round interview, then the SP was
also covered by this private plan for some time during the current round.

TECHNICAL NOTES
52

DeletedPlans	

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

81

PrivateCurrentPrevRnd	

Private plan "current" at the time of previous round
interview =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=prev. round & (COVTIME=1/WholeTime or
COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:47:13 PM Monday, November 17, 2008	

Page 254 of 353

HI17PREV

HI17PREV

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

PRIVINTRO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3372

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

The next questions are about private plans [you were/(SP) was]

covered by as of (REFERENCE DATE).

Int. Instr II:
INPUT FIELDS / ROUTING

1:47:15 PM Monday, November 17, 2008

Page 255 of 353

HI17PREV
PRIVINTRO

Field1:
Cheshire Name:

( HIQ6190 )

TEMP

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TContinueEMPTY
1
No
No

Number Label
1 Continue

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI17PREV_IN - NAVIGATOR ( HIQ6195 )

English text: CONTINUE
Attribute
Empty

Route
HI17PREV_IN - NAVIGATOR ( HIQ6195 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:47:16 PM Monday, November 17, 2008

Page 256 of 353

HI17PREV_IN

HI17PREV_IN

Page Order # :

Design Screen Type:

Instance Navigator

Fields:

Field 1:

NAVIGATOR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

3373

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display all private plans that were "current" at the time of the
previous round interview.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING

1:47:17 PM Monday, November 17, 2008

Page 257 of 353

HI17PREV_IN
NAVIGATOR

Field1:
Cheshire Name:

( HIQ6195 )

N/A

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TInstanceNavigator
1
No
No

Number Label
1 SelectItemInList	
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI12B - (HIQ6200 )

English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview	
HI17 - PRVCOVER ( HIQ6205 )
English text: CONTINUE INTERVIEW SELECTED

BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:

PLAN key = PLAN.PLANBASE + PLAN.PLANNUM

PLAN.PLANNUM = Number of private plan being asked about from the previous round.

PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND

PLRO.PLROPLAN = PLAN.PLANNUM of private plan being asked about from the previous

round.

PLRO.PLRORND = current round.


SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans	

1:47:19 PM Monday, November 17, 2008	

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

Page 258 of 353

HI17PREV_IN
81

PrivateCurrentPrevRnd

Private plan "current" at the time of previous round
interview =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=prev. round & (COVTIME=1/WholeTime or
COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:47:19 PM Monday, November 17, 2008

Page 259 of 353

BOX HI12B

BOX HI12B

Page Order # :

3374

BOX INSTRUCTIONS
( HIQ6200 )

CREATE A CURRENT ROUND PLRO FOR PRIVATE PLAN .
GO TO HI21 - COVTIME ( HIQ6230 ).

ASSIGNMENTS
If Private plan was current at the time of the previous round interview, then the SP was also

covered by the Private plan for some time during the current round.

Create a current round PLRO to store the status of this private plan in the current round.

PLRO KEY = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND

In addition, set HMO flag, PLRO.PPRVHMO, to equal value from previous round.

See detailed instructions below.

PLROPLAN

PLRO.PLROPLAN = PLAN.PLANNUM of Private
Plan current at time of previous round.

PLRORND

PLRO.PLRORND = current round.

PPRVHMO

Set current round PLRO.PPRVHMO = previous
round PLRO.PPRVHMO.

TECHNICAL NOTES

DESIGN NOTES

1:47:19 PM Monday, November 17, 2008

Page 260 of 353

HI17

HI17

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

PRVCOVER

Enable Functions:	

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

3380

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If no private plans were "current" at the time of the previous round
interview, display "Now, I would like to ask about other types of
health insurance.".
Else do not display.
If SP is deceased or institutionalized, display "was SP".

Else display "(have you/has SP) been".

If SP has reported being covered by any private plan in the current 

round, display "any other" and "plan".

Else display "plans".


Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:	

Display report above question text.
Display all insurance plans SP reported being covered by in the

current round in the following order:

First line:

If SP was covered by a Medicare Managed care plan, display name

of this Medicare Managed care plan.

Else display "MEDICARE" for the Medicare plan.


1:47:21 PM Monday, November 17, 2008	

Page 261 of 353

HI17
Next list Medicaid, Tricare, all Public Plans, all Private Plans and all

Medicare Prescription Drug Plans. If there is more than one plan of

any type, display in order of entry.

Report header: PLANS DISCUSSED AT THIS POINT OF THE

INTERVIEW

Column 1, header = "Plan Name", display PLAN.PLNAME.

Column 2, header = "Plan Type", display PLAN.PLANTYPE:

If PLANTYPE=1/Medicare, display "(MCAR)".

If PLANTYPE=2/Medicaid, display "(MCAD)".

If PLANTYPE=3/PublicPlan, display "(PUBL)".

If PLANTYPE=4/PrivatePlan, display "(PRIV)".

If PLANTYPE=5/MHMO, display "(MHMO)".

If PLANTYPE=6/Tricare, display "(TRIC)".

If PLANTYPE=7MPDP, display "(MPDP)".


TEXT:
Context Header:
Int. Instr I:
Question Text:

We’ve talked about [READ PLAN(S) LISTED ABOVE].
(Now, I would like to ask about other types of health insurance.) At
any time [since (REFERENCE DATE)/between (PREVIOUS ROUND
INTERVIEW DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], [(have you/has SP) been/was SP]
covered by (any other) private health insurance or private managed
care (plan/plans)?
By "private", I mean a supplemental or Medigap plan, or a plan that
is provided by a former or current employer. Such plans cover the
cost of hospital or doctor visits, prescribed medicines, or dental care.

Int. Instr II:
INPUT FIELDS / ROUTING

1:47:23 PM Monday, November 17, 2008

Page 262 of 353

HI17
( HIQ6205 )

PRVCOVER

Field1:
Cheshire Name:

HRND.PRVCOVER

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI20 - PLAN_PRIVATE ( HIQ6220 )

English text: YES
No

BOX HI13A - (HIQ6210 )

English text: NO
Attribute
Don't know

Route
BOX HI13A - (HIQ6210 )

Refusal

BOX HI13A - (HIQ6210 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans	

1:47:26 PM Monday, November 17, 2008	

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

Page 263 of 353

HI17
53

PlanTypes

Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Managed Care: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.

93

AnyPlansCurrentRnd

SP reported being covered by any plans during the
current round =
There is PLAN & PLRO where (PLRO.PLROPLAN =
PLAN.PLANNUM & PLRO.PLRORND = current round &
(PLRO.COVTIME ^= empty or PLRO.COVANYTIM =
1/Yes)).
Exclude Deleted Plans. See T.N. 52.

81

PrivateCurrentPrevRnd

Private plan "current" at the time of previous round
interview =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=prev. round & (COVTIME=1/WholeTime or
COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

1:47:26 PM Monday, November 17, 2008

Page 264 of 353

BOX HI13A

BOX HI13A

Page Order # :

3410

BOX INSTRUCTIONS
( HIQ6210 )

IF (SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP IS NEW FROM
FACILITY), GO TO HI19 - GAPCOVER ( HIQ6215 ).
ELSE GO TO HI35 - PRVOCOV ( HIQ7590 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

25

NewFromFacility

SP is new from facility (i.e. all previous round interviews
were in a facility) =
MRES.INTTYPE=2/NewFromFacility on MRES where
MRES.MRESRND = current round.

DESIGN NOTES

1:47:26 PM Monday, November 17, 2008

Page 265 of 353

HI19

HI19

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

GAPCOVER

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3420

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:

Some people who are eligible for Medicare have additional coverage
through a private insurance carrier. This is sometimes referred to as
Medigap or Medicare Supplement. At any time since (REFERENCE
DATE) did (you/SP) have this type of health insurance coverage?

Int. Instr II:
INPUT FIELDS / ROUTING

1:47:27 PM Monday, November 17, 2008

Page 266 of 353

HI19
GAPCOVER

Field1:
Cheshire Name:

( HIQ6215 )

HRND.GAPCOVER

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI20 - PLAN_PRIVATE ( HIQ6220 )

English text: YES
No

HI35 - PRVOCOV ( HIQ7590 )

English text: NO
Attribute
Don't know

Route
HI35 - PRVOCOV ( HIQ7590 )

Refusal

HI35 - PRVOCOV ( HIQ7590 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:47:29 PM Monday, November 17, 2008

Page 267 of 353

HI20

HI20

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PLAN_PRIVATE

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Name:

Plan Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No

No


Grid Functions:

Add Line
Delete Line

No
No

3430

Display as ' Add a Plan '

Display as ' Edit a Plan '


DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Always display "(other)" in parenthesis.
If SP is deceased or institutionalized, display "provided".
Else display "provide".

Multi Field display:

Roster/Grid Instructions:

Display all health insurance plans from the Plan Roster.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare
Medicare Managed Care plans.
Medicaid
Tricare
Public plans
Private plans hat SP has already reported being covered by durng
the current round, this includes plans that are current or have
stopped in current round.
Medicare Prescription Drug Plans

Roster/Grid display:

COL #
1

1:47:30 PM Monday, November 17, 2008

HEADER
Plan Name

INSTRUCTIONS
Display PLAN.PLNAME.

Page 268 of 353

HI20
2

Plan Type	

Display PLAN.PLANTYPE:
1/Medicare, display "(MCAR)"
2/Medicaid, display "(MCAD)"
3/PublicPlan, display "(PUBL)"
4/PrivatePlan, display "(PRIV)"
5/MHMO, display "(MHMO)"
6/Tricare, display "(TRIC)"
7/MPDP, display "(MPDP)"

3

Plan Status	

Display CURRENT ROUND PLAN
STATUS.

Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

What is the name of each of the (other) private plans that

(provide/provided) (your/SP’s) medical insurance coverage?

Int. Instr II:	

SELECT OR ADD ALL PRIVATE PLAN NAMES AT THIS ROSTER.

INPUT FIELDS / ROUTING

Field1:	
Cheshire Name:

PLAN_PRIVATE

( HIQ6220 )

TEMP

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:


String
TPlanPick32
1

No
No


Number Label	
1 [Continuous answer.]	

FieldSize:
Min Value:

Max Value:

Mask:


32

Route
HI20_IN - NAVIGATOR ( HIQ6225 )

BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM

PLAN.PLANNUM = Number of plan selected at HI20.


1:47:31 PM Monday, November 17, 2008	

Page 269 of 353

HI20
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HI20.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
Plans selected at HI20 are Private plans that the SP was enrolled in for some time in the
current round.
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
PLROPLAN

PLRO.PLROPLAN=this PLAN.PLANNUM.

PLRORND

PLRO.PLRORND=current round.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

53

PlanTypes

Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Managed Care: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.

93

AnyPlansCurrentRnd

SP reported being covered by any plans during the
current round =
There is PLAN & PLRO where (PLRO.PLROPLAN =
PLAN.PLANNUM & PLRO.PLRORND = current round &
(PLRO.COVTIME ^= empty or PLRO.COVANYTIM =
1/Yes)).
Exclude Deleted Plans. See T.N. 52.

95

PlanIsCurrent

If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

1:47:31 PM Monday, November 17, 2008

Page 270 of 353

HI20
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

DESIGN NOTES

1:47:31 PM Monday, November 17, 2008

Page 271 of 353

HI20_IN

HI20_IN

Page Order # :

Design Screen Type:

Instance Navigator

Fields:

Field 1:

NAVIGATOR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

3440

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display plans selected at HI20.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING

1:47:32 PM Monday, November 17, 2008

Page 272 of 353

HI20_IN
NAVIGATOR

Field1:
Cheshire Name:

( HIQ6225 )

N/A

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TInstanceNavigator
1
No
No

Number Label
1 SelectItemInList
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI21 - COVTIME ( HIQ6230 )

English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
HI35 - PRVOCOV ( HIQ7590 )
English text: CONTINUE INTERVIEW SELECTED

BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at HI20.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HI20.
PLRO.PLRORND = current round.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:47:33 PM Monday, November 17, 2008

Page 273 of 353

HI21

HI21

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

COVTIME

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3450

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display plan name for the private plan being asked about,
PLAN.PLNAME.

Question display:

If asking about a private plan that was "current" at the time of the
previous round interview, display "At the time of the last interview...".
Else do not display.
Display plan name for the private plan being asked about,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

PRIVATE INSURANCE PLAN = (PRIVATE PLAN NAME)

Int. Instr I:
Question Text:

1:47:35 PM Monday, November 17, 2008

[At the time of the last interview (you were/SP was) covered by
(PRIVATE PLAN NAME).] (Were you/Was SP) covered by
(PRIVATE PLAN NAME) the whole time between (REFERENCE
DATE) and (today/ DATE OF DEATH/DATE OF
INSTITUTIONALIZATION), or only part of the time?
Page 274 of 353

HI21
Int. Instr II:
INPUT FIELDS / ROUTING
( HIQ6230 )

COVTIME

Field1:
Cheshire Name:

PLRO.COVTIME

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TCovtime

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 WholeTime
2

Route
BOX HI17 - (HIQ6940 )

English text: THE WHOLE TIME
PartOfTime

HI22 - COVNOW ( HIQ6260 )

English text: PART OF THE TIME
Attribute
Don't know

Route
HI22 - COVNOW ( HIQ6260 )

Refusal

HI22 - COVNOW ( HIQ6260 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

1:47:38 PM Monday, November 17, 2008

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

Page 275 of 353

HI21
81

PrivateCurrentPrevRnd	

Private plan "current" at the time of previous round
interview =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=prev. round & (COVTIME=1/WholeTime or
COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES
HI21 called from ST, NS, CPS when private plan is added at the Source of
Payment Roster.

1:47:38 PM Monday, November 17, 2008	

Page 276 of 353

HI22

HI22

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

COVNOW

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3480

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is deceased or institutionalized, display "Was SP covered by
(PRIVATE PLAN NAME) on (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)?".
Else display "(Are you/Is SP) now covered by (PRIVATE PLAN
NAME)?".
Display plan name for the private plan being asked about,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

[(Are you/Is SP) now covered by (PRIVATE PLAN NAME)?] [Was
SP covered by (PRIVATE PLAN NAME) on (DATE OF DEATH/
DATE OF INSTITUTIONALIZATION)?]

1:47:39 PM Monday, November 17, 2008	

Page 277 of 353

HI22
Int. Instr II:
INPUT FIELDS / ROUTING
( HIQ6260 )

COVNOW

Field1:
Cheshire Name:

PLRO.COVNOW

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI16 - (HIQ6270 )

English text: YES
No

HI24 - COVENDMM ( HIQ6910 )

English text: NO
Attribute
Don't know

Route
BOX HI17 - (HIQ6940 )

Refusal

BOX HI17 - (HIQ6940 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY

1:47:42 PM Monday, November 17, 2008

Page 278 of 353

HI22
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

1:47:42 PM Monday, November 17, 2008

Page 279 of 353

BOX HI16

BOX HI16

Page Order # :

3490

BOX INSTRUCTIONS
( HIQ6270 )

IF THIS PRIVATE PLAN WAS "CURRENT" AT THE TIME OF THE
PREVIOUS ROUND INTERVIEW, GO TO BOX HI17 - (HIQ6940 ).
ELSE GO TO HI23 - COVBEGMM ( HIQ6880 ).

ASSIGNMENTS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

63

ThisPlanCurrentPrevRn
d

This Plan was "current" at the time of the previous round
interview =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:47:42 PM Monday, November 17, 2008

Page 280 of 353

HI23

HI23

Page Order # :

Design Screen Type:

Date

Fields:

Field 1:

COVBEGMM

Field 2:

COVBEGDD

Field 3:

COVBEGYY

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

3860

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display plan name for the private plan being asked about,
PLAN.PLNAME.

Multi Field display:

Horizontal Alignment
Display all fields at one time.

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

On what date did (your/SP’s) coverage under (PRIVATE PLAN
	
NAME) start between (REFERENCE DATE) and (today/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)?

