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BOX NSBEG
BOX NSBEG
3:16:25 PM Monday, August 03, 2009
Page Order # :
5
Page 1 of 278
BOX NSBEG
BOX INSTRUCTIONS
( NSQ1010 )
CREATE LIST OF EVENTS ENTERED IN THE CURRENT ROUND THAT
ARE NOT ASSOCIATED WITH CHARGE DATA ALREADY ENTERED .
IF AT LEAST ONE EVENT ENTERED IN THE CURRENT ROUND IS NOT
ASSOCIATED WITH CHARGE DATA ALREADY ENTERED, GO TO NS1_IN NAVIGATOR ( NSQ1025 ).
ELSE GO TO NS81 - NSTATEMENT ( NSQ2960 ).
ASSIGNMENTS
Each time BOX NSBEG is executed, a new list of events eligible for NS will be generated.
To generate list of events that will be asked about in NS, execute the following check:
(EVNT.EVNTDFLG ^= 1/Yes and EVNT.EVERRFLG ^= 1/Yes),
AND
(There is NO XCEV where
(XCEV.XCEVEVNT = EVNT.EVNTNUM and XCEV.XCEVRNDC = current round
and XCEV.DELLINK = empty)),
AND
(
(EVNT.EVNTTYPE = IP &
(EVNT.EV95FLG = previous round) or
(EVNT.EVNTRNDC = current round and EVNT.IPSTATUS ^= 1/StillInHospital) or
((MRES.INTTYPE = 9/ExitInterviewSkipPrev) and (EVNT.IPSTATUS = 1/StillInHospital)))
OR
((EVNT.EVNTTYPE = HF or HP) and
there is a HERO where
(HERO.HEROEVNT = EVNT.EVNTNUM and HERO.HERORND=current round and
HERO.HERODFLG ^=1/Yes and (HERO.OTHMEALS = 1/Yes or
HERO.HELPUNIT^=empty)))
OR
((EVNT.EVNTTYPE = OM) and
(
(EVNT.OMETYPE = 7/Alteration and
((EVNT.EVNTRNDC = current round and
EVNT.OMSTATUS ^= 1/AlterationNotComplete) or
(EVNT.EV95FLG = previous round)))
OR
((EVNT.OMETYPE = 3/Orthopedic, 8/Oxygen, or 9/Kidney) and
((EVNT.EVNTRNDC = current round) or
(EVNT.RENTPROB = 2/Rent and
((EVNT.RENTSTIL = 1/Yes) or
(EVNT.RENTSTIL ^=1/Yes and EVNT.RENTENDR = current round) or
(EVNT.HADPYMNT = 1/Yes and EVNT.PYMNTRND = current round)))))
OR
(EVNT.OMETYPE = 10/OtherMedicalExpense and
((EVNT.OTHRTYPE = 5/OstomySupplies, 6/IncontinenceSupplies, or 7/Bandages)
and there is a PMRO where
(PMRO.PMROEVNT = EVNT.EVNTNUM and
PMRO.PMRORND = current round and (PMRO.GETNUM is > 0 and
3:16:25 PM Monday, August 03, 2009
Page 2 of 278
BOX NSBEG
PMRO.GETNUM ^= DK and
PMRO.GETNUM ^= RF)) or
(EVNT.OTHRTYPE = 9/BloodPressureEquipment and
EVNT.EVNTRNDC = current round) or
((EVNT.OTHRTYPE = 1/Toilet, 2/Tub, 3/Chair, 4/Bed, 8/PulmonaryEquipment,
or 10/Other) and
((EVNT.EVNTRNDC = current round) or
(EVNT.RENTPROB = 2/Rent and
((EVNT.RENTSTIL = 1/Yes) or
(EVNT.RENTSTIL ^=1/Yes and EVNT.RENTENDR = current round) or
(EVNT.HADPYMNT = 1/Yes and EVNT.PYMNTRND = current round))))
OR
((EVNT.OMETYPE = 1/Eyeglasses, 2/Hearing, 4/Diabetic, 5/Ambulance or 6/Prosthesis)
and (EVNT.EVNTRNDC = current round))
)
OR
((EVNT.EVNTTYPE = PM) and
((there is PMRO where PMRO.PMROEVNT = EVNT.EVNTNUM and
PMRO.PMRORND = current round and PMRO.GETNUM > 0 and PMRO.GETNUM ^=
DK and
PMRO.GETNUM ^= RF) or
(there is a PMRO where PMRO.PMROEVNT = EVNT.EVNTNUM and
PMRO.PMRORND = previous round and (PMRO.GETNUM is > 0 and PMRO.GETNUM
^= DK and
PMRO.GETNUM ^= RF) and PMRO.PMSUMFLG = 1/Yes and
PMRO.PMRODFLG ^= 1/Yes))))
OR
((EVNT.EVNTTYPE = DU, ER, OP, MP, SD, or SL) and
(EVNT.EVNTRNDC = current round.))
)
TOTAL NUMBER OF NS EVENTS = Total number of events to be asked about in NS.
Display at NS1.
If no events flagged as eligble for NS, go to NS81.
Else go to NS1_IN.
We will only collect details for the first event in the list generated at BOX NSBEG in this
loop. Once the detail loop is complete, the route will return to BOX NSBEG to generate a
new list of events eligible for NS. The purpose of this is to exclude any events that were
flagged for NS, but are no longer eligible because the event has been linked to a new
current round charge bundle.
Design Intent:
IF (EVENT NOT FLAGGED AS DELETED) AND
(EVENT NOT FLAGGED AS "ENTERED IN ERROR" ALREADY IN NS) AND
(EVENT NOT LINKED TO COST RECORD) AND
((IP EVNTS THAT STOPPED IN CURRENT ROUND) or
(IP EVNTS ADDED IN CURRENT ROUND AND NOT STILL IN HOSPITAL) or
(ONGOING IP EVENTS FOR EXIT CASES INTTYPE = 9) or
(HH EVENTS ADDED IN CURRENT ROUND WHERE SP RECEIVED SERVICES OTHER
THAN MEAL SERVICES) or
(OM ALTERATIONS ADDED IN CURRENT ROUND THAT ARE COMPLETE) or
(OM ALTERATIONS COMPLETED IN CURRENT ROUND) or
3:16:25 PM Monday, August 03, 2009
Page 3 of 278
BOX NSBEG
(OM ORTHOPEDIC, OXYGEN OR KIDNEY ITEMS ADDED IN CURRENT ROUND) or
(OM ORTHOPEDIC, OXYGEN OR KIDNEY ITEMS THAT ARE ON-GOING RENTALS) or
(OM ORTHOPEDIC, OXYGEN OR KIDNEY ITEMS RENTALS THAT STOPPED
IN CURRENT ROUND) or
(OM ORTHOPEDIC, OXYGEN OR KIDNEY ITEMS RENT-TO-BUYS, SP IS EXPECTING
TO MAKE A PAYMENT IN THE CURRENT ROUND) or
(OM OTHER MEDICAL EXPENSES ADDED IN CURRENT ROUND THAT
HAD PURCHASES > 0 AND ^= DK, RF IF APPLICABLE) or
(OM OTHER MEDICAL EXPENSES THAT ARE ON-GOING RENTALS) or
(OM OTHER MEDICAL EXPENSE RENTALS THAT STOPPED IN CURRENT ROUND) or
(OM OTHER MEDICAL EXPENSE RENT-TO-BUYS, SP IS EXPECTING TO MAKE A
PAYMENT IN THE CURRENT ROUND) or
(ALL OTHER OMES ADDED IN THE CURRENT ROUND) or
(PM EVENTS ADDED IN CURRENT ROUND WITH NUMBER OF PURCHASES > 0 AND
^= DK, RF) or
(PM EVENTS ADDED IN PMS WITH NUMBER OF PURCHASES > 0 AND ^= DK, RF) or
(ALL OTHER EVNTS THAT ARE ADDED IN THE CURRENT ROUND)).
If PM purchases are added in both PMS and PM in the current round, this PM should only
be asked about once in NS. Display of purchases will reflect the total number of purchases
added in PMS + PM.
TECHNICAL NOTES
DESIGN NOTES
SUMMARY OF DESIGNI INTENT FOR GLOBAL DISPLAY FILLS
(EVENT) vs. (ORIGINAL CHARGE BUNDLE EVENT):
OM AND PM PURCHASES:
When displaying the # of purchases for OM (ostomy supplies, bandages,
incontinence supplies) and PM events being asked about in NS prior to
BOX NS4 or at NSL5 or at NSL6, the specifications indicate that the
global display fill "(EVENT)" should be implemented.
Otherwise, the global display fill "(ORIGINAL CHARGE BUNDLE
EVENT)" should be implemented.
The primary difference between these two display fills is that "(EVENT)" is
calculated based on the current and/or previous round PMRO.GETNUM
for the display of PM and OM purchases, while "(ORIGINAL CHARGE
BUNDLE EVENT)" is calculated based on XCEV.NUMLINKS.
Where "(EVENT)" is specifed in NS, NS will use calculate this display fill
(see general specifications global display fills) based on the following
logic:
OM purchases:
# of Purchases = PMRO.GETNUM on PMRO where
PMRO.PMRORND = current round.
PM purchases:
If there is a PMRO where (PMRO.PMROEVNT = EVNT.EVNTNUM and
PMRO.PMRORND = current round and PMRO.GETNUM > 0 and
PMRO.GETNUM ^= DK and PMRO.GETNUM ^= RF) AND
if there is a PMRO where (PMRO.PMROEVNT = EVNT.EVNTNUM and
PMRO.PMRORND = previous round and PMRO.GETNUM > 0 and
PMRO.GETNUM ^= DK and PMRO.GETNUM ^= RF and
PMRO.PMSUMFLG = 1=Yes and PMRO.PMRODFLG ^= 1/Yes), then
display:
3:16:25 PM Monday, August 03, 2009
Page 4 of 278
BOX NSBEG
# of purchases =
(PMRO.GETNUM on PMRO where PMRO.PMRORND = previous
round) +
(PMRO.GETNUM on PMRO where PMRO.PMRORND = current round).
Else If there is a PMRO where (PMRO.PMROEVNT = EVNT.EVNTNUM
and PMRO.PMRORND = current round and PMRO.GETNUM > 0 and
PMRO.GETNUM ^= DK and PMRO.GETNUM ^= RF), then display:
# of purchases = PMRO.GETNUM on PMRO where
PMRO.PMRORND = current round.
Else if there is a PMRO where (PMRO.PMROEVNT = EVNT.EVNTNUM
and PMRO.PMRORND = previous round and PMRO.GETNUM > 0 and
PMRO.GETNUM ^= DK and PMRO.GETNUM ^= RF and
PMRO.PMSUMFLG = 1.Yes and PMRO.PMRODFLG ^= 1/Yes), then
display:
# of purchases = PMRO.GETNUM on PMRO where
PMRO.PMRORND = previous round).
Where "(ORIGINAL CHARGE BUNDLE EVENT)" is specified in NS (this
includes coming to NS from CPS), NS will use calculate this display fill
(see general specifications global display fills) based on the following
logic:
OM and PM Purchases:
# of PURCHASES = XCEV.NUMLINKS
XCEV.NUMLINKS will be set at BOX NS4 if administering NS, and will
be already filled if coming from CPS.
While administering NS, we will probe for an updated value for
NUMLINKS at NS8. This updated value will overwrite the
XCEV.NUMLINKS set at BOX NS4 or the value already prefilled coming
from CPS.
REPEAT VISITS:
When displaying the # of visits for REPEAT VISIT events being asked
about in NS prior to BOX NS4 or at NSL5 or at NSL6, the specifications
indicate that the global display fill "(EVENT)" should be implemented.
Otherwise, the global display fill "(ORIGINAL CHARGE BUNDLE
EVENT)" should be implemented.
The primary difference between these two display fills is that "(EVENT)" is
calculated based on EVNT.RVTIMES, while "(ORIGINAL CHARGE
BUNDLE EVENT)" is calculated based on XCEV.RVLINKS.
Where "(EVENT)" is specified in NS, NS will use calculate this display fill
(see general specifications global display fills) based on the following
logic:
# of Visits = EVNT.RVTIMES.
Where "(ORIGINAL CHARGE BUNDLE EVENT)" is specified in NS (this
includes coming to NS from CPS), NS will use calculate this display fill
(see general specifications global display fills) based on the following
logic:
# of Visits = XCEV.RVLINKS
3:16:25 PM Monday, August 03, 2009
Page 5 of 278
NS1_IN
NS1_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
7
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:
Ask NS details for each event in list generated at BOX NSBEG.
Invoke NO TRAVEL I/N.
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
3:16:26 PM Monday, August 03, 2009
Page 6 of 278
NS1_IN
NAVIGATOR
Field1:
( NSQ1025 )
N/A
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
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
NS1 - NSINT ( NSQ1030 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
BOX NSBEG - (NSQ1010 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:16:28 PM Monday, August 03, 2009
Page 7 of 278
NS1
NS1
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
NSINT
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
10
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If one or more charge bundles entered in ST section, display "Now
that…"
Else display "Let's".
TOTAL NUMBER OF NS EVENTS = Display total number of events
in list generated at BOX NSBEG.
If NS1 - NSINT has already been asked in the current round, display
"REMAINING".
Else do not display.
If NS1 - NSINT has already been asked in the current round, display
"Next let’s look at".
Else display "Let’s start with".
If Event is associated with a Managed Care Plan, display
"[your/(SP's)]".
Else display "the".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
3:16:29 PM Monday, August 03, 2009
Page 8 of 278
NS1
TEXT:
EVENT: (EVENT)
Context Header:
Int. Instr I:
[Now that we're done with [your/(SP's)] statements, let's/Let's] talk
about the medical services and costs for which [you/(SP)] did not
have a statement.]
Question Text:
THERE ARE (TOTAL NUMBER OF NS EVENTS) EVENTS
(REMAINING) TO ASK ABOUT.
(Let's start with/Next let's look at) (the/[your/(SP's)]) costs for the
(EVENT).
Int. Instr II:
INPUT FIELDS / ROUTING
NSINT
Field1:
( NSQ1030 )
TEMP
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
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX NS1 - (NSQ1080 )
English text: CONTINUE
Attribute
Empty
Route
BOX NS1 - (NSQ1080 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
3:16:31 PM Monday, August 03, 2009
Page 9 of 278
NS1
TECHNICAL NOTES
243
ChargeBundlesEntered
One or more charge bundle previously entered in ST
section =
HRND.EVERSTMT = 1/Yes on HRND where
HRND.HRNDRND = current round.
266
EventAssocHMO
Event is associated with a Managed Care Plan =
For this EVNT, ((PROV.HMOASSOC = 1/Yes on PROV
where PROV.PROVNUM = EVNT.EVNTPROV) or
(EVNT.HMOREFER=1/Yes) or
(PMRO.PMSATHMO=1/Yes on PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=current round))).
DESIGN NOTES
3:16:31 PM Monday, August 03, 2009
Page 10 of 278
BOX NS1
BOX NS1
3:16:31 PM Monday, August 03, 2009
Page Order # :
20
Page 11 of 278
BOX NS1
BOX INSTRUCTIONS
( NSQ1080 )
IF (ST1 - MHMOSTMT = 3/Never AND ((SP HAS A MEDICARE MANAGED
CARE PLAN THAT DOES NOT HAVE RX COVERAGE ANYTIME IN THE
CURRENT ROUND) OR (SP HAS A PRIVATE PLAN THAT IS A MANAGED
CARE PLAN ANYTIME IN THE CURRENT ROUND) OR (SP IS IN THE EXIT
SAMPLE) OR (EVENT IS ASSOCIATED WITH A MANAGED CARE PLAN)))
OR (EVENT TYPE = 'OM' AND EVENT IS A RENTAL ITEM AND PS1
HADPYMNT = 1/Yes) OR ((EVNTTYPE = 'DU' OR 'PM') AND SP DOES NOT
HAVE ANY OTHER HEALTH INSURANCE PLAN BESIDES MEDICARE IN
THE CURRENT ROUND) , GO TO BOX NS4 - (NSQ1125 ).
ELSE IF (SP IS IN THE EXIT SAMPLE), GO TO NS4 - NSRECDSTAT (
NSQ1120 ).
ELSE GO TO NS2 - NSEXMCMAIL ( NSQ1090 ).
ASSIGNMENTS
TECHNICAL NOTES
16
ExitSample
SP is in the Exit Sample =
(MRES.INTTYPE = 8/ExitInterviewHadPrev or
9/ExitInterviewSkipPrev) on MRES where
MRES.MRESRND = current round.
266
EventAssocHMO
Event is associated with a Managed Care Plan =
For this EVNT, ((PROV.HMOASSOC = 1/Yes on PROV
where PROV.PROVNUM = EVNT.EVNTPROV) or
(EVNT.HMOREFER=1/Yes) or
(PMRO.PMSATHMO=1/Yes on PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=current round))).
241
TypeOfEvent
Type of Event =
EVNT.EVNTTYPE.
242
OMRental
Other Medical Expense Item is Rented =
EVNT.RENTPROB = 2/Rent.
372
MHMORxAnytime
SP had Medicare Managed Care plan (Medicare
Advantage plan) with RX coverage during curr.rnd=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=curr.rnd &
COVANYTM=1/Yes & MHMORX=1/Yes)). Exclude
Deleted Plans. See T.N.52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
3:16:31 PM Monday, August 03, 2009
Page 12 of 278
BOX NS1
416
OnlyMedicareCurrRnd
SP does not have plan besides Medicare in current round
=
If there is PLAN where PLANTYPE ^=1/Medicare, there
is no PLRO where (PLRO.PLROPLAN=PLANNUM &
PLRO.PLRORND=curr. round & (COVTIME^=empty or
COVANYTM=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
3:16:31 PM Monday, August 03, 2009
Page 13 of 278
NS2
NS2
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
NSEXMCMAIL
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
30
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP was covered by TRICARE and any other insurance plan
besides Medicare during the current round, display "Medicare,
Insurance, and Tricare".
Else if SP was covered by TRICARE and is not covered by any
other insurance plan besides Medicare during the current round,
display "Medicare and Tricare"
Else if SP was not covered by TRICARE and was covered by any
other insurance plan besides Medicare during the current round,
display "Medicare and Insurance".
Else display "Medicare".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
EVENT: (EVENT)
Int. Instr I:
Question Text:
3:16:33 PM Monday, August 03, 2009
As far as you know, is anything expected in the mail from (Medicare,
Insurance, and Tricare/Medicare and Tricare/Medicare and
Page 14 of 278
NS2
Insurance/Medicare) about [READ EVENT ABOVE]?
[PROBE IF NECESSARY: Please include any statements received
about [your/(SP’s)] Medicare prescription drug benefit.]
Int. Instr II:
INPUT FIELDS / ROUTING
NSEXMCMAIL
Field1:
TEMP
Cheshire Name:
Item Text display:
( NSQ1090 )
Do not display response option 9/FlagCostForCPS.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TExmcmail
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX NS4 - (NSQ1125 )
2
English text: YES
No
BOX NS4 - (NSQ1125 )
3
English text: NO
EventEnteredInError
NS3 - EVERRVB ( NSQ1110 )
4
English text: EVENT ENTERED IN ERROR
HasStatementForEvent
ST4 - MATCHST ( STQ1110 )
9
English text: HAVE STATEMENT FOR EVENT
FlagCostForCps
DO NOT DISPLAY.
English text: FLAG COST FOR CPS
Attribute
Don't know
Route
BOX NS4 - (NSQ1125 )
Refusal
BOX NS4 - (NSQ1125 )
BACKGROUND VARIABLE ASSIGNMENTS
If NS2 - NSEXMCMAIL = 4/HasStatementForEvent, increment a counter that records how
many times NS calls ST to collect a statement. This counter is also incremented at NS4.
3:16:38 PM Monday, August 03, 2009
Page 15 of 278
NS2
See detailed instructions below.
EVERRFLG
If NS2 - NSEXMCMAIL = 3/EventEnteredInError, set
EVNT.EVERRFLG = 1/Yes.
HAVESTMT
If NS2 - NSEXMCMAIL = 4/HasStatementForEvent,
set HRND.HAVESTMT = HRND.HAVESTMT + 1.
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.
258
TricarePlan
SP covered by TRICARE during the current round =
There is a PLAN where PLAN.PLANTYPE = 6/Tricare
& PLRO where (PLRO.PLROPLAN = PLAN.PLANNUM &
PLRO.PLRORND = current round & PLRO.COVTIME^=
empty).
Exclude Deleted Plans. See T.N. 52.
259
InsurancePlan
SP covered by Insurance plan other than Medicare
during current round =
PLAN where (PLANTYPE = 2/Medicaid, 3/PublicPlan, or
4/PrivatePlan) & PLRO where
(PLROPLAN=PLAN.PLANNUM & PLRORND=current
round & COVTIME^=empty).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
3:16:38 PM Monday, August 03, 2009
Page 16 of 278
NS3
NS3
Page Order # :
Design Screen Type:
Verbatim Text
Fields:
Field 1:
EVERRVB
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
40
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:
EVENT: (EVENT)
Int. Instr I:
REMINDER: "EVENT ENTERED IN ERROR" INSTRUCTS THE
HOME OFFICE TO DELETE THIS EVENT.
IF YOU HAVE ENTERED THIS CODE IN ERROR, SELECT
PREVIOUS PAGE AND ENTER THE CORRECT CODE AT NS2.
OTHERWISE, EXPLAIN WHY YOU SELECTED "EVENT ENTERED
IN ERROR" FOR THIS EVENT.
Question Text:
Int. Instr II:
3:16:38 PM Monday, August 03, 2009
Page 17 of 278
NS3
INPUT FIELDS / ROUTING
Field1:
EVERRVB
( NSQ1110 )
NONE.
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
EVNT.EVERRVB1
EVNT.EVERRVB2
EVNT.EVERRVB3
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 NS4 - (NSQ1125 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:16:39 PM Monday, August 03, 2009
Page 18 of 278
NS4
NS4
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
NSRECDSTAT
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:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
EVENT: (EVENT)
Int. Instr I:
Question Text:
[Have you/Has (SP)] received a statement for the [READ EVENT
ABOVE]?
Int. Instr II:
INPUT FIELDS / ROUTING
3:16:41 PM Monday, August 03, 2009
Page 19 of 278
NS4
NSRECDSTAT
Field1:
Cheshire Name:
( NSQ1120 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRecdstat
1
No
No
Number Label
1 StatementReceivedAndAvailable
FieldSize:
Min Value:
Max Value:
Mask:
Route
ST4 - MATCHST ( STQ1110 )
2
English text: STATEMENT RECEIVED AND AVAILABLE
StatementReceivedNotAvailable
BOX NS4 - (NSQ1125 )
3
English text: STATEMENT RECEIVED, NOT AVAILABLE
StatementNotReceived
BOX NS4 - (NSQ1125 )
English text: STATEMENT NOT RECEIVED
Attribute
Don't know
Route
BOX NS4 - (NSQ1125 )
Refusal
BOX NS4 - (NSQ1125 )
BACKGROUND VARIABLE ASSIGNMENTS
If NS4 - NSRECDSTAT = 1/StatementReceivedAndAvailable, increment a counter that
records how many times NS calls ST to collect a statement. This counter is also
incremented at NS2. See detailed instructions below.
HAVESTMT
If NS4 - NSRECDSTAT =
1/StatementReceivedAndAvailable, set
HRND.HAVESTMT = HRND.HAVESTMT + 1.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
3:16:44 PM Monday, August 03, 2009
Page 20 of 278
NS4
DESIGN NOTES
3:16:44 PM Monday, August 03, 2009
Page 21 of 278
BOX NS4
BOX NS4
3:16:44 PM Monday, August 03, 2009
Page Order # :
60
Page 22 of 278
BOX NS4
BOX INSTRUCTIONS
( NSQ1125 )
CREATE A NEW CHARGE BUNDLE FOR THIS EVENT .
IF NS2 - NSEXMCMAIL = 1/Yes or 3/EventEnteredInError, GO TO BOX
NS80 - (NSQ2930 ).
ELSE GO TO BOX NS4A - (NSQ1127 ).
ASSIGNMENTS
NS details will be collected on COST and CORO.
COST Key = COST.COSTBASE + COST.COSTNUM.
COST.COSTNUM = Number of charge bundle created at BOX NS4.
CORO Key = CORO.COROBASE + CORO.COROCOST + CORO.CORORND.
CORO.COROCOST = COST.COSTNUM of charge bundle created at BOX NS4.
CORO.CORORND = current round.
Create current round COST and CORO records for new Charge Bundle.
BASE.LASTCOST holds the highest COST.COSTNUM prior to fielding cases. Not all
COST records are fielded. The first time a COST record is generated in the field,
BASE.LASTCOST should be >= to the highest COST.COSTNUM fielded. The new
COST.COSTNUM should be calculated based on BASE.LASTCOST + 001. Each time a
COST record is generated in the field, BASE.LASTCOST will be updated to match the
highest COST.COSTNUM in the field. Therefore, each time a COST record is generated in
the field, the new COST.COSTNUM should be calculated based on BASE.LASTCOST +
001. See detailed instructions below.
Additional NS details will be collected on XCEV:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVBASE and XCEV.XCEVBAS2 = BASE.BASEID.
XCEV.XCEVCOST = COST.COSTNUM of charge bundle created at BOX NS4.
XCEV.XCEVEVNT = EVNT.EVNTNUM of event being asked about.
Create an XCEV record to link the event being asked about to the new charge bundle
created at BOX NS4.
For OM purchases, set XCEV.NUMLINKS based on the current round PMRO.GETNUM
(see details below).
For REPEAT VISITS, set XCEV.RVLINKS based on EVNT.RVTIMES (see details below).
For PM purchases, set XCEV.NUMLINKS based on the following logic:
If there is a PMRO where (PMRO.PMROEVNT = EVNT.EVNTNUM and PMRO.PMRORND
= current round and PMRO.GETNUM > 0 and PMRO.GETNUM ^= DK and
PMRO.GETNUM ^= RF) AND
if there is a PMRO where (PMRO.PMROEVNT = EVNT.EVNTNUM and PMRO.PMRORND
= previous round and PMRO.GETNUM > 0 and PMRO.GETNUM ^= DK and
PMRO.GETNUM ^= RF and PMRO.PMSUMFLG = 1=Yes and PMRO.PMRODFLG ^=
1/Yes), then set:
XCEV.NUMLINKS =
(PMRO.GETNUM on PMRO where PMRO.PMRORND = previous round) +
(PMRO.GETNUM on PMRO where PMRO.PMRORND = current round).
Else If there is a PMRO where (PMRO.PMROEVNT = EVNT.EVNTNUM and
PMRO.PMRORND = current round and PMRO.GETNUM > 0 and PMRO.GETNUM ^= DK
3:16:44 PM Monday, August 03, 2009
Page 23 of 278
BOX NS4
and PMRO.GETNUM ^= RF), then set:
XCEV.NUMLINKS = PMRO.GETNUM on PMRO where PMRO.PMRORND = current
round.
Else if there is a PMRO where (PMRO.PMROEVNT = EVNT.EVNTNUM and
PMRO.PMRORND = previous round and PMRO.GETNUM > 0 and PMRO.GETNUM ^=
DK and PMRO.GETNUM ^= RF and PMRO.PMSUMFLG = 1.Yes and PMRO.PMRODFLG
^= 1/Yes), then set:
XCEV.NUMLINKS = PMRO.GETNUM on PMRO where PMRO.PMRORND = previous
round).
Set variables as instructed below:
COSTNUM
Create COST where COST.COSTNUM =
BASE.LASTCOST + 001. This assumes that
BASE.LASTCOST is incremented each time a COST
record is generated in the field.
COSTRNDC
Set COST.COSTRNDC = current round.
COSTTYPE
Set COST.COSTTYPE=2/NS.
MCREDPCT
Set COST.MCREDPCT = 0.
COROCOST
Create CORO where CORO.COROCOST = this
COST.COSTNUM.
CORORND
Create CORO where CORO.CORORND = current
round.
ORIGNSEV
Set COST.ORIGNSEV = EVNT.EVNTNUM.
COROTYPE
Set CORO.COROTYPE = 2/NS.
EXMCMAIL
If NS2 - NSEXMCMAIL ^= EMPTY, set
COST.EXMCMAIL = NS2 - NSEXMCMAIL.
REDCSTAT
If NS4 - NSRECDSTAT ^= EMPTY, set
CORO.RECDSTAT = NS4 - NSRECDSTAT.
XCEVCOST
Create XCEV where XCEV.XCEVCOST = this
COST.COSTNUM.
XCEVEVNT
Create XCEV where XCEV.XCEVEVNT =
EVNT.EVNTNUM of EVNT selected.
XCEVRNDC
Set XCEV.XCEVRNDC = current round.
LASTCOST
Once the new COST record is generated, set
BASE.LASTCOST to the new COST.COSTNUM.
NUMLINKS
If EVNT.EVNTTYPE=OM &
EVNT.OTHRTYPE=5/OstomySupplies,
6/IncontinenceSupplies, or 7/Bandages), set
XCEV.NUMLINKS = PMRO.GETNUM on PMRO
where (PMRO.PMROEVNT = EVNT.EVNTNUM &
PMRO.PMRORND=current round).
If EVNT.EVNTTYPE = PM, see instructions above
for setting XCEV.NUMLINKS.
RVLINKS
If REPEAT VISIT EVENT, EVNT.VISTTYPE =
2/RepeatVisit, set XCEV.RVLINKS =
EVNT.RVTIMES.
TECHNICAL NOTES
DESIGN NOTES
3:16:44 PM Monday, August 03, 2009
Page 24 of 278
BOX NS4
SUMMARY OF DESIGNI INTENT FOR GLOBAL DISPLAY FILLS
(EVENT) vs. (ORIGINAL CHARGE BUNDLE EVENT):
OM AND PM PURCHASES:
When displaying the # of purchases for OM (ostomy supplies, bandages,
incontinence supplies) and PM events being asked about in NS prior to
BOX NS4, the specifications indicate that the global display fill "(EVENT)"
should be implemented.
Otherwise, following BOX NS4, the global display fill "(ORIGINAL
CHARGE BUNDLE EVENT)" should be implemented.
The primary difference between these two display fills is that "(EVENT)" is
calculated based on the current and/or previous round PMRO.GETNUM
for the display of PM and OM purchases, while "(ORIGINAL CHARGE
BUNDLE EVENT)" is calculated based on XCEV.NUMLINKS.
3:16:44 PM Monday, August 03, 2009
Page 25 of 278
BOX NS4A
BOX NS4A
Page Order # :
65
BOX INSTRUCTIONS
( NSQ1127 )
IF (EVENT TYPE IS NOT AN OTHER MEDICAL EXPENSE) AND (EVENT IS
ASSOCIATED WITH A MANAGED CARE PLAN), GO TO NS6 - TOTALCHG
( NSQ1270 ).
ELSE GO TO NS5 - TOTALCHG ( NSQ1130 ).
ASSIGNMENTS
TECHNICAL NOTES
435
EventNotOM
Event Type is not an Other Medical expense event =
EVNT.EVNTTYPE ^= 'OM'.
266
EventAssocHMO
Event is associated with a Managed Care Plan =
For this EVNT, ((PROV.HMOASSOC = 1/Yes on PROV
where PROV.PROVNUM = EVNT.EVNTPROV) or
(EVNT.HMOREFER=1/Yes) or
(PMRO.PMSATHMO=1/Yes on PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=current round))).
DESIGN NOTES
BOX NS4A is called from CPS1 when SP reports still not having a
statement. COST and CORO have already been created in CPS.
3:16:44 PM Monday, August 03, 2009
Page 26 of 278
NS5
NS5
Page Order # :
Design Screen Type:
Dollar
Fields:
Field 1:
TOTALCHG
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
70
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If EVNT.EVNTTYPE = 'OM' and EVNT.RENTPROB = 2/Rent, then:
Display "was the charge for the (OME ITEM TYPE) rented (with
the option to buy) between (REFERENCE DATE) and
(TODAY/DATE OF DEATH/DATE OF INSTITUTIONALIZATION)".
If EVNT.RENT2BUY = 2/PurchasedRentToBuy, display "with the
option to buy".
Else do not display.
Else then:
Display "was the total charge (that is, the total amount billed)".
Always display "(that is,…)".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
Int. Instr I:
Question Text:
3:16:45 PM Monday, August 03, 2009
Including any amounts that may be paid by Medicare or anyone else,
Page 27 of 278
NS5
what [was the charge for the (OME ITEM TYPE) rented (with the
option to buy) between (REFERENCE DATE) and (TODAY/DATE
OF DEATH/DATE OF INSTITUTIONALIZATION)/was the total
charge (that is, the total amount billed)]?
IF CHARGE REPORTED AS HOURLY RATE, CALCULATE AND
ENTER THE TOTAL CHARGE FOR THE ENTIRE ROUND.
Int. Instr II:
INPUT FIELDS / ROUTING
TOTALCHG
Field1:
( NSQ1130 )
CORO.TOTALCHG
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
TOTAL AMOUNT:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Real
TAmt
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
BOX NS5 - (NSQ1190 )
Refusal
BOX NS5 - (NSQ1190 )
FieldSize:
Min Value:
Max Value:
Mask:
0
999999.99
Dollars
Route
BOX NS5 - (NSQ1190 )
BACKGROUND VARIABLE ASSIGNMENTS
TOTALAMT
COST.TOTALAMT = NS5 - TOTALCHG.
TOTALTYP
CORO.TOTALTYP = 1/TotalCharge.
NSDATQNO
COST.NSDATQNO = 1/NS5.
SOFT EDIT CHECKS
TOTALCHG = 0.01 - 20,000, DK, RF.
If not true, display message "UNLIKELY RESPONSE. PLEASE
VERIFY".
HARD EDIT CHECKS
TOTALCHG = 0.01 - 999,999.99, DK, RF.
If not true, display message "INVALID AMOUNT. TOTAL CHARGE
MUST BE GREATER THAN 0, DON'T KNOW, OR REFUSAL.
3:16:47 PM Monday, August 03, 2009
Page 28 of 278
NS5
PLEASE REENTER."
TECHNICAL NOTES
241
TypeOfEvent
Type of Event =
EVNT.EVNTTYPE.
242
OMRental
Other Medical Expense Item is Rented =
EVNT.RENTPROB = 2/Rent.
DESIGN NOTES
3:16:48 PM Monday, August 03, 2009
Page 29 of 278
BOX NS5
BOX NS5
80
Page Order # :
BOX INSTRUCTIONS
( NSQ1190 )
IF TOTALCHG = 0 AND SP CURRENTLY COVERED BY MEDICAID, GO TO
BOX NS80 - (NSQ2930 ).
ELSE IF EVENT TYPE = 'OM' AND EVENT IS A RENTAL ITEM, GO TO NS7 MONTHCOV ( NSQ1300 ).
ELSE IF (EVENT TYPE = 'PM' OR 'OM') AND NUMBER OF PURCHASES
BEING ASKED ABOUT IN NS IS > 1, GO TO NS8 - NUMLINKS ( NSQ1310 ).
ELSE IF (EVENT WAS ENTERED AS A REPEAT VISIT), GO TO NS9 RVLINKS ( NSQ1312 ).
ELSE GO TO BOX NS9 - (NSQ1320 ).
ASSIGNMENTS
TECHNICAL NOTES
241
TypeOfEvent
Type of Event =
EVNT.EVNTTYPE.
242
OMRental
Other Medical Expense Item is Rented =
EVNT.RENTPROB = 2/Rent.
135
RepeatVisitEvent
If Event entered as a Repeat Visit =
EVNT.VISTTYPE=2/RepeatVisit.
276
CurrentMedicaid
SP currently covered by Medicaid =
There is a PLAN where PLANTYPE=2/Medicaid & 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.
413
TotalPurchasesInNS
Total number of purchases being asked about in NS
(following BOX NS4) =
XCEV.NUMLINKS on XCEV where XCEV.XCEVEVNT =
this EVNT.EVNTNUM and XCEV.XCEVCOST and
COST.COSTNUM for charge bundle being asked about.
DESIGN NOTES
BOX NS5 first checks to see if TOTAL CHARGE = 0 and if SP has
MEDICAID. If true, we do not subsequent charge data. Else if this is not
true, the remaining conditions in this route box direct route based on
event type.
3:16:48 PM Monday, August 03, 2009
Page 30 of 278
NS6
NS6
Page Order # :
Design Screen Type:
Dollar
Fields:
Field 1:
TOTALCHG
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
90
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:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
Int. Instr I:
Question Text:
What was the copayment amount for the [READ EVENT ABOVE]?
[EXPLAIN IF NECESSARY: Managed care plans commonly charge
a fixed amount, or copayment, for health services provided. For
example, the person may pay $10 for each office visit and $5 for
each drug prescription.]
Int. Instr II:
ENTER 0 IF NO COPAYMENT FOR THE EVENT.
INPUT FIELDS / ROUTING
3:16:49 PM Monday, August 03, 2009
Page 31 of 278
NS6
TOTALCHG
Field1:
( NSQ1270 )
CORO.TOTALCHG
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
COPAY AMOUNT:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Real
TAmt
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
BOX NS6 - (NSQ1290 )
Refusal
BOX NS6 - (NSQ1290 )
FieldSize:
Min Value:
Max Value:
Mask:
0
999999.99
Route
BOX NS6 - (NSQ1290 )
BACKGROUND VARIABLE ASSIGNMENTS
TOTALAMT
COST.TOTALAMT = NS6 - TOTALCHG.
TOTALTYP
CORO.TOTALTYP = 2/CoPayment
NSDATQNO
COST.NSDATQNO = 2/NS6.
SOFT EDIT CHECKS
TOTALCHG = 0.00 - 50.00, DK, RF.
If not true, display message "UNLIKELY RESPONSE. PLEASE
VERIFY".
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:16:50 PM Monday, August 03, 2009
Page 32 of 278
BOX NS6
BOX NS6
Page Order # :
100
BOX INSTRUCTIONS
( NSQ1290 )
IF TOTALCHG = 0 AND SP CURRENTLY COVERED BY MEDICAID, GO TO
BOX NS80 - (NSQ2930 ).
IF EVENT TYPE = 'PM' AND THE TOTAL OF NUMBER OF PURCHASES
BEING ASKED ABOUT IN NS IS > 1, GO TO NS8 - NUMLINKS ( NSQ1310 ).
ELSE IF (EVENT WAS ENTERED AS A REPEAT VISIT), GO TO NS9 RVLINKS ( NSQ1312 ).
ELSE GO TO BOX NS9 - (NSQ1320 ).
ASSIGNMENTS
TECHNICAL NOTES
241
TypeOfEvent
Type of Event =
EVNT.EVNTTYPE.
413
TotalPurchasesInNS
Total number of purchases being asked about in NS
(following BOX NS4) =
XCEV.NUMLINKS on XCEV where XCEV.XCEVEVNT =
this EVNT.EVNTNUM and XCEV.XCEVCOST and
COST.COSTNUM for charge bundle being asked about.
DESIGN NOTES
BOX NS6 does not include routing for OM rentals to NS7 - MONTHCOV
and does not include routing for OM purchases to NS8 - NUMLINKS
because OM's will never route to BOX NS6. See BOX NS4A.
3:16:50 PM Monday, August 03, 2009
Page 33 of 278
NS7
NS7
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
MONTHCOV
Field 2:
MONCOV96
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:
110
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:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
Question Text:
How many months are covered by the charge for the period of time
[since (REFERENCE DATE)/between (REFERENCE DATE) and
(DATE OF DEATH/DATE OF INSTITUTIONALIZATION)]?
Int. Instr II:
INPUT FIELDS / ROUTING
3:16:52 PM Monday, August 03, 2009
Page 34 of 278
NS7
MONTHCOV
Field1:
XCEV.MONTHCOV
Cheshire Name:
Item Text display:
( NSQ1300 )
Display previously collected XCEV.MONTHCOV and allow
value to be updated.
Item Text:
Label:
Label Position:
MONTHS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMonthcov
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Empty
Route
NS7 - MONCOV96 ( NSQ1302 )
Don't know
NS7 - MONCOV96 ( NSQ1302 )
Refusal
NS7 - MONCOV96 ( NSQ1302 )
3:16:56 PM Monday, August 03, 2009
FieldSize:
Min Value:
Max Value:
Mask:
1
72
Route
NS7 - MONCOV96 ( NSQ1302 )
Page 35 of 278
NS7
MONCOV96
Field2:
( NSQ1302 )
NONE
Cheshire Name:
WE NEED TO TRANFORM MONCOV96=1 BACK TO
XCEV.MONTHCOV=96.
Item Text display:
Display previously collected XCEV.MONCOV96 and allow
value to be updated.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TMonCov96
1
No
No
Number Label
1 LessThanOneMonth
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX NS9 - (NSQ1320 )
English text: LESS THAN 1 MONTH
Attribute
Empty
Route
BOX NS9 - (NSQ1320 )
BACKGROUND VARIABLE ASSIGNMENTS
Collect # of months on XCEV:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVCOST = COST.COSTNUM of charge bundle being asked about.
XCEV.XCEVEVNT = EVNT.EVNTNUM of OM Rental event being asked about.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
MONTHCOV and MONCOV96 cannot both be EMPTY.
If not true, display message "ENTRY REQUIRED. PLEASE ENTER
NUMBER OF MONTHS OR SELECT "LESS THAN 1 MONTH".
Edit #2
MONTHCOV and MONCOV96 cannot both be FILLED.
If not true, display message "INVALID ENTRY. PLEASE ENTER
NUMBER OF MONTHS OR SELECT "LESS THAN 1 MONTH".
3:16:59 PM Monday, August 03, 2009
Page 36 of 278
NS7
TECHNICAL NOTES
DESIGN NOTES
3:16:59 PM Monday, August 03, 2009
Page 37 of 278
NS8
NS8
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
NUMLINKS
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
120
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If Total charge was collected for charge bundle then:
If (NS5 - TOTALCHG = DK or RF) , display "were covered by the
total charge".
Else if (NS5-TOTALCHG = 0), display "was there no charge".
Else display "(NS5 - TOTALCHG)".
Else if CoPayment was collected for charge bundle then:
If (NS6 - TOTALCHG = DK or RF), display "were covered by the
copayment".
Else if (NS6 - TOTALCHG = 0), display "was there no
copayment".
Else display "were covered by the (NS6-TOTALCHG)".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
3:17:00 PM Monday, August 03, 2009
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Page 38 of 278
NS8
Int. Instr I:
How many of the times [you/(SP)] obtained [READ EVENT ABOVE]
since (REFERENCE DATE) [were covered by the total charge/was
there no charge/were covered by the (TOTAL CHARGE)/were
covered by the copayment/was there no copayment/were covered
by the (COPAYMENT)]?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
NUMLINKS
Field1:
XCEV.NUMLINKS
Cheshire Name:
Item Text display:
( NSQ1310 )
Display previously collected XCEV.NUMLINKS and allow
value to be updated.
Item Text:
Label:
Label Position:
NUMBER OF TIMES:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TNumlinks
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
BOX NS9 - (NSQ1320 )
Refusal
BOX NS9 - (NSQ1320 )
FieldSize:
Min Value:
Max Value:
Mask:
1
100
Route
BOX NS9 - (NSQ1320 )
BACKGROUND VARIABLE ASSIGNMENTS
Collect # of purchases on XCEV:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVCOST = COST.COSTNUM of charge bundle being asked about.
XCEV.XCEVEVNT = EVNT.EVNTNUM of (OM Ostomy Supplies, Incontinence supplies, or
bandages) or (PM) being asked about.
NOCHGNUM
COST.NOCHGNUM = NS8 - NUMLINKS.
SOFT EDIT CHECKS
3:17:01 PM Monday, August 03, 2009
Page 39 of 278
NS8
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:17:01 PM Monday, August 03, 2009
Page 40 of 278
NS9
NS9
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
RVLINKS
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
130
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If EVNT.EVNTTYPE = 'OP', display "visits to the OPD at".
Else if EVNT.EVNTTYPE = 'SL' display "lab services provided by".
Else display "visits to".
If Total charge was collected for charge bundle then:
If (NS5 - TOTALCHG = DK or RF) , display "were covered by the
total charge".
Else if (NS5-TOTALCHG = 0), display "was there no charge".
Else display "(NS5 - TOTALCHG)".
Else if CoPayment was collected for charge bundle then:
If (NS6 - TOTALCHG = DK or RF), display "were covered by the
copayment".
Else if (NS6 - TOTALCHG = 0), display "was there no
copayment".
Else display "were covered by the (NS6-TOTALCHG)".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
3:17:02 PM Monday, August 03, 2009
Page 41 of 278
NS9
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Context Header:
Int. Instr I:
How many of the (NUMBER OF VISITS) (visits to the OPD at/lab
services provided by/visits to) (PROVIDER NAME) during the month
of (EVENT MONTH) [were covered by the total charge/was there no
charge/were covered by the (TOTAL CHARGE)/were covered by the
copayment/was there no copayment/were covered by the
(COPAYMENT)]?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
RVLINKS
Field1:
XCEV.RVLINKS
Cheshire Name:
Item Text display:
( NSQ1312 )
Display previously collected XCEV.RVLINKS and allow
value to be updated.
Item Text:
Label:
Label Position:
NUMBER OF VISITS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TRvtimes
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
BOX NS9 - (NSQ1320 )
Refusal
BOX NS9 - (NSQ1320 )
FieldSize:
Min Value:
Max Value:
Mask:
1
90
Route
BOX NS9 - (NSQ1320 )
BACKGROUND VARIABLE ASSIGNMENTS
Collect # of visits on XCEV:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVCOST = COST.COSTNUM of charge bundle being asked about.
XCEV.XCEVEVNT = EVNT.EVNTNUM of Repeat Visit event currently being asked about.
NOCHGVIS
3:17:04 PM Monday, August 03, 2009
COST.NOCHGVIS = NS9 - RVLINKS.
Page 42 of 278
NS9
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:17:04 PM Monday, August 03, 2009
Page 43 of 278
BOX NS9
BOX NS9
Page Order # :
140
BOX INSTRUCTIONS
( NSQ1320 )
IF (COPAYMENT WAS COLLECTED FOR CHARGE BUNDLE INSTEAD OF
A TOTAL CHARGE), GO TO BOX NS45 - (NSQ1990 ).
ELSE GO TO NS10 - INCOTHER ( NSQ1330 ).
ASSIGNMENTS
TECHNICAL NOTES
268
CoPaymentCollected
CoPayment was collected for Charge Bundle =
For this COST, there is a CORO where
(CORO.COROCOST = COST.COSTNUM &
CORO.CORORND = current round & CORO.TOTALTYP
= 2/CoPayment).
If administering CPS, check most recent CORO where
CORO.TOTALTYP ^= empty.
269
TotalChargeCollected
Total Charge was collected for Charge Bundle =
For this COST, there is a CORO where
(CORO.COROCOST=COST.COSTNUM &
CORO.CORORND=current round &
CORO.TOTALTYP=1/TotalCharge).
If administering CPS, check most recent CORO where
CORO.TOTALTYP ^= empty.
DESIGN NOTES
COPAYMENT and TOTAL CHARGE are both collected on current round
CORO.TOTALCHG and copied to COST.TOTALAMT.
The design intent at BOX NS9 is to determine whether or not
CORO.TOTALCHG was collected at NS5, where we probed for TOTAL
CHARGE, or was collected at NS6, where we probed for COPAYMENT.
NS5 sets CORO.TOTALTYP = 1/TotalCharge to flag that
CORO.TOTALCHG was collected at NS5.
NS6 sets CORO.TOTALTYP = 2/CoPayment to flag that
CORO.TOTALCHG was collected at NS6.
3:17:04 PM Monday, August 03, 2009
Page 44 of 278
NS10
NS10
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
INCOTHER
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
150
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
IF NS5 - TOTALCHG = DK or RF, display "THE TOTAL CHARGE".
Else if NS5 - TOTALCHG = 0, display "THIS"
Else display "(NS5 - TOTALCHG)".
If EVNT.EVNTTYPE = 'PM', display "MEDICINE".
Else if EVNT.EVNTTYPE = 'OM', display "ITEM".
Else display "EVENT".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
DOES [THE TOTAL CHARGE/THIS/(TOTAL CHARGE)] COVER
THIS (EVENT/ITEM/MEDICINE) ONLY OR DOES IT INCLUDE
OTHER EVENTS/ITEMS/MEDICINES?
Question Text:
3:17:05 PM Monday, August 03, 2009
Page 45 of 278
NS10
Int. Instr II:
INPUT FIELDS / ROUTING
INCOTHER
Field1:
( NSQ1330 )
COST.INCOTHER
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
TIncother
1
No
No
FieldSize:
Min Value:
Max Value:
Mask:
Number Label
1 OnlyThisEvent
2
Route
BOX NS45 - (NSQ1990 )
English text: ONLY THIS EVENT/ITEM/MEDICINE
OtherEvents
NS12 - INCTYPE ( NSQ1390 )
3
English text: OTHER EVENTS/ITEMS/MEDICINES
CantTell
BOX NS45 - (NSQ1990 )
English text: CAN'T TELL
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:17:07 PM Monday, August 03, 2009
Page 46 of 278
NS12
NS12
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
INCTYPE
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
290
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:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
Question Text:
What else was included?
Int. Instr II:
CHECK ALL THAT APPLY.
INPUT FIELDS / ROUTING
3:17:09 PM Monday, August 03, 2009
Page 47 of 278
NS12
INCTYPE
Field1:
( NSQ1390 )
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=COST.INCDATES
2=COST.INCHHS - NEED TO ADD TO CHESHIRE
DATABASE
3=COST.INCOMS
4=COST.INCPMS
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TIncTypes
4
No
No
Number Label
1 ProvDates
2
3
4
English text: PROVIDER SERVICE DATES
HHVisits
English text: HOME HEALTH VISITS
OMExpenses
English text: OTHER MEDICAL EXPENSES
Pmed
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX NS12 - (NSQ1400 )
BOX NS12 - (NSQ1400 )
BOX NS12 - (NSQ1400 )
BOX NS12 - (NSQ1400 )
English text: PRESCRIBED MEDICINES
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:17:11 PM Monday, August 03, 2009
Page 48 of 278
BOX NS12
BOX NS12
Page Order # :
300
BOX INSTRUCTIONS
( NSQ1400 )
IF THE RESPONSE TO NS12 - INCTYPE INCLUDES 1/ProvDates, GO TO
NS13 - PROVIDER_NSDATE ( NSQ1410 ).
ELSE GO TO BOX NS26 - (NSQ1720 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
3:17:11 PM Monday, August 03, 2009
Page 49 of 278
NS13
NS13
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PROVIDER_NSDATE
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
310
Display as ' Add a Provider '
Display as ' Edit a Provider '
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:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
WHICH MEDICAL PROVIDER IS IN THIS CHARGE BUNDLE?
Question Text:
Int. Instr II:
3:17:12 PM Monday, August 03, 2009
SELECT OR ADD ONLY ONE PROVIDER.
Page 50 of 278
NS13
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
PROVIDER_NSDATE
( NSQ1410 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TProvPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
NS14 - NSDATEUPD ( NSQ1412 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on PROV:
PROV key = PROV.PROVBASE + PROV.PROVNUM
PROV.PROVNUM = Number of Provider selected at NS13.
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
Provider name
Set COST.COSTPROV = Provider selected at NS13. See additional instructions below.
COSTPROV
COST.COSTPROV = PROV.PROVNUM of provider
selected at NS13.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
Interviewer can add or select Provider at this roster.
3:17:12 PM Monday, August 03, 2009
Page 51 of 278
NS14
NS14
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
NSDATEUPD
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
312
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:
Display name of Provider, PROV.PROVNAME, selected at NS13.
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report below Question Text.
Display all events for this provider where:
EVNT.EVNTTYPE = 'DU', 'ER', 'IP', 'IU', 'OP', 'MP', 'SD', or 'SL', and
EVNT.EVNTPROV = the PROV.PROVNUM selected at NS13, and
EVNT.EVNTDFLG ^= 1/Yes
Display in order of entry.
Report Header: PROVIDER SERVICE EVENTS
Column 1, Header = "Type".
Column 1, Display =
Display EVNT.EVNTTYPE
Column 2, Header = "Start Date".
Column 2, Display =
Display EVENT DATE in "Mon DD YYYY" format.
3:17:14 PM Monday, August 03, 2009
Page 52 of 278
NS14
Column 3, Header = "Stop Date".
Column 3, Display =
If (EVNT.EVNTTYPE = 'IU') or (EVNT.EVNTTYPE = 'IP' and
EVNT.IPSTATUS ^= 1/StillInHospital), display EVENT END DATE in
"Mon DD YYYY" format.
Else do not display.
Column 4, Header = "Status".
Column 4, Display =
If EVNT.EVNTTYPE = 'IP' and EVNT.IPSTATUS = 1/StillInHospital,
display "ON".
Else if EVNT.VISTTYPE = 2/RepeatVisit, display "RV".
Else do not display.
Column 5, Header = "# Visits".
Column 5, Display =
If EVNT.VISTTYPE = 2/RepeatVisit, display EVNT.RVTIMES.
Else do not display.
Column 6, Header = "Round".
Column 6, Display =
Display "R" + EVNT.EVNTRNDC. EX: R45
Column 7, Display =
If Event Date is out of the Survey Reference Period, display "ORP".
Else do not display.
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
PROVIDER: (PROVIDER NAME)
Int. Instr I:
THE FOLLOWING EVENT DATES HAVE BEEN ENTERED FOR
THIS PROVIDER.
Question Text:
Int. Instr II:
DO YOU NEED TO ADD OR EDIT AN EVENT DATE FOR THIS
CHARGE BUNDLE?
INPUT FIELDS / ROUTING
3:17:15 PM Monday, August 03, 2009
Page 53 of 278
NS14
NSDATEUPD
Field1:
( NSQ1412 )
TEMP
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
TSTDateUpd
1
No
No
Number Label
1 No
FieldSize:
Min Value:
Max Value:
Mask:
Route
NS24 - EVENT_NSDATE ( NSQ1705 )
2
English text: NO, DO NOT NEED TO ADD OR EDIT EVENT DATES
YesAddEvent
NS16 - EVENT_NSDATEADD ( NSQ1430 )
3
English text: YES, NEED TO ADD EVENT DATE
YesEditEvent
NS15 - EVENT_NSDATEDIT ( NSQ1414 )
English text: YES, NEED TO EDIT EVENT DATE
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
246
ORPEvent
Existing Event Date is outside survery reference period =
EVNT.EVORPFLAG = 1/ORP.
New event is Out of the Survey Reference Period =
See general specifications for Date check logic for
determing ORP events.
DESIGN NOTES
3:17:17 PM Monday, August 03, 2009
Page 54 of 278
NS15
NS15
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_NSDATEDIT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Statement Event Edit Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
Yes
No
No
Add Line
Delete Line
No
No
Grid Functions:
314
Display as ' Edit Event Date '
DISPLAY INSTRUCTIONS:
Context header display:
Display name of Provider, PROV.PROVNAME, selected at NS13.
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all events for this provider where:
EVNT.EVNTTYPE = 'DU', 'ER', 'IP', 'IU', 'OP', 'MP', 'SD', or 'SL', and
EVNT.EVNTPROV = the PROV.PROVNUM selected at NS13, and
EVNT.EVNTDFLG ^= 1/Yes
If EVNT.EVNTTYPE = 'IP' and EVNT.IPSTATUS = 1/StillInHospital,
display as a protected row.
Display in order of entry.
Roster/Grid display:
3:17:17 PM Monday, August 03, 2009
COL #
HEADER
INSTRUCTIONS
1
Type
Display EVNT.EVNTTYPE.
2
Start Date
Display EVENT DATE in "Mon DD YYYY"
format.
3
Stop Date
If (EVNT.EVNTTYPE = 'IU') or
(EVNT.EVNTTYPE = 'IP' and
EVNT.IPSTATUS ^=1/StillInHospital),
display EVENT END DATE in "Mon DD
YYYY" format.
Else do not display.
Page 55 of 278
NS15
4
Status
If EVNT.EVNTTYPE = 'IP' and
EVNT.IPSTATUS = 1/StillInHospital,
display "ON".
Else if EVNT.VISTTYPE = 2/RepeatVisit,
display "RV".
Else do not display.
5
# Visits
If EVNT.VISTTYPE = 2/RepeatVisit,
display EVNT.RVTIMES.
Else do not display.
6
Round
Display 'R' + EVNT.EVNTRNDC. EX:
R45
If Event Date is out of the Survey
Reference Period, display "ORP".
Else do not display.
7
Report display:
TEXT:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
PROVIDER: (PROVIDER NAME)
Context Header:
Int. Instr I:
Question Text:
SELECT AND EDIT THE EVENT DATE THAT NEEDS
CORRECTION.
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
EVENT_NSDATEDIT
( NSQ1414 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
3:17:18 PM Monday, August 03, 2009
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
NS14 - NSDATEUPD ( NSQ1412 )
Page 56 of 278
NS15
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of event selected at NS15.
If event selected for editing, see STATEMENT EVENT EDIT ROSTER POP-UP
specifications for pop-up window programming specifications.
Variables updated in STATEMENT EVENT EDIT ROSTER Pop-Up Window:
EVNT.VISTTYPE
SingleVisit or RepeatVisit
EVNT.RVTIMES
# of visits
EVNT.EVBEGMM
Event Month
EVNT.EVBEGDD
Event Day
EVNT.EVBEGYY
Event Year
EVNT.EVENDMM
Event End Month
EVNT.EVENDDD
Event End Day
EVNT.EVENDYY
Event End Year
NOTE: EVNT.IPSTATUS cannot be updated in Pop-Up Window.
EVORPFLG
If Event date edited is outside the Survey Reference
Period, set EVNT.EVORPFLG = 1/ORP. See
General Specifications for setting this ORP flag.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, should be on or
before (TODAY).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BEFORE (TODAY). PLEASE REENTER."
Edit #2
If (EVNTTYPE = 'IP' or 'IU'), then Discharge date,
EVENDMM/EVENDDD/EVENDYY, should be on or before (TODAY).
If not true, display message "INVALID DATE. DISCHARGE DATE
MUST BE ON OR BEFORE (TODAY). PLEASE REENTER."
Edit #3
If (EVNTTYPE = 'IP' or 'IU'), then Discharge date,
EVENDMM/EVENDDD/EVENDYY, must be on or
after the Admission date, EVBEGMM/EVBEGDD/EVBEGYY.
If not true, display message: "INVALID DATE. DISCHARGE DATE
MUST BE ON OR AFTER (ADMISSION DATE). PLEASE
REENTER."
Edit #4
If EVNTTYPE = 'IP', then the IP Admission and Discharge Date
cannot overlap an existing IP stay.
If not true, display message "INVALID DATE. THIS DATE
OVERLAPS AN EXISTING IP STAY FROM (ADMISSION DATE) TO
[(DISCHARGE DATE)/SP STILL IN HOSPITAL]. PLEASE
REENTER."
Display instructions:
Display (ADMISSION DATE) of existing IP stay that the IP stay
added overlaps.
If existing IP stay IPSTATUS=1/StillInHosptial, display "SP STILL IN
3:17:18 PM Monday, August 03, 2009
Page 57 of 278
NS15
HOSPITAL".
Else display (DISCHARGE DATE) of existing IP stay that the IP stay
added overlaps.
See General specifcations for overlapping date logic.
Edit #5
If EVNTTYPE = 'IU' and 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, (DATE
OF INSTITUTIONALIZATION). PLEASE REENTER."
Edit #6
If EVNT.EVNTTYPE = 'DU', 'ER', 'OP', 'MP', 'SL' or 'SD', then Date of
event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an existing
event date for the same provider.
The following must be true for the event added to be a duplicate of
an existing event:
Both event's EVNTDFLG ^= 1/Yes,
Both event's EVNTTYPE match.
Both event's EVNTPROV match.
Both event's EVENT DATE match. See general specifications for
matching date logic.
The date of the event added should not match any event date for the
same provider.
If not true, display message "INVALID DATE. THIS DATE HAS
ALREADY BEEN ENTERED. PLEASE REENTER. PLEASE
REENTER."
TECHNICAL NOTES
246
ORPEvent
Existing Event Date is outside survery reference period =
EVNT.EVORPFLAG = 1/ORP.
New event is Out of the Survey Reference Period =
See general specifications for Date check logic for
determing ORP events.
DESIGN NOTES
Interviewer can select events to be edited at this roster.
3:17:18 PM Monday, August 03, 2009
Page 58 of 278
NS16
NS16
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_NSDATEADD
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Statement Event 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
320
Display as ' Add Event Date '
Display as ' Edit Event Date '
DISPLAY INSTRUCTIONS:
Context header display:
Display name of Provider, PROV.PROVNAME, selected at NS13.
Question display:
Always display "(S)" in interviewer instructions in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Display all events for this provider where:
EVNT.EVNTTYPE = 'DU', 'ER', 'IP', 'IU', 'OP', 'MP', 'SD', or 'SL', and
EVNT.EVNTPROV = the PROV.PROVNUM selected at NS13, and
EVNT.EVNTDFLG ^= 1/Yes
Display in order of entry.
Display all loaded events as protected rows.
Roster/Grid display:
3:17:19 PM Monday, August 03, 2009
COL #
HEADER
INSTRUCTIONS
1
Type
Display EVNT.EVNTTYPE.
2
Start Date
Display EVENT DATE in "Mon DD YYYY"
format.
3
Stop Date
If (EVNT.EVNTTYPE = 'IU') or
(EVNT.EVNTTYPE = 'IP' and
EVNT.IPSTATUS ^=1/StillInHospital),
display EVENT END DATE in "Mon DD
YYYY" format.
Else do not display.
Page 59 of 278
NS16
4
Status
If EVNT.EVNTTYPE = 'IP' and
EVNT.IPSTATUS = 1/StillInHospital,
display "ON".
Else if EVNT.VISTTYPE = 2/RepeatVisit,
display "RV".
Else do not display.
5
# Visits
If EVNT.VISTTYPE = 2/RepeatVisit,
display EVNT.RVTIMES.
Else do not display.
6
Round
Display 'R' + EVNT.EVNTRNDC. EX:
R45
If Event Date is out of the Survey
Reference Period, display "ORP".
Else do not display.
7
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
PROVIDER: (PROVIDER NAME)
Int. Instr I:
ADD THE MISSING EVENT DATE(S) IN THIS CHARGE BUNDLE.
Question Text:
ADD ALL EVENT DATES FOR THIS PROVIDER.
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
EVENT_NSDATEADD
( NSQ1430 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TSTEventPick135
1
No
No
Number Label
1 [Continuous answer.]
3:17:20 PM Monday, August 03, 2009
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX NS16A - (NSQ1550 )
Page 60 of 278
NS16
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of event selected at NS16.
For each event added at NS16, see STATEMENT EVENT ROSTER POP-UP specifications
for pop-up window programming instructions:
Variables populated in Statement Event Roster Pop-Up Window:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVNTTYPE
EVNT.VISTTYPE
EVNT.RVTIMES
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
EVNT.EVENDMM
EVNT.EVENDDD
EVNT.EVENDYY
EVNT.STEVTYPE
BASE.LASTEVNT
Set additional fields specified below:
EVCHGFLG
If Event added, set EVNT.EVCHGFLG = 1/Yes.
EVORPFLG
If Event date added is outside the Survey Reference
Period, set EVNT.EVORPFLG = 1/ORP. See
General Specifications for setting this ORP flag.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, should be on or
before (TODAY).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BEFORE (TODAY). PLEASE REENTER."
Edit #2
If (EVNTTYPE = 'IP' or 'IU'), then Discharge date,
EVENDMM/EVENDDD/EVENDYY, should be on or before (TODAY).
If not true, display message "INVALID DATE. DISCHARGE DATE
MUST BE ON OR BEFORE (TODAY). PLEASE REENTER."
Edit #3
If (EVNTTYPE = 'IP' or 'IU'), then Discharge date,
EVENDMM/EVENDDD/EVENDYY, must be on or
after the Admission date, EVBEGMM/EVBEGDD/EVBEGYY.
If not true, display message: "INVALID DATE. DISCHARGE DATE
MUST BE ON OR AFTER (ADMISSION DATE). PLEASE
REENTER."
Edit #4
If EVNTTYPE = 'IP', then the IP Admission and Discharge Date
cannot overlap an existing IP stay.
If not true, display message "INVALID DATE. THIS DATE
3:17:20 PM Monday, August 03, 2009
Page 61 of 278
NS16
OVERLAPS AN EXISTING IP STAY FROM (ADMISSION DATE) TO
[(DISCHARGE DATE)/SP STILL IN HOSPITAL]. PLEASE
REENTER."
Display instructions:
Display (ADMISSION DATE) of existing IP stay that the IP stay
added overlaps.
If existing IP stay IPSTATUS=1/StillInHosptial, display "SP STILL IN
HOSPITAL".
Else display (DISCHARGE DATE) of existing IP stay that the IP stay
added overlaps.
See General specifcations for overlapping date logic.
Edit #5
If EVNTTYPE = 'IU' and 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, (DATE
OF INSTITUTIONALIZATION). PLEASE REENTER."
Edit #6
If EVNT.EVNTTYPE = 'DU', 'ER', 'OP', 'MP', 'SL' or 'SD', then Date of
event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an existing
event date for the same provider.
The following must be true for the event added to be a duplicate of
an existing event:
Both event's EVNTDFLG ^= 1/Yes,
Both event's EVNTTYPE match.
Both event's EVNTPROV match.
Both event's EVENT DATE match. See general specifications for
matching date logic.
The date of the event added should not match any event date for the
same provider.
If not true, display message "INVALID DATE. THIS DATE HAS
ALREADY BEEN ENTERED. PLEASE REENTER. 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
SP is Deceased =
MRES.SPALIVE=3/Deceased.
3:17:20 PM Monday, August 03, 2009
Page 62 of 278
NS16
246
ORPEvent
Existing Event Date is outside survery reference period =
EVNT.EVORPFLAG = 1/ORP.
New event is Out of the Survey Reference Period =
See general specifications for Date check logic for
determing ORP events.
DESIGN NOTES
Interviewer can only add events at this roster.
3:17:20 PM Monday, August 03, 2009
Page 63 of 278
BOX NS16A
BOX NS16A
Page Order # :
370
BOX INSTRUCTIONS
( NSQ1550 )
IF AT LEAST ONE EVENT ADDED AT NS16 IS A 'DU', 'ER', 'IP', 'IU', 'OP', OR
'MP' EVENT TYPE AND THE EVENT DATE WAS NOT OUTSIDE THE
SURVEY REFERENCE PERIOD, GO TO BOX NS16B - (NSQ1555 ).
ELSE GO TO NS14 - NSDATEUPD ( NSQ1412 ).
ASSIGNMENTS
TECHNICAL NOTES
246
ORPEvent
Existing Event Date is outside survery reference period =
EVNT.EVORPFLAG = 1/ORP.
New event is Out of the Survey Reference Period =
See general specifications for Date check logic for
determing ORP events.
241
TypeOfEvent
Type of Event =
EVNT.EVNTTYPE.
DESIGN NOTES
We do not collect event details for EVNT.EVNTTYPE = 'SD' or 'SL'.
3:17:20 PM Monday, August 03, 2009
Page 64 of 278
BOX NS16B
BOX NS16B
Page Order # :
375
BOX INSTRUCTIONS
( NSQ1555 )
IF AT LEAST ONE EVENT ADDED AT NS16 IS A 'DU', 'ER', 'IP', 'OP', OR
'MP' EVENT TYPE, GO TO NS17 - NSDATEINTRO ( NSQ1560 ).
ELSE GO TO BOX NS18 - (NSQ1620 ).
ASSIGNMENTS
TECHNICAL NOTES
241
TypeOfEvent
Type of Event =
EVNT.EVNTTYPE.
DESIGN NOTES
We do not display NS17 Introduction if EVNT.EVNTTYPE = 'IU'.
3:17:20 PM Monday, August 03, 2009
Page 65 of 278
NS17
NS17
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
NSDATEINTRO
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
380
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(s)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Before we continue with this statement, I would like to ask you a few
questions about the visit(s) I just added.
Int. Instr II:
INPUT FIELDS / ROUTING
3:17:21 PM Monday, August 03, 2009
Page 66 of 278
NS17
NSDATEINTRO
Field1:
( NSQ1560 )
TEMP
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
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX NS17 - (NSQ1570 )
English text: CONTINUE
Attribute
Empty
Route
BOX NS17 - (NSQ1570 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:17:23 PM Monday, August 03, 2009
Page 67 of 278
BOX NS17
BOX NS17
Page Order # :
390
BOX INSTRUCTIONS
( NSQ1570 )
IF AT LEAST ONE EVENT ADDED AT NS16 IS A 'DU' OR 'MP' EVENT TYPE
AND THE PROVIDER SPECIALTY HAS NOT BEEN COLLECTED, GO TO
NS18 - PROVSPEC ( NSQ1600 ).
ELSE GO TO BOX NS18 - (NSQ1620 ).
ASSIGNMENTS
TECHNICAL NOTES
170
ProviderSpecCollected
Provider Specialty has already been collected =
PROV.PROVSPEC ^= EMPTY.
Provider Specialty has not been collected =
PROV.PROVSPEC = EMPTY.
241
TypeOfEvent
Type of Event =
EVNT.EVNTTYPE.
DESIGN NOTES
3:17:23 PM Monday, August 03, 2009
Page 68 of 278
NS18
NS18
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
PROVSPEC
Field 2:
PROVSPOS
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:
420
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of Provider, PROV.PROVNAME, selected at NS13.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What kind of medical person is (PROVIDER NAME)?
Int. Instr II:
INPUT FIELDS / ROUTING
3:17:27 PM Monday, August 03, 2009
Page 69 of 278
NS18
3:17:37 PM Monday, August 03, 2009
Page 70 of 278
NS18
PROVSPEC
Field1:
( NSQ1600 )
PROV.PROVSPEC
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
TProvspec
1
No
No
Number Label
1 Dentist
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX NS18 - (NSQ1620 )
English text: DENTIST/DENTAL PROVIDER
MedicalDoctor
BOX NS18 - (NSQ1620 )
4
English text: MEDICAL DOCTOR
Audiologist
English text: AUDIOLOGIST
Chiropractor
5
English text: CHIROPRACTOR
ClinicalSocialWorker
BOX NS18 - (NSQ1620 )
6
English text: CLINICAL SOCIAL WORKER
Dietitian
BOX NS18 - (NSQ1620 )
7
English text: DIETITIAN-NUTRITIONIST
HearingTherapist
BOX NS18 - (NSQ1620 )
8
English text: HEARING THERAPIST
HomeHealthAide
BOX NS18 - (NSQ1620 )
9
English text: HOME HEALTH/HEALTH AIDE
Homemaker
BOX NS18 - (NSQ1620 )
3
BOX NS18 - (NSQ1620 )
BOX NS18 - (NSQ1620 )
10
English text: HOMEMAKER
HospiceWorker
BOX NS18 - (NSQ1620 )
11
English text: HOSPICE WORKER
IvTherapist
BOX NS18 - (NSQ1620 )
12
English text: I.V. THERAPIST
Nurse
BOX NS18 - (NSQ1620 )
13
English text: NURSE (RN)
NursePractitioner
BOX NS18 - (NSQ1620 )
English text: NURSE PRACTITIONER
3:17:54 PM Monday, August 03, 2009
Page 71 of 278
NS18
14
NursesAide
BOX NS18 - (NSQ1620 )
15
English text: NURSE'S AIDE
OccupationalTherapist
BOX NS18 - (NSQ1620 )
16
English text: OCCUPATIONAL THERAPIST (OT)
Optometrist
BOX NS18 - (NSQ1620 )
17
English text: OPTOMETRIST (OD)
Osteopath
BOX NS18 - (NSQ1620 )
18
English text: OSTEOPATH (DO)
Paramedic
BOX NS18 - (NSQ1620 )
19
English text: PARAMEDIC
PhysicalTherapist
BOX NS18 - (NSQ1620 )
20
English text: PHYSICAL THERAPIST (PT)
PhysiciansAssistant
BOX NS18 - (NSQ1620 )
21
English text: PHYSICIAN'S ASSISTANT
Podiatrist
BOX NS18 - (NSQ1620 )
22
English text: PODIATRIST (FOOT DOCTOR)
Psychologist
BOX NS18 - (NSQ1620 )
23
English text: PSYCHOLOGIST
RespiratoryTherapist
BOX NS18 - (NSQ1620 )
25
English text: RESPIRATORY THERAPIST
SocialWorker
English text: SOCIAL/CASE WORKER
SpeechTherapist
BOX NS18 - (NSQ1620 )
26
English text: SPEECH THERAPIST
MentalHealth
BOX NS18 - (NSQ1620 )
24
BOX NS18 - (NSQ1620 )
28
English text: THERAPIST (MENTAL HEALTH)
XrayTechnician
BOX NS18 - (NSQ1620 )
English text: X-RAY TECHNICIAN
LicensedPracticalNurse
BOX NS18 - (NSQ1620 )
29
English text: LICENSED PRACTICAL NURSE (LPN)
Acupuncturist
BOX NS18 - (NSQ1620 )
27
31
English text: ACUPUNCTURIST
Homeopath
English text: HOMEOPATH
MassageTherapist
32
English text: MASSAGE THERAPIST
Naturopath
BOX NS18 - (NSQ1620 )
33
English text: NATUROPATH
LicensedCounselor
BOX NS18 - (NSQ1620 )
34
English text: LICENSED PROFESSIONAL COUNSELOR [LPC]
LabTechnician
BOX NS18 - (NSQ1620 )
30
BOX NS18 - (NSQ1620 )
BOX NS18 - (NSQ1620 )
English text: LAB TECHNICIAN
3:18:14 PM Monday, August 03, 2009
Page 72 of 278
NS18
91
Other
NS18 - PROVSPOS ( NSQ1610 )
English text: OTHER MEDICAL PROVIDER SPECIALTY
Attribute
Don't know
Route
BOX NS18 - (NSQ1620 )
Refusal
BOX NS18 - (NSQ1620 )
Field2:
PROVSPOS
( NSQ1610 )
PROV.PROVSPOS
Cheshire Name:
Item Text display:
Display "(SPECIFY)" in the same blue font used for
interviewer instructions.
Item Text:
OTHER MEDICAL PROVIDER (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 NS18 - (NSQ1620 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:18:17 PM Monday, August 03, 2009
Page 73 of 278
BOX NS18
BOX NS18
Page Order # :
430
BOX INSTRUCTIONS
( NSQ1620 )
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 NS19 VAPLACE ( NSQ1630 ).
ELSE GO TO BOX NS19 - (NSQ1650 ).
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
3:18:17 PM Monday, August 03, 2009
Page 74 of 278
NS19
NS19
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
440
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of Provider, PROV.PROVNAME, selected at NS13.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Is (PROVIDER NAME) associated with a Department of Veterans
Affairs, or V.A. facility?
Int. Instr II:
INPUT FIELDS / ROUTING
3:18:18 PM Monday, August 03, 2009
Page 75 of 278
NS19
VAPLACE
Field1:
( NSQ1630 )
PROV.VAPLACE
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
BOX NