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

IU1

IU1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

IUPROBE

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

20

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is Institutionalized, display "Other than the current institutional
stay that started on (DATE OF INSTITUTIONALIZATION), between
(REFERENCE DATE) and (DATE OF INSTITUTIONALIZATION)
was (SP)"
Else if SP is Deceased, display "Between (REFERENCE DATE)
and (DATE OF DEATH), was (SP)".
Else display "Since (REFERENCE DATE), [have you/has (SP)]
been"
If SP is Institutionalized, display "another".
Else display "a".

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:

SHOW CARD IU

Question Text:

[Since (REFERENCE DATE), [have you/has (SP)] been/Between

11:29:47 AM Thursday, February 26, 2009

Page 1 of 22

IU1
(REFERENCE DATE) and (DATE OF DEATH), was (SP)/Other than
the current institutional stay that started on (DATE OF
INSTITUTIONALIZATION), between (REFERENCE DATE) and
(DATE OF INSTITUTIONALIZATION) was (SP)] a patient in
(a/another) nursing home or any similar place that provides longterm care -- such as the places shown on this card?
LONG-TERM CARE PLACES INCLUDE SKILLED NURSING
HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE
HOMES, NURSING HOME UNITS IN HOSPITALS, FACILITIES
FOR THE MENTALLY RETARDED, PSYCHIATRIC FACILITIES
AND GROUP HOMES.

Int. Instr II:

INPUT FIELDS / ROUTING
IUPROBE

Field1:
Cheshire Name:
Item Text display:

( IUQ1020 )

HRND.IUPROBE
Do not display option 3/IndicatedYesByDataprep.

Item Text:
Label:

Label Position:

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

Enumerated
TProbe
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
IU2 - PROVIDER_IU ( IUQ1030 )

2

English text: YES
No

3

English text: NO
IndicatedYesByDataPrep

BOX IU3 - (IUQ1155 )

DO NOT DISPLAY.

DATA EDITING ONLY.

English text: INDICATED YES BY DATAPREP
Attribute
Don't know

Route
BOX IU3 - (IUQ1155 )

Refusal

BOX IU3 - (IUQ1155 )

BACKGROUND VARIABLE ASSIGNMENTS

11:29:53 AM Thursday, February 26, 2009

Page 2 of 22

IU1

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
40

SPInstitute

SP is institutionalized =
MRES.SPALIVE=2/AliveAndInstitute on MRES where
MRES.MRESRND = current round.

DESIGN NOTES

11:29:53 AM Thursday, February 26, 2009

Page 3 of 22

IU2

IU2

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PROVIDER_IU

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Name:

Provider 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

30

Display as ' Add a Facility '
Display as ' Edit a Facility '

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Display all Providers except for Providers where
PROV.PROVNUM=01 and 02, which are reserved for PM and OM
events.
Display in order of entry.

Roster/Grid display:

COL #

HEADER

1

Provider Name

INSTRUCTIONS
Display PROV.PROVNAME.

Report display:

TEXT:
Context Header:

REFERENCE PERIOD: (REFERENCE DATE) - (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)

Int. Instr I:
Question Text:

Where [were you/was (SP)] a patient -- in which nursing home?

Int. Instr II:

SELECT OR ADD ONLY ONE FACILITY.

11:29:54 AM Thursday, February 26, 2009

Page 4 of 22

IU2
INPUT FIELDS / ROUTING
PROVIDER_IU

Field1:

( IUQ1030 )

TEMP

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

String
TProvPick4

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

1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

4

Route
BOX IU1 - (IUQ1040 )

BACKGROUND VARIABLE ASSIGNMENTS
PROVIDER INSTRUCTIONS:

Roster details will be collected on PROV:

PROV key = PROV.PROVBASE + PROV.PROVNUM

PROV.PROVNUM = Number of Provider selected at IU2.

If Provider added at Provider Roster, see PROVIDER ROSTER POP-UP specifications for

pop-up window programming instructions.

Variables populated in Provider Roster Pop-Up Window:

PROV.PROVNUM
PROV.PROVRNDC
PROV.PROVNAME

Provider number
Round number
Hospital name (Also known as Provider name)

If Provider added, set provider type as instructed below.
EVENT INSTRUCTIONS:
Current round IU visits are stored on EVNT. An EVNT is generated once the Provider is

selected at IU2:

EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM

EVNT.EVNTNUM = number of event generated at IU2.