Int. Instr II:

1:47:44 PM Monday, November 17, 2008

Page 281 of 353

HI23
INPUT FIELDS / ROUTING
COVBEGMM

Field1:
Cheshire Name:

( HIQ6880 )

PLRO.COVBEGMM

Item Text display:
Item Text:
Label:

Label Position:


MM
Under

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Integer
TMonthInt
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HI23 - COVBEGDD ( HIQ6890 )

Refusal

HI23 - COVBEGDD ( HIQ6890 )

1:47:47 PM Monday, November 17, 2008

FieldSize:
Min Value:
Max Value:
Mask:

2
01
12

Route
HI23 - COVBEGDD ( HIQ6890 )

Page 282 of 353

HI23
COVBEGDD

Field2:
Cheshire Name:

( HIQ6890 )

PLRO.COVBEGDD

Item Text display:
Item Text:
Label:
Label Position:

DD
Under

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer
TDayDKRF
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HI23 - COVBEGYY ( HIQ6900 )

Refusal

HI23 - COVBEGYY ( HIQ6900 )

1:47:51 PM Monday, November 17, 2008

FieldSize:
Min Value:
Max Value:
Mask:

2
1
31

Route
HI23 - COVBEGYY ( HIQ6900 )

Page 283 of 353

HI23
( HIQ6900 )

COVBEGYY

Field3:
Cheshire Name:

PLRO.COVBEGYY

Item Text display:
Item Text:
Label:
Label Position:

YY
Under

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer
TMcyear

FieldSize:

Min Value:
Max Value:
Mask:


1
No
No

Number Label
1 [Continuous answer.]

0

99


Route
HI23A - YSTRTCOV ( HIQ6903 )

Attribute
Don't know

Route
HI23A - YSTRTCOV ( HIQ6903 )

Refusal

HI23A - YSTRTCOV ( HIQ6903 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
EDIT #1

PLAN BEGIN DATE, COVBEGMM/COVBEGDD/COVBEGYY,

should be on or between (REFERENCE DATE) and (REFERENCE

PERIOD END DATE).

If not true, display message: "DATE MUST BE ON OR BETWEEN

(REFERENCE DATE) AND (REFERENCE PERIOD END DATE).

PLEASE REENTER."

TECHNICAL NOTES
114

CoverageStartDate

Health Insurance Plan coverage start date =
PLRO.COVBEGMM / PLRO.COVBEGDD /
PLRO.COVBEGYY.
Check PLRO where PLRO.PLROPLAN =
PLAN.PLANNUM and PLRO.PLRORND = round #
checking.

DESIGN NOTES
1:47:53 PM Monday, November 17, 2008

Page 284 of 353

HI23

1:47:53 PM Monday, November 17, 2008

Page 285 of 353


HI23A

HI23A

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

YSTRTCOV

Field 2:

YSTRTCOS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

3865

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display plan name for the private plan being asked about,
PLAN.PLNAME.

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:

SHOW CARD HIMC2A

Question Text:

What is the most important reason (you/SP) decided to get coverage
through (PRIVATE PLAN NAME)?

Int. Instr II:

INPUT FIELDS / ROUTING


1:47:56 PM Monday, November 17, 2008	

Page 286 of 353

HI23A

1:48:02 PM Monday, November 17, 2008

Page 287 of 353


HI23A
YSTRTCOV

Field1:
Cheshire Name:

( HIQ6903 )

PLRO.YSTRTCOV

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TMhmomemb
1
No
No

Number Label
1 LowerCost
2

English text: LOWER COST
ToGetRx

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI17 - (HIQ6940 )
BOX HI17 - (HIQ6940 )

4

English text: TO GET RX COVERAGE
BenefitBesideRx
BOX HI17 - (HIQ6940 )
English text: TO GET BENEFIT COVERAGE OTHER THAN RX
DoctorInPlan
BOX HI17 - (HIQ6940 )

5

English text: DOCTOR IS MEMBER OF THIS PLAN
SpsEmpPaysPrem
BOX HI17 - (HIQ6940 )

6

English text: SP'S CURRENT/FORMER EMPLOYER PAYS PREMIUM
SpousesEmpPaysPrem
BOX HI17 - (HIQ6940 )

7

English text: SPOUSE'S CURRENT/FORMER EMPLOYER PAYS PREMIUM
PlanNameChanged
BOX HI17 - (HIQ6940 )

3

8
9
10
91

English text: PREVIOUS PLAN NAME CHANGED OR WAS BOUGHT BY/MERGED WITH
CURRENT PLAN
SelectionOfProvider
BOX HI17 - (HIQ6940 )
English text: BETTER SELECTION OF PROVIDERS OR QUALITY OF CARE
Recommendation
BOX HI17 - (HIQ6940 )
English text: RECOMMENDATION OR REPUTATION
ChoiceOfDoctors
BOX HI17 - (HIQ6940 )
English text: SP WANTED CHOICE OF DOCTORS
Other
HI23A - YSTRTCOS ( HIQ6908 )
English text: OTHER

Attribute
Don't know

Route
BOX HI17 - (HIQ6940 )

1:48:12 PM Monday, November 17, 2008

Page 288 of 353

HI23A

Refusal

BOX HI17 - (HIQ6940 )

Field2:
Cheshire Name:

YSTRTCOS

( HIQ6908 )

PLRO.YSTRTCOS

Item Text display:

Display "(SPECIFY)" in same blue font used for interviewer

instructions.


Item Text:

OTHER (SPECIFY)


Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


String

TOthrspec
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HI17 - (HIQ6940 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:48:14 PM Monday, November 17, 2008

Page 289 of 353

HI24

HI24

Page Order # :

Design Screen Type:

Date

Fields:

Field 1:

COVENDMM

Field 2:

COVENDDD

Field 3:

COVENDYY

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

3870

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display plan name for the private plan being asked about,
PLAN.PLNAME.

Multi Field display:

Horizontal Alignment
Display all fields at one time.

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

On what date since [(REFERENCE DATE)/between (PREVIOUS
ROUND INTERVIEW DATE) and (DATE OF DEATH/
DATE OF INSTITUTIONALIZATION)] did (your/SP’s) coverage
under (PRIVATE PLAN NAME) stop?

Int. Instr II:

1:48:15 PM Monday, November 17, 2008	

Page 290 of 353

HI24
INPUT FIELDS / ROUTING
COVENDMM

Field1:
Cheshire Name:

( HIQ6910 )

PLRO.COVENDMM

Item Text display:
Item Text:
Label:

Label Position:


MM
Under

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Integer
TMonthInt
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HI24 - COVENDDD ( HIQ6920 )

Refusal

HI24 - COVENDDD ( HIQ6920 )

1:48:19 PM Monday, November 17, 2008

FieldSize:
Min Value:
Max Value:
Mask:

2
01
12

Route
HI24 - COVENDDD ( HIQ6920 )

Page 291 of 353

HI24
COVENDDD

Field2:
Cheshire Name:

( HIQ6920 )

PLRO.COVENDDD

Item Text display:
Item Text:
Label:
Label Position:

DD
Under

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer
TDayDKRF
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HI24 - COVENDYY ( HIQ6930 )

Refusal

HI24 - COVENDYY ( HIQ6930 )

1:48:23 PM Monday, November 17, 2008

FieldSize:
Min Value:
Max Value:
Mask:

2
1
31

Route
HI24 - COVENDYY ( HIQ6930 )

Page 292 of 353

HI24
( HIQ6930 )

COVENDYY

Field3:
Cheshire Name:

PLRO.COVENDYY

Item Text display:
Item Text:
Label:
Label Position:

YY
Under

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer
TMcyear

FieldSize:

Min Value:
Max Value:
Mask:


1
No
No

Number Label
1 [Continuous answer.]

0

99


Route
BOX HI17 - (HIQ6940 )

Attribute
Don't know

Route
BOX HI17 - (HIQ6940 )

Refusal

BOX HI17 - (HIQ6940 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
EDIT #1

PLAN END DATE, COVENDMM/COVENDDD/COVENDYY, should

be on or between (REFERENCE DATE) and (REFERENCE

PERIOD END DATE).

If not true, display message: "DATE MUST BE ON OR BETWEEN

(REFERENCE DATE) AND (REFERENCE PERIOD END DATE).

PLEASE REENTER."

TECHNICAL NOTES
115

CoverageStopDate

Health Insurance Plan coverage stop date =
PLRO.COVENDMM / PLRO.COVENDDD /
PLRO.COVENDYY.
Check PLRO where PLRO.PLROPLAN =
PLAN.PLANNUM and PLRO.PLRORND = round #
checking.

DESIGN NOTES
1:48:24 PM Monday, November 17, 2008

Page 293 of 353

HI24

1:48:24 PM Monday, November 17, 2008

Page 294 of 353


BOX HI17

BOX HI17

Page Order # :

3880

BOX INSTRUCTIONS
( HIQ6940 )	

IF THIS PRIVATE PLAN IS NEW OR HAS BEEN "RESTARTED", GO TO
HI25 - PPRVHMO ( HIQ6970 ).
ELSE IF THIS PRIVATE PLAN WAS "CURRENT" AT THE TIME OF THE
PREVIOUS ROUND INTERVIEW AND IS STILL "CURRENT", AND IT IS A
FALL ROUND, GO TO HI26 - PERS_MIPNUM ( HIQ6990 ).
ELSE GO TO HI30 - PRVRXCOV ( HIQ7155 ).

