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pdfBOX 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
| File Type | application/pdf |
| Author | hubbard_r |
| File Modified | 2010-04-05 |
| File Created | 0000-00-00 |