BASE.LASTEVNT holds the highest EVNT.EVNTNUM prior to fielding cases. Not all

EVNT records are fielded. The first time an EVNT record is generated in the field,

BASE.LASTEVNT should be >= to the highest EVNT.EVNTNUM fielded. The new

EVNT.EVNTNUM should be calculated based on BASE.LASTEVNT + 001. Each time an

EVNT record is generated in the field, BASE.LASTEVNT will be updated to match the

highest EVNT.EVNTNUM in the field. Therefore, each time an EVNT record is generated in

11:29:56 AM Thursday, February 26, 2009

Page 5 of 22

IU2
the field, the new EVNT.EVNTNUM should be calculated based on BASE.LASTEVNT +
001. See detailed instructions below.
Set Event Provider as the Provider selected at IU2. Set additional EVNT variables as
instructed below.
LASTEVNT

Once new EVNT record is generated, set
BASE.LASTEVNT = new EVNT.EVNTNUM.

EVNTNUM

Set new EVNT.EVNTNUM = BASE.LASTEVNT +
001. This assumes that BASE.LASTEVNT is
incremented each time an EVNT record is generated
in the field.

EVNTRNDC

EVNT.EVNTRNDC = current round.

EVNTTYPE

EVNT.EVNTTYPE = 'IU'.

STEVTYPE

EVNT.STEVTYPE = 7/IU.

EVNTPROV

EVNT.EVNTPROV = PROV.PROVNUM of provider
selected at IU2.

PROVTYPE

PROV.PROVTYPE=5/Institution.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES
Begin Loop 1: Probe for one provider (facility), collect event date for this
provider.

11:29:56 AM Thursday, February 26, 2009

Page 6 of 22

BOX IU1

BOX IU1

Page Order # :

40

BOX INSTRUCTIONS
( IUQ1040 )

IF (SP REPORTED RECEIVING HEALTH CARE SERVICES THROUGH V.A.
IN THE CURRENT ROUND OR ANY PREVIOUS ROUND) AND (IF THIS
PROVIDER IS ASSOCIATED WITH V.A. IS UNKNOWN), GO TO IU3 VAPLACE ( IUQ1050 ).
ELSE TO IU4 - EVBEGMM ( IUQ1070 ).

ASSIGNMENTS

TECHNICAL NOTES
423

SPReceivedCaretThruV
A

SP reported receiving health care services through V.A.in
the current or any previous round =
There is an HRND where HRND.HRNDRND = current
round and HRND.VACOVER = 1/Yes.
HRND.VACOVER is set at BOX HI20 or collected at HI36.

127

ProviderVAUnknown

If Provider is associated with V.A. is unknown =
PROV.VAPLACE = empty.

DESIGN NOTES

11:29:56 AM Thursday, February 26, 2009

Page 7 of 22

IU3

IU3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

VAPLACE

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

50

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display name of facility, PROV.PROVNAME, currently being asked
about.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Is (FACILITY NAME) a Department of Veterans Affairs, or V.A.,

facility?

Int. Instr II:
INPUT FIELDS / ROUTING

11:29:59 AM Thursday, February 26, 2009

Page 8 of 22

IU3
VAPLACE

Field1:
Cheshire Name:

( IUQ1050 )

PROV.VAPLACE

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
IU4 - EVBEGMM ( IUQ1070 )

English text: YES
No

IU4 - EVBEGMM ( IUQ1070 )

English text: NO
Attribute
Don't know

Route
IU4 - EVBEGMM ( IUQ1070 )

Refusal

IU4 - EVBEGMM ( IUQ1070 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

11:30:03 AM Thursday, February 26, 2009

Page 9 of 22

IU4

IU4

Page Order # :

Design Screen Type:

Date

Fields:

Field 1:

EVBEGMM

Field 2:

EVBEGDD

Field 3:

EVBEGYY

Field 4:

EVENDMM

Field 5:

EVENDDD

Field 6:

EVENDYY

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:

70

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display name of facility, PROV.PROVNAME, currently being asked
about.

Multi Field display:

Vertical Alignment
Display Admission date input fields, EVBEGMM, EVBEGDD,
EVBEGYY, on 1st line.
Display Discharge date input fields, EVENDMM, EVENDDD,
EVENDYY, on 2nd line.

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

TEXT:
Context Header:

11:30:09 AM Thursday, February 26, 2009

REFERENCE PERIOD: (REFERENCE DATE) - (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)
Page 10 of 22

IU4
Int. Instr I:
When [were you/was (SP)] admitted to and discharged from
(FACILITY NAME)?

Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING

EVBEGMM

Field1:
Cheshire Name:

( IUQ1070 )

EVNT.EVBEGMM

Item Text display:
Item Text:

ADMISSION DATE:

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
IU4 - EVBEGDD ( IUQ1072 )

Refusal

IU4 - EVBEGDD ( IUQ1072 )

11:30:16 AM Thursday, February 26, 2009

FieldSize:
Min Value:
Max Value:
Mask:

2
01
12

Route
IU4 - EVBEGDD ( IUQ1072 )

Page 11 of 22

IU4
EVBEGDD

Field2:
Cheshire Name:

( IUQ1072 )

EVNT.EVBEGDD

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
IU4 - EVBEGYY ( IUQ1074 )

Refusal

IU4 - EVBEGYY ( IUQ1074 )

11:30:27 AM Thursday, February 26, 2009

FieldSize:
Min Value:
Max Value:
Mask:

2
1
31

Route
IU4 - EVBEGYY ( IUQ1074 )

Page 12 of 22

IU4
EVBEGYY

Field3:
Cheshire Name:

( IUQ1074 )

EVNT.EVBEGYY

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
TYear2DKRF
1
No
No

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

Route
IU4 - EVENDMM ( IUQ1080 )

Refusal

IU4 - EVENDMM ( IUQ1080 )

11:30:37 AM Thursday, February 26, 2009

FieldSize:
Min Value:
Max Value:
Mask:

2
00
99

Route
IU4 - EVENDMM ( IUQ1080 )

Page 13 of 22

IU4
EVENDMM

Field4:
Cheshire Name:

( IUQ1080 )

EVNT.EVENDMM

Item Text display:
Item Text:

DISCHARGE DATE:

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
IU4 - EVENDDD ( IUQ1100 )

Refusal

IU4 - EVENDDD ( IUQ1100 )

11:30:46 AM Thursday, February 26, 2009

FieldSize:
Min Value:
Max Value:
Mask:

2
01
12

Route
IU4 - EVENDDD ( IUQ1100 )

Page 14 of 22

IU4
EVENDDD

Field5:
Cheshire Name:

( IUQ1100 )

EVNT.EVENDDD

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
IU4 - EVENDYY ( IUQ1120 )

Refusal

IU4 - EVENDYY ( IUQ1120 )

11:30:53 AM Thursday, February 26, 2009

FieldSize:
Min Value:
Max Value:
Mask:

2
1
31

Route
IU4 - EVENDYY ( IUQ1120 )

Page 15 of 22

IU4
EVENDYY

Field6:
Cheshire Name:

( IUQ1120 )

EVNT.EVENDYY

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
TYear2DKRF
1
No
No

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

Route
IU7 - IUMORE ( IUQ1150 )

Refusal

IU7 - IUMORE ( IUQ1150 )

FieldSize:
Min Value:
Max Value:
Mask:

2
00
99

Route
IU7 - IUMORE ( IUQ1150 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

If dates entered at IU4 do not have missing data, EVBEGMM,

EVBEGDD, EVBEGYY, EVENDMM, EVENDDD, EVENDYY ^= DK

and EVBEGMM, EVBEGDD, EVBEGYY, EVENDMM, EVENDDD,

EVENDYY ^= RF, then Admission date,

EVBEGMM/EVBEGDD/EVBEGYY, and Discharge date,

EVENDMM/EVENDDD/EVENDYY, should not match.

If not true, display message "VERIFY THAT SP WAS ADMITTED

AND DISCHARGED ON THE SAME DATE."

HARD EDIT CHECKS
Edit #1:

Admission date, EVBEGMM/EVBEGDD/EVBEGYY, must be on or

between (REFERENCE DATE) and (TODAY/DATE OF

DEATH/DATE OF INSTITUTIONALIZATION).

If not true, display message "INVALID DATE. ADMISSION DATE

MUST BE ON OR BETWEEN (REFERENCE DATE) AND

(TODAY/DATE OF DEATH/DATE OF INSTITUTIONALIZATION)".

INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.

Edit #2:

11:30:57 AM Thursday, February 26, 2009

Page 16 of 22

IU4
Discharge date, EVENDMM/EVENDDD/EVENDYY, must be on or

between (ADMISSION DATE) and (TODAY/DATE OF DEATH/DATE

OF INSTITUTIONALIZATION).

If not true, display message "INVALID DATE. DISCHARGE DATE

MUST BE ON OR BETWEEN (ADMISSION DATE) AND

(TODAY/DATE OF DEATH/DATE OF INSTITUTIONALIZATION)".

INVOLVES EVENDMM, EVENDDD, EVENDYY.

Edit #3

If SPALIVE=2/AliveAndInstitute and date of institutionalization

colllected at INS2 does not have any missing data, SPINSTMM,

SPINSTDD, SPINSTYY ^= DK and SPINSTMM, SPINSTDD,

SPINSTYY ^= RF, then admission date,

EVBEGMM/EVBEGDD/EVBEGYY, and discharge date,

EVENDMM/EVENDDD/EVENDYY, cannot match date of

institutionalization collected at INS2,

SPINSTMM/SPINSTDD/SPINSTYY.

If not true, display message "INVALID DATE. THIS DATE

MATCHES THE CURRENT INSTITUTIONALIZATION DATE".

Edit #4:

Admission date, EVBEGMM/EVBEGDD/EVBEGYY, cannot match

an existing IU stay admission date for the same provider. If the

Admission date does not have missing data, EVBEGMM,

EVBEGDD, EVBEGYY ^= DK and EVBEGMM, EVBEGDD,

EVBEGYY ^= RF, then check this date against other IU stay

admission dates for this provider.

The following must be true for the IU stay added at IU4 to be a

duplicate of an existing IU stay:

Both EVNTDFLG ^= 1/Yes,

Both EVNTTYPE=IU,

Both EVNTRNDC=current round,

EVNTPROV matches,

EVBEGMM matches,

EVBEGDD matches,

EVBEGYY matches.

The Admission date added at IU4 cannot match an existing IU stay

admission date for the same provider.

If not true, display message "INVALID DATE. THE ADMISSION

DATE MATCHES AN EXISTING ADMISSION DATE TO (FACILITY

NAME)."

Display instructions: Display facility name, PROV.PROVNAME,

selected at IU2.

Edit #5:

Discharge date, EVENDMM/EVENDDD/EVENDYY, cannot match an

existing IU stay discharge date for the same provider. If the

Discharge date does not have missing data, EVENDMM, EVENDDD,

EVENDYY ^= DK and EVENDMM, EVENDDD, EVENDYY ^= RF,

then check this date against other IP stay discharge dates for this

provider.

The following must be true for the IU stay added at IU4 to be a

duplicate of an existing IU stay:

Both EVNTDFLG ^= 1/Yes,

Both EVNTRNDC=current round,

Both EVNTTYPE=IU,

EVNTPROV matches,

EVENDMM matches,

EVENDDD matches,

11:30:57 AM Thursday, February 26, 2009

Page 17 of 22

IU4
EVENDYY matches.
The Discharge date added at IU4 cannot match an existing IU stay
discharge date for the same provider.
If not true, display message "INVALID DATE. THE DISCHARGE
DATE MATCHES AN EXISTING DISCHARGE DATE TO (FACILITY
NAME)."
Display instructions: Display facility name, PROV.PROVNAME,
selected at IU2.
See General specifications for duplicate date logic.
TECHNICAL NOTES

DESIGN NOTES

11:30:57 AM Thursday, February 26, 2009

Page 18 of 22

IU7

IU7

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

IUMORE

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

100

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is deceased or institutionalized, display "did (SP) have".
Else if proxy interview, display "has (SP) had".
Else display "have you had".

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:

IF RESPONDENT HAS ALREADY MENTIONED ANOTHER STAY
AT A NURSING HOME, ENTER “YES” WITHOUT ASKING.
OTHERWISE, ASK:

Question Text:

[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/DATE OF INSTITUTIONALIZATION)], [have you
had/has (SP) had/did (SP) have] any other stays in this or any other
nursing home or similar place that provides long-term care?

Int. Instr II:

11:31:00 AM Thursday, February 26, 2009

Page 19 of 22

IU7
INPUT FIELDS / ROUTING
( IUQ1150 )

IUMORE

Field1:
Cheshire Name:
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
IU2 - PROVIDER_IU ( IUQ1030 )

English text: YES
No
English text: NO

BOX IU3 - (IUQ1155 )

Attribute
Don't know

Route
BOX IU3 - (IUQ1155 )

Refusal

BOX IU3 - (IUQ1155 )

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.

11:31:06 AM Thursday, February 26, 2009

Page 20 of 22

IU7
MRES.RROSTNUM='01'.
DESIGN NOTES

11:31:06 AM Thursday, February 26, 2009

Page 21 of 22

BOX IU3

BOX IU3

Page Order # :

110

BOX INSTRUCTIONS
( IUQ1155 )

GO TO NEXT SECTION .

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

11:31:06 AM Thursday, February 26, 2009

Page 22 of 22