ASSIGNMENTS

TECHNICAL NOTES
61

ThisPlanNew

This Plan is new =
PLAN.PLANRNDC = current round and
PLAN.PLANSUMM ^= 1/Yes.
Exclude Deleted Plans. See T.N. 52.

62

ThisPlanRestarted

This Plan has been restarted =
For this PLAN, there is no PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND = previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

63

ThisPlanCurrentPrevRn
d

This Plan was "current" at the time of the previous round
interview =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

71

ThisPlanCurrent

This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

98

FallRound

If the remainder of (Current round divided by 3) = 1, then
it is a Fall round.

DESIGN NOTES

1:48:24 PM Monday, November 17, 2008	

Page 295 of 353

HI25

HI25

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PPRVHMO

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3890

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display plan name for the private plan being asked about,
PLAN.PLNAME.

Question display:

If (this private plan not "current") or (SP is deceased or
institutionalized), display "Was".
Else display "Is".
Always display "(Health Maintenance Organization)" and
"(Preferred Provider Organization)" in parenthesis.
Always display "(network)" in parenthesis.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:	

PRIVATE INSURANCE PLAN = (PRIVATE PLAN NAME)

Int. Instr I:	

CODE WITHOUT ASKING IF VOLUNTEERED.

Question Text:	

(Is/Was) this a managed care plan, such as an HMO (Health
Maintenance Organization) or PPO (Preferred Provider
Organization)?

1:48:26 PM Monday, November 17, 2008	

Page 296 of 353

HI25
[EXPLAIN IF NECESSARY: Managed care plans generally provide
a full range of health care services for a prepaid fee. Health care is
generally provided by primary care doctors, specialists, or hospitals
on the plan’s list (network) except in an emergency.]
Int. Instr II:
INPUT FIELDS / ROUTING
PPRVHMO

Field1:	
Cheshire Name:

( HIQ6970 )

PLRO.PPRVHMO

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label	
1 Yes	
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI26 - PERS_MIPNUM ( HIQ6990 )

English text: YES
No	
English text: NO

Attribute
Don't know

Route
HI26 - PERS_MIPNUM ( HIQ6990 )

Refusal

HI26 - PERS_MIPNUM ( HIQ6990 )

HI26 - PERS_MIPNUM ( HIQ6990 )

BACKGROUND VARIABLE ASSIGNMENTS
If PLAN is new in the current round, store response to HI25 - PPRVHMO also on PLAN
record. Set variable as instructed below.
PRVHMO	

If PLAN is new in the current round, set
PLAN.PRVHMO=PLRO.PPRVHMO.

SOFT EDIT CHECKS

HARD EDIT CHECKS

1:48:29 PM Monday, November 17, 2008	

Page 297 of 353

HI25

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

71

ThisPlanCurrent

This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:48:29 PM Monday, November 17, 2008

Page 298 of 353

HI26

HI26

Page Order # :

Design Screen Type:	

Roster

Fields:	

Field 1:

PERS_MIPNUM

Enable Functions:	

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Name:

Person Roster

Roster Type:

Single Item Select

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
Yes

Grid Functions:	

Add Line
Delete Line

No
No

3900

Display as ' Add a Person '
Display as ' Edit a Person '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If (this private plan is not "current") or (SP is deceased or
institutionalized), display "was".
Else display "is".
Display plan name for the private plan being asked about,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:	

Display all persons from the Person Roster.
Display SP on first line, followed by the name of the SP's spouse.
Display remaining persons in the order that they were entered in
Person Roster.
Do not allow SP to be edited.

Roster/Grid display:	

COL #

1:48:29 PM Monday, November 17, 2008	

HEADER

INSTRUCTIONS

1

First Name	

Display ROST.ROSTFNAM.

2

Last Name	

Display ROST.ROSTLNAM.

3

Relationship to SP	

Display Relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Page 299 of 353

HI26
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

Who (is/was) listed as the main insured person on the (PRIVATE

PLAN NAME) policy or contract?

Int. Instr II:

SELECT OR ADD ONLY ONE PERSON.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PERS_MIPNUM

( HIQ6990 )

TEMP

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:


String
TRostPick4
1

No
No


Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:


4

Route
HI27 - PPRVGET ( HIQ7010 )

BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on ROST:

ROST key = ROST.ROSTBASE + ROST.ROSTNUM

ROST.ROSTNUM = Number of Person selected at HI26.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions:

Variables populated in Person Roster Pop-Up Window:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTREAS

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS


1:48:30 PM Monday, November 17, 2008

Page 300 of 353

HI26
Person selected at HI26 is the Main Insured Person (MIP). The ROST.ROSTNUM for the
MIP is stored on PLAN and the PLAN's current round PLRO.
If person added to roster, set reason on ROST where ROST.ROSTNUM = number of
person added.
See detailed instructions below.
ROSTREAS	

If person added to roster, set
ROST.ROSTREAS=6/MIP.

MIPNUM	

PLRO.MIPNUM=ROST.ROSTNUM of person
selected.

PLMIPNUM	

PLAN.PLMIPNUM=PLRO.MIPNUM. (NOTE for
future reference. Will need to create TRNS if
PLMIPNUM is being updated from previous round).

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
96

SPsSpouse

SP's Spouse =
There is a ROST where ROST.ROSTREL=2/Spouse.

59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

71

ThisPlanCurrent

This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:48:30 PM Monday, November 17, 2008	

Page 301 of 353

HI27

HI27

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

PPRVGET

Field 2:

PPRVGTOS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

3910

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display plan name for the private plan being asked about,
PLAN.PLNAME.
If the respondent is the MIP, display "you" .
Else display the name of the MIP.

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:	

For the (PRIVATE PLAN NAME) plan, did (you/MIP) sign up directly,
or did (you/MIP) get this insurance through a current employer, a
former employer, a union, a family business, AARP, or some other
way?

1:48:33 PM Monday, November 17, 2008	

Page 302 of 353

HI27
Int. Instr II:

INPUT FIELDS / ROUTING


1:48:39 PM Monday, November 17, 2008

Page 303 of 353


HI27
PPRVGET

Field1:
Cheshire Name:
Item Text display:

( HIQ7010 )

PLRO.PPRVGET
Display name of MIP in response categories.

Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TPrvget
1
No
No

Number Label
1 Directly
2

English text: DIRECTLY
CurrentEmployer

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI29 - PRVNMCOV ( HIQ7150 )
HI29 - PRVNMCOV ( HIQ7150 )

4

English text: (MIP'S) CURRENT EMPLOYER
FormerEmployer
HI29 - PRVNMCOV ( HIQ7150 )
English text: (MIP'S) FORMER EMPLOYER
Union
HI29 - PRVNMCOV ( HIQ7150 )

5

English text: (MIP'S) UNION
FamilyBusiness

HI29 - PRVNMCOV ( HIQ7150 )

6

English text: (MIP'S) FAMILY BUSINESS
Aarp

HI29 - PRVNMCOV ( HIQ7150 )

7

English text: AARP
DecSpousesEmployer

HI29 - PRVNMCOV ( HIQ7150 )

8

English text: DECEASED SPOUSE'S EMPLOYER
DecSpousesUnion
HI29 - PRVNMCOV ( HIQ7150 )

9

English text: DECEASED SPOUSE'S UNION
ProfessionalOrg

3

91

HI29 - PRVNMCOV ( HIQ7150 )

English text: PROFESSIONAL/FRATERNAL ORGANIZATION
Other
HI27 - PPRVGTOS ( HIQ7030 )
English text: SOME OTHER WAY

Attribute
Don't know

Route
HI29 - PRVNMCOV ( HIQ7150 )

Refusal

HI29 - PRVNMCOV ( HIQ7150 )

1:48:46 PM Monday, November 17, 2008

Page 304 of 353

HI27
( HIQ7030 )

PPRVGTOS

Field2:
Cheshire Name:

PLRO.PPRVGTOS

Item Text display:

Display "(SPECIFY)" in same blue font used for interviewer

instructions.


Item Text:

OTHER (SPECIFY)


Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


String

TOthrspec

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]	

30

Route
HI29 - PRVNMCOV ( HIQ7150 )

BACKGROUND VARIABLE ASSIGNMENTS
If PLAN is new in the current round, store response to HI27 - PPRVGET and PPRVGTOS
also on PLAN record. Set variable as instructed below.
PRVGET	

If PLAN is new in the current round, set
PLAN.PRVGET=PLRO.PPRVGET.

PRVGETOS	

If PLAN is new in the current round, set
PLAN.PRVGETOS=PLRO.PPRVGTOS.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

82

MIP

Main insured person (MIP) for this PLAN =
PLAN.PLMIPNUM.
MIP name = ROST.ROSTFNAM + ROST.ROSTLNAM on
ROST where ROST.ROSTNUM = PLAN.PLMIPNUM.

DESIGN NOTES
1:48:47 PM Monday, November 17, 2008	

Page 305 of 353

HI27

1:48:47 PM Monday, November 17, 2008

Page 306 of 353


HI29

HI29

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

PRVNMCOV

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3960

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (this private plan is not "current") or (SP is deceased or
institutionalized), display "were".
Else display "are".
If the respondent is the MIP display "your".
Else display name of the MIP selected at HI26.
Display plan name for the private plan being asked about,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

1:48:48 PM Monday, November 17, 2008

How many family members, including (yourself/SP), (are/were)

covered by (your/MIP’s) (PRIVATE PLAN NAME)?

Page 307 of 353

HI29
Int. Instr II:

INPUT FIELDS / ROUTING

PRVNMCOV

Field1:
Cheshire Name:

( HIQ7150 )

PLRO.PRVNMCOV

Item Text display:
Item Text:
Label:

Label Position:


NUMBER COVERED:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Integer
TPrvnmcov

FieldSize:

Min Value:
Max Value:
Mask:


1
No
No

Number Label
1 [Continuous answer.]	

1

15


Route
HI30 - PRVRXCOV ( HIQ7155 )

Attribute
Don't know

Route
HI30 - PRVRXCOV ( HIQ7155 )

Refusal

HI30 - PRVRXCOV ( HIQ7155 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
PRVNMCOV = 1-4.

If not true, display message "THE AMOUNT ENTERED SEEMS

UNLIKELY. PLEASE VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES
82

MIP	

1:48:50 PM Monday, November 17, 2008	

Main insured person (MIP) for this PLAN =
PLAN.PLMIPNUM.
MIP name = ROST.ROSTFNAM + ROST.ROSTLNAM on
ROST where ROST.ROSTNUM = PLAN.PLMIPNUM.

Page 308 of 353

HI29
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

71

ThisPlanCurrent

This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:48:50 PM Monday, November 17, 2008

Page 309 of 353

HI30

HI30

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PRVRXCOV

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

3990

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display plan name for the private plan being asked about,

PLAN.PLNAME.

If (this private plan is not "current") or (SP is deceased or

institutionalized), display "included".

Else display "includes".

Display "[you/(SP)]" in text of probe in BOLD.

If (this private plan is not "current") or (SP is deceased or

institutionalized), display "had".

Else if SP is respondent, display "have".

Else display "has".

If (this private plan is not "current") or (SP is deceased or

institutionalized), display "Did".

Else display "Does".

If the respondent is the MIP display "your".

Else display the name of the MIP.


Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:

1:48:51 PM Monday, November 17, 2008

Page 310 of 353

HI30
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

Supplemental insurance plans may cover a variety of services or
may be specific to only certain services, such as prescribed
medicines or dental coverage. I’d like to know what [your/(SP’s)]
(PLAN NAME) coverage (includes/included).
[PROBE: I am asking about the type of insurance coverage that
[you/(SP)] personally (have/has/had), not what the plan offers
everyone.]
(Does/Did) [your/(MIP’s)] (PRIVATE PLAN NAME) plan cover
prescribed medicines?

Int. Instr II:
INPUT FIELDS / ROUTING

1:48:53 PM Monday, November 17, 2008

Page 311 of 353

HI30
( HIQ7155 )

PRVRXCOV

Field1:
Cheshire Name:

PLRO.PRVRXCOV

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI17AB - (HIQ7160 )

English text: YES
No

BOX HI17AB - (HIQ7160 )

English text: NO
Attribute
Don't know

Route
BOX HI17AB - (HIQ7160 )

Refusal

BOX HI17AB - (HIQ7160 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

1:48:56 PM Monday, November 17, 2008

Page 312 of 353

HI30
82

MIP

Main insured person (MIP) for this PLAN =
PLAN.PLMIPNUM.
MIP name = ROST.ROSTFNAM + ROST.ROSTLNAM on
ROST where ROST.ROSTNUM = PLAN.PLMIPNUM.

59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

71

ThisPlanCurrent

This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:48:56 PM Monday, November 17, 2008

Page 313 of 353

BOX HI17AB

BOX HI17AB

Page Order # :

3995

BOX INSTRUCTIONS
( HIQ7160 )	

IF (THIS PRIVATE PLAN IS NEW OR HAS BEEN "RESTARTED") OR (THIS
PRIVATE PLAN WAS "CURRENT" AT THE TIME OF THE PREVIOUS
ROUND INTERVIEW AND IS STILL "CURRENT", AND IT IS A FALL
ROUND), GO TO HI31A - PRVMSCOV ( HIQ7190 ).
ELSE GO TO BOX HI17AD - (HIQ7270 ).

ASSIGNMENTS

TECHNICAL NOTES
61

ThisPlanNew

This Plan is new =
PLAN.PLANRNDC = current round and
PLAN.PLANSUMM ^= 1/Yes.
Exclude Deleted Plans. See T.N. 52.

62

ThisPlanRestarted

This Plan has been restarted =
For this PLAN, there is no PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND = previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

63

ThisPlanCurrentPrevRn
d

This Plan was "current" at the time of the previous round
interview =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

71

ThisPlanCurrent

This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

98

FallRound

If the remainder of (Current round divided by 3) = 1, then
it is a Fall round.

DESIGN NOTES

1:48:56 PM Monday, November 17, 2008	

Page 314 of 353

HI31A

HI31A

Page Order # :

Design Screen Type:

List

Fields:

Field 1:

PRVMSCOV

Field 2:

PRVIPCOV

Field 3:

PRVNHCOV

Field 4:

MHMODENT

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:

4005

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (this private plan is not "current") or (SP is deceased or
institutionalized), display "Did".
Else display "Does".
If the respondent is the MIP display "your".
Else display the name of the MIP.
Display plan name for the private plan being asked about,
PLAN.PLNAME.

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

1:48:59 PM Monday, November 17, 2008

Page 315 of 353

HI31A
Int. Instr I:
(Does/Did) (your/MIP’s) (PRIVATE PLAN NAME) cover...

Question Text:

[PROBE IF NECESSARY: I am asking about the type of insurance
coverage that (you/SP) personally (have/has/had), not what the plan
offers everyone.]
Int. Instr II:
INPUT FIELDS / ROUTING
PRVMSCOV

Field1:
Cheshire Name:

( HIQ7190 )

PLRO.PRVMSCOV

Item Text display:

Display "b." before the question text.

Item Text:

doctor visits or lab work?

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI31A - PRVIPCOV ( HIQ7200 )

English text: YES
No

HI31A - PRVIPCOV ( HIQ7200 )

English text: NO
Attribute
Don't know

Route
HI31A - PRVIPCOV ( HIQ7200 )

Refusal

HI31A - PRVIPCOV ( HIQ7200 )

1:49:04 PM Monday, November 17, 2008

Page 316 of 353

HI31A
PRVIPCOV

Field2:
Cheshire Name:

( HIQ7200 )

PLRO.PRVIPCOV

Item Text display:

Display "c." before the question text.

Item Text:

inpatient hospital care?

Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI31A - PRVNHCOV ( HIQ7210 )

English text: YES
No

HI31A - PRVNHCOV ( HIQ7210 )

English text: NO
Attribute
Don't know

Route
HI31A - PRVNHCOV ( HIQ7210 )

Refusal

HI31A - PRVNHCOV ( HIQ7210 )

1:49:10 PM Monday, November 17, 2008

Page 317 of 353

HI31A
PRVNHCOV

Field3:
Cheshire Name:

( HIQ7210 )

PLRO.PRVNHCOV

Item Text display:

Display "d." before the question text.

Item Text:

nursing home or long term care?

Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI31A - MHMODENT ( HIQ7220 )

English text: YES
No

HI31A - MHMODENT ( HIQ7220 )

English text: NO
Attribute
Don't know

Route
HI31A - MHMODENT ( HIQ7220 )

Refusal

HI31A - MHMODENT ( HIQ7220 )

1:49:15 PM Monday, November 17, 2008

Page 318 of 353

HI31A
MHMODENT

Field4:
Cheshire Name:

( HIQ7220 )

PLRO.MHMODENT

Item Text display:

Display "e." before the question text.

Item Text:

dental care?

Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI17AD - (HIQ7270 )

English text: YES
No

BOX HI17AD - (HIQ7270 )

English text: NO
Attribute
Don't know

Route
BOX HI17AD - (HIQ7270 )

Refusal

BOX HI17AD - (HIQ7270 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

1:49:18 PM Monday, November 17, 2008

Page 319 of 353

HI31A
82

MIP

Main insured person (MIP) for this PLAN =
PLAN.PLMIPNUM.
MIP name = ROST.ROSTFNAM + ROST.ROSTLNAM on
ROST where ROST.ROSTNUM = PLAN.PLMIPNUM.

59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

71

ThisPlanCurrent

This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:49:18 PM Monday, November 17, 2008

Page 320 of 353

BOX HI17AD

BOX HI17AD

Page Order # :

4035

BOX INSTRUCTIONS
( HIQ7270 )	

IF (THIS PRIVATE PLAN IS NEW OR HAS BEEN "RESTARTED") OR (THIS
PRIVATE PLAN WAS "CURRENT" AT THE TIME OF THE PREVIOUS
ROUND INTERVIEW AND IS STILL "CURRENT", AND IT IS A FALL
ROUND), GO TO HI32 - MIPPINS ( HIQ7470 ).
ELSE GO TO BOX HI19 - (HIQ7570 ).

ASSIGNMENTS

TECHNICAL NOTES
61

ThisPlanNew

This Plan is new =
PLAN.PLANRNDC = current round and
PLAN.PLANSUMM ^= 1/Yes.
Exclude Deleted Plans. See T.N. 52.

62

ThisPlanRestarted

This Plan has been restarted =
For this PLAN, there is no PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND = previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

63

ThisPlanCurrentPrevRn
d

This Plan was "current" at the time of the previous round
interview =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

71

ThisPlanCurrent

This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

98

FallRound

If the remainder of (Current round divided by 3) = 1, then
it is a Fall round.

DESIGN NOTES

1:49:18 PM Monday, November 17, 2008	

Page 321 of 353

HI32

HI32

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

MIPPINS

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

4180

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display plan name for the private plan being asked about,

PLAN.PLNAME.

If (this private plan is not "current") or (SP is deceased or

institutionalized), display "have had".

Else display "have" .

If (this private plan is not "current") or (SP is deceased or

institutionalized) display "Did".

Else if respondent is the MIP, display "Do".

Else display "Does".

If respondent is MIP, display "you".

Else display the name of the MIP.

Always display "[Do not include the cost of any deductibles...]" in

brackets.


Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

1:49:19 PM Monday, November 17, 2008

Page 322 of 353

HI32
TEXT:
Context Header:
Int. Instr I:
(Do/Does/Did) (you/MIP) pay any or all of the premium or cost for the
(PRIVATE PLAN NAME) coverage?

Question Text:

[Do not include the cost of any deductibles (you/SP) or (your/SP’s)
family may (have/have had) to pay.]
Int. Instr II:
INPUT FIELDS / ROUTING
MIPPINS

Field1:
Cheshire Name:

( HIQ7470 )

PLRO.MIPPINS

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI33 - MIPPAMT ( HIQ7490 )

English text: YES
No

HI33A - MHMOCOST ( HIQ7520 )

English text: NO
Attribute
Don't know

Route
HI33A - MHMOCOST ( HIQ7520 )

Refusal

HI33A - MHMOCOST ( HIQ7520 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

1:49:22 PM Monday, November 17, 2008

Page 323 of 353

HI32
HARD EDIT CHECKS

TECHNICAL NOTES
82

MIP	

Main insured person (MIP) for this PLAN =
PLAN.PLMIPNUM.
MIP name = ROST.ROSTFNAM + ROST.ROSTLNAM on
ROST where ROST.ROSTNUM = PLAN.PLMIPNUM.

59

SPStatus	

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =

MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY

SP is Institutionalized =

MRES.SPALIVE=2/AliveAndInstitute

SP is Deceased =

MRES.SPALIVE=3/Deceased.


71

ThisPlanCurrent	

This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

DESIGN NOTES

1:49:22 PM Monday, November 17, 2008	

Page 324 of 353

HI33

HI33

Page Order # :

Design Screen Type:

Quantity Unit Hybrid

Fields:

Field 1:

MIPPAMT

Field 2:

MIPPUNIT

Field 3:

MIPPUNOS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No

No

No

No


Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

4200

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (this private plan is not "current") or (SP is deceased or

institutionalized) display "did".

Else if respondent is the MIP, display "do".

Else display "does".

If respondent is MIP, display "you".

Else display the name of the MIP.

Display plan name for the private plan being asked about,

PLAN.PLNAME.

If this private plan is not "current", display "Was".

Else display "Is".

Always display "[Please do not include any…]" in brackets.

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:
Roster/Grid display:
Report display:

1:49:25 PM Monday, November 17, 2008

Page 325 of 353

HI33
TEXT:
Context Header:
Int. Instr I:
How much (do/does/did) (you/MIP) pay for the (PRIVATE PLAN 

NAME) coverage?

[Please do not include any amount that may be paid for anyone

other than (you/SP).]


Question Text:

[PROBE IF NECESSARY: (Is/Was) that per year, per month, per

week, or what?]

Int. Instr II:
INPUT FIELDS / ROUTING
MIPPAMT

Field1:
Cheshire Name:

( HIQ7490 )

PLRO.MIPPAMT

Item Text display:
Item Text:
Label:

Label Position:


AMOUNT:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Real
TMippamt
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HI33A - MHMOCOST ( HIQ7520 )

Refusal

HI33A - MHMOCOST ( HIQ7520 )

1:49:31 PM Monday, November 17, 2008

FieldSize:
Min Value:
Max Value:
Mask:

0.01
99999.99
Dollars

Route
HI33 - MIPPUNIT ( HIQ7500 )

Page 326 of 353

HI33
MIPPUNIT

Field2:
Cheshire Name:

( HIQ7500 )

PLRO.MIPPUNIT

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TMippunit
1
No
No

Number Label
1 PerYear
2

English text: PER YEAR
Quarterly

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI33A - MHMOCOST ( HIQ7520 )
HI33A - MHMOCOST ( HIQ7520 )

4

English text: QUARTERLY/EVERY 3 MONTHS
Bimonthly
HI33A - MHMOCOST ( HIQ7520 )
English text: BIMONTHLY/EVERY 2 MONTHS
PerMonth
HI33A - MHMOCOST ( HIQ7520 )

5

English text: PER MONTH
PerWeek

HI33A - MHMOCOST ( HIQ7520 )

6

English text: PER WEEK
SemiAnnually

HI33A - MHMOCOST ( HIQ7520 )

7

English text: SEMI-ANNUALLY/2 TIMES PER YEAR
SemiMonthly
HI33A - MHMOCOST ( HIQ7520 )

3

91

English text: SEMI-MONTHLY/2 TIMES PER MONTH
Other
HI33 - MIPPUNOS ( HIQ7510 )
English text: OTHER

Attribute
Don't know

Route
HI33A - MHMOCOST ( HIQ7520 )

Refusal

HI33A - MHMOCOST ( HIQ7520 )

1:49:38 PM Monday, November 17, 2008

Page 327 of 353

HI33
( HIQ7510 )

MIPPUNOS

Field3:
Cheshire Name:

PLRO.MIPPUNOS

Item Text display:

Display "(SPECIFY)" in same blue font used for interviewer

instructions.


Item Text:

OTHER (SPECIFY)


Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


String

TOthrspec

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]	

30

Route
HI33A - MHMOCOST ( HIQ7520 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

If MIPAMT ^= DK and MIPAMT ^= RF, then,

If MIPUNIT = 1/PerYear, then MIPAMT = $50.00 - 10,000.00.

Else if MIPUNIT = 2/Quarterly, then MIPAMT = $15.00 - 2500.00.

Else if MIPUNIT = 3/Bimonthly, then MIPAMT = $10.00 - 1650.00.

Else if MIPUNIT = 4/PerMonth, then MIPAMT = $5.00 - 850.00.

Else if MIPUNIT = 5/PerWeek, then MIPAMT = $5.00 - 200.00.

Else if MIPUNIT = 6/SemiAnnually, then MIPAMT = $25.00 - 

5,000.00.

Else if MIPUNIT = 7/SemiMonthly, then MIPAMT = $2.00 - 425.00.

Else if MIPUNIT = 91/Other ,then MIPAMT = $5.00 - 15,000.00.

If not true, display message "THE AMOUNT ENTERED SEEMS

UNLIKELY. PLEASE VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES
82

MIP	

1:49:39 PM Monday, November 17, 2008	

Main insured person (MIP) for this PLAN =
PLAN.PLMIPNUM.
MIP name = ROST.ROSTFNAM + ROST.ROSTLNAM on
ROST where ROST.ROSTNUM = PLAN.PLMIPNUM.

Page 328 of 353

HI33
59

SPStatus	

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =

MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY

SP is Institutionalized =

MRES.SPALIVE=2/AliveAndInstitute

SP is Deceased =

MRES.SPALIVE=3/Deceased.


71

ThisPlanCurrent	

This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

DESIGN NOTES

1:49:39 PM Monday, November 17, 2008	

Page 329 of 353

HI33A

HI33A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

MHMOCOST

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

4210

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (this private plan is not "current") or (SP is deceased or
institutionalized) display "Did".
Else display "Does".
If the respondent is the MIP, display "your" .
Else display the name of the MIP.
Display plan name for the private plan being asked about,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

1:49:40 PM Monday, November 17, 2008

(Does/Did) anyone else, such as an employer, a union or 

professional organization pay all or some portion of the premium or
cost for (your/MIP’s) (PRIVATE PLAN NAME) coverage?
Page 330 of 353

HI33A
Int. Instr II:
INPUT FIELDS / ROUTING
MHMOCOST

Field1:
Cheshire Name:

( HIQ7520 )

PLRO.MHMOCOST

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI33B - MHMOWHO ( HIQ7530 )

English text: YES
No

BOX HI17B - (HIQ7550 )

English text: NO
Attribute
Don't know

Route
BOX HI17B - (HIQ7550 )

Refusal

BOX HI17B - (HIQ7550 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY

1:49:43 PM Monday, November 17, 2008

Page 331 of 353

HI33A
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
71

ThisPlanCurrent	

This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

4

Respondent	

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

82

MIP	

Main insured person (MIP) for this PLAN =
PLAN.PLMIPNUM.
MIP name = ROST.ROSTFNAM + ROST.ROSTLNAM on
ROST where ROST.ROSTNUM = PLAN.PLMIPNUM.

DESIGN NOTES

1:49:43 PM Monday, November 17, 2008	

Page 332 of 353

HI33B

HI33B

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

MHMOWHO

Field 2:

MHMOWHOS

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

4220

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (this private plan is not "current") or (SP is deceased or
institutionalized) display "paid".
Else display "pays".
If the respondent is the MIP, display "your" .
Else display the name of the MIP.
Display plan name for the private plan being asked about,
PLAN.PLNAME.

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:
1:49:45 PM Monday, November 17, 2008

Who else (pays/paid) all or some portion of the cost for (your/MIP’s)

Page 333 of 353

HI33B
(PRIVATE PLAN NAME) coverage?
Int. Instr II:

INPUT FIELDS / ROUTING


1:49:51 PM Monday, November 17, 2008

Page 334 of 353

HI33B
MHMOWHO

Field1:
Cheshire Name:
Item Text display:

( HIQ7530 )

PLRO.MHMOWHO
[(SP's)/(MIP's)]: Display (MIP's), name of Main Insured
person, in response text for "1/CurrentEmployer",
"2/FormerEmployer", and "3/Union".

Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
TMhmowho
1
No
No

Number Label
1 CurrentEmployer

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI17B - (HIQ7550 )

3

English text: [(SP's)/(MIP's)] CURRENT EMPLOYER
FormerEmployer
BOX HI17B - (HIQ7550 )
English text: (SP's/MIP's) FORMER EMPLOYER
Union
BOX HI17B - (HIQ7550 )

4

English text: (SP's/MIP's) UNION
SpousesCurrentEmployer

2

BOX HI17B - (HIQ7550 )

6

English text: SPOUSE'S CURRENT EMPLOYER
SpousesFormerEmployer
BOX HI17B - (HIQ7550 )
English text: SPOUSE'S FORMER EMPLOYER
ProfessionalOrg
BOX HI17B - (HIQ7550 )

7

English text: PROFESSIONAL/FRATERNAL ORGANIZATION
Medicaid
BOX HI17B - (HIQ7550 )

5

91

English text: MEDICAID/MEDICAL ASSISTANCE
Other
HI33B - MHMOWHOS ( HIQ7540 )
English text: OTHER

Attribute
Don't know

Route
BOX HI17B - (HIQ7550 )

Refusal

BOX HI17B - (HIQ7550 )

1:49:57 PM Monday, November 17, 2008

Page 335 of 353

HI33B
MHMOWHOS

Field2:
Cheshire Name:

( HIQ7540 )

PLRO.MHMOWHOS

Item Text display:

Display "(SPECIFY)" in same blue font used for interviewer

instructions.


Item Text:

OTHER (SPECIFY)


Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


String

TOthrspec

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]

30

Route
BOX HI17B - (HIQ7550 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

71

ThisPlanCurrent

1:49:58 PM Monday, November 17, 2008

This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

Page 336 of 353

HI33B
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

82

MIP	

Main insured person (MIP) for this PLAN =
PLAN.PLMIPNUM.
MIP name = ROST.ROSTFNAM + ROST.ROSTLNAM on
ROST where ROST.ROSTNUM = PLAN.PLMIPNUM.

DESIGN NOTES

1:49:58 PM Monday, November 17, 2008	

Page 337 of 353

BOX HI17B

BOX HI17B

Page Order # :

4230

BOX INSTRUCTIONS
( HIQ7550 )

IF THIS PRIVATE PLAN IS A MANAGED CARE PLAN, GO TO HI33C ­
MHMOPOS ( HIQ7560 ).
ELSE GO TO BOX HI19 - (HIQ7570 ).

ASSIGNMENTS

TECHNICAL NOTES
88

ThisPrivPlanHMO

This private plan is a managed care plan =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:49:58 PM Monday, November 17, 2008

Page 338 of 353

HI33C

HI33C

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

MHMOPOS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

4240

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display plan name for the private plan being asked about,
PLAN.PLNAME.
If (this private plan is not "current") and (SP is not respondent),
display "Was".
Else if (this private plan is not "current") and (SP is respondent),
display "Were".
Else if (this private plan is "current") and (SP is not respondent),
display "Is".
Else display "Are".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

1:50:00 PM Monday, November 17, 2008

Some managed care plans offer a point-of-service option which

allows members to receive services from out-of-plan providers even
Page 339 of 353

HI33C
in non-emergency situations. (Are/Were/Is/Was) (you/SP) enrolled
in a point-of-service option offered by (PRIVATE PLAN NAME)?
[EXPLAIN IF NECESSARY: In a point-of-service option, the
member typically pays a higher copayment when seeing an out-of­
plan provider. For example, if a member sees an in-plan provider,
there may only be a $10 copayment. However, the member may
have to pay 20 percent of the cost and the managed care plan will
pay 80 percent of the cost to receive the same service from an outof-plan provider.]
Int. Instr II:

INPUT FIELDS / ROUTING

MHMOPOS

Field1:
Cheshire Name:

( HIQ7560 )

PLRO.MHMOPOS

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI19 - (HIQ7570 )

English text: YES
No

BOX HI19 - (HIQ7570 )

English text: NO
Attribute
Don't know

Route
BOX HI19 - (HIQ7570 )

Refusal

BOX HI19 - (HIQ7570 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

1:50:02 PM Monday, November 17, 2008

Page 340 of 353

HI33C
HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:50:02 PM Monday, November 17, 2008

Page 341 of 353

BOX HI19

BOX HI19

1:50:02 PM Monday, November 17, 2008

Page Order # :

4250


Page 342 of 353


BOX HI19
BOX INSTRUCTIONS
( HIQ7570 )	

IF ADMINISTERING ST, GO TO BOX ST69A - (STQ2825 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS69A - (NSQ2825 ).
ELSE IF ADMINISTERING CPS, GO TO BOX CPS29A - (CPS1710 ).
ELSE IF REVIEWING PRIVATE PLANS THAT WERE "CURRENT" AT THE
TIME OF THE PREVIOUS ROUND INTERVIEW, GO TO HI17PREV_IN ­
NAVIGATOR ( HIQ6195 ).
ELSE GO TO HI20_IN - NAVIGATOR ( HIQ6225 ).

ASSIGNMENTS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

81

PrivateCurrentPrevRnd

Private plan "current" at the time of previous round
interview =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=prev. round & (COVTIME=1/WholeTime or
COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

83

PrivateNew

Private Plan is new =
PLAN.PLANTYPE=4/PrivatePlan and PLAN.PLANRNDC
= current round and PLAN.PLANSUMM ^= 1/Yes.
Exclude Deleted Plans. See T.N. 52.

84

PrivateRestarted

Private Plan has been restarted =
For this PLAN, there is no PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND = previous round &
(COVTIME=1/WholeTime or COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES
If administering ST, NS, CPS, you have completed the Private plan detail

questions for the Private plan(s) added at the Source of Payment roster.

Return to the section being administered as specified above.

NOTE ON ELSE CONDITION:

ASKING ABOUT PREVIOUS ROUND PLANS:

Once all items at HI17PREV_IN Instance Navigator screen are DONE,

routing will return to HI17PREV_IN until Interviewer selects CONTINUE 

INTERVIEW. 

ASKING ABOUT CURRENT ROUND PLANS:

Once all items at HI20_IN Instance Navigator screen are DONE, routing

will return to HI20_IN until Interviewer selects CONTINUE INTERVIEW.


1:50:02 PM Monday, November 17, 2008	

Page 343 of 353

HI35

HI35

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

PRVOCOV

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

4270

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Always display "(other)" in parenthesis.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

Display report above question text.
Display all insurance plans SP reported being covered by in the

current round in the following order:

First line:

If SP was covered by a Medicare Managed care plan, display name

of this Medicare Managed care plan.

Else display "MEDICARE" for the Medicare plan.

Next list Medicaid, Tricare, all Public Plans, all Private Plans and all

Medicare Prescription Drug Plans. If there is more than one plan of

any type, display in order of entry.

Report header: PLANS DISCUSSED AT THIS POINT OF THE

INTERVIEW

Report layout:

Column 1, header="Plan Name", display PLAN.PLNAME.

Column 2, header="Plan Type", display PLAN.PLANTYPE:


1:50:04 PM Monday, November 17, 2008	

Page 344 of 353

HI35
If PLANTYPE=1/Medicare, display "(MCAR)".

If PLANTYPE=2/Medicaid, display "(MCAD)".

If PLANTYPE=3/PublicPlan, display "(PUBL)".

If PLANTYPE=4/PrivatePlan, display "(PRIV)".

If PLANTYPE=5/MHMO, display "(MHMO)".

If PLANTYPE=6/Tricare, display "(TRIC)".

If PLANTYPE=7/MPDP, display "(MPDP)".


TEXT:
Context Header:

REFERENCE PERIOD: (REFERENCE DATE) to (REFERENCE
PERIOD END DATE)

Int. Instr I:
Question Text:

We’ve talked about [READ PLAN(S) LISTED ABOVE]. (Do
you/Does SP/Did SP) have medical coverage under any (other)
private insurance plans we haven’t talked about?

Int. Instr II:

INPUT FIELDS / ROUTING


1:50:06 PM Monday, November 17, 2008

Page 345 of 353

HI35
( HIQ7590 )

PRVOCOV

Field1:
Cheshire Name:

HRND.PRVOCOV

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HI20 - PLAN_PRIVATE ( HIQ6220 )

English text: YES
No

BOX HI19B - (HIQ7600 )

English text: NO
Attribute
Don't know

Route
BOX HI19B - (HIQ7600 )

Refusal

BOX HI19B - (HIQ7600 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
53

PlanTypes

1:50:09 PM Monday, November 17, 2008

Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Managed Care: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.

Page 346 of 353

HI35
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

93

AnyPlansCurrentRnd

SP reported being covered by any plans during the
current round =
There is PLAN & PLRO where (PLRO.PLROPLAN =
PLAN.PLANNUM & PLRO.PLRORND = current round &
(PLRO.COVTIME ^= empty or PLRO.COVANYTIM =
1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:50:09 PM Monday, November 17, 2008

Page 347 of 353

BOX HI19B

BOX HI19B

Page Order # :

4275

BOX INSTRUCTIONS
( HIQ7600 )

IF (SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP IS NEW FROM
FACILITY), GO TO HI34 - OTHNHCOV ( HIQ7605 ).
ELSE GO TO BOX HI21A - (HIQ7620 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

25

NewFromFacility

SP is new from facility (i.e. all previous round interviews
were in a facility) =
MRES.INTTYPE=2/NewFromFacility on MRES where
MRES.MRESRND = current round.

DESIGN NOTES

1:50:09 PM Monday, November 17, 2008

Page 348 of 353

HI34

HI34

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

OTHNHCOV

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

4280

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If SP has reported being covered by any plans in the current round
other than Medicare, display "Other than the plans you have already
told me about, [do you/does (SP)/did (SP)]".
Else display "[Do you/Does (SP)/Did (SP)]".
If SP is deceased or institutionalized, display "paid".
Else display "pays".
Display "just" and "nursing home" in BOLD.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:	

Display report above question text.
Display all insurance plans SP reported being covered by in the
current round.
First, display MEDICARE MANAGED CARE PLANS (MHMO) name
if SP has MHMO, or MEDICARE if no MHMO.
Next list Medicaid, Tricare, Public Plans, Medicare Prescription Drug
Plans, and Private Plans.
If there is more than one Public Plan, display the Public Plans in

1:50:10 PM Monday, November 17, 2008	

Page 349 of 353

HI34
order of entry.

If there is more than one Private Plan, display the Private Plans in

order of entry.

Report header: PLANS DISCUSSED AT THIS POINT OF THE

INTERVIEW

Report layout:

Column 1, header="Plan Name", display PLAN.PLNAME.

Column 2, header="Plan Type", display PLAN.PLANTYPE:

If PLANTYPE=1/Medicare, display "(MCAR)".

If PLANTYPE=2/Medicaid, display "(MCAD)".

If PLANTYPE=3/PublicPlan, display "(PUBL)".

If PLANTYPE=4/PrivatePlan, display "(PRIV)".

If PLANTYPE=5/MHMO, display "(MHMO)".

If PLANTYPE=6/Tricare, display "(TRIC)".

If PLANTYPE=7/MPDP, display "(MPDP)".


TEXT:
Context Header:

REFERENCE PERIOD: (REFERENCE DATE) to (REFERENCE
PERIOD END DATE)

Int. Instr I:
Question Text:

[Other than the plans you have already told me about, [do you/does
(SP)/did (SP)]/[Do you/Does (SP)/Did (SP)]] have any insurance that
(pays/paid) just for nursing home care or other long term care?

Int. Instr II:

INPUT FIELDS / ROUTING


1:50:13 PM Monday, November 17, 2008

Page 350 of 353

HI34
OTHNHCOV

Field1:
Cheshire Name:

( HIQ7605 )

HRND.OTHNHCOV

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HI21A - (HIQ7620 )

English text: YES
No

BOX HI21A - (HIQ7620 )

English text: NO
Attribute
Don't know

Route
BOX HI21A - (HIQ7620 )

Refusal

BOX HI21A - (HIQ7620 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans	

1:50:16 PM Monday, November 17, 2008	

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

Page 351 of 353

HI34
93

AnyPlansCurrentRnd

SP reported being covered by any plans during the
current round =
There is PLAN & PLRO where (PLRO.PLROPLAN =
PLAN.PLANNUM & PLRO.PLRORND = current round &
(PLRO.COVTIME ^= empty or PLRO.COVANYTIM =
1/Yes)).
Exclude Deleted Plans. See T.N. 52.

53

PlanTypes

Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Managed Care: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.

384

AnyPlansNotMedicare

SP covered by plan in current round other than Medicare
=
There is a PLAN where PLAN.PLANTYPE^=1/Medicare
& PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round & (COVTIME^=empty or
COVANYTM=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:50:16 PM Monday, November 17, 2008

Page 352 of 353

BOX HI21A

BOX HI21A

Page Order # :

4300

BOX INSTRUCTIONS
( HIQ7620 )

GO TO NEXT SECTION .

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

1:50:16 PM Monday, November 17, 2008

Page 353 of 353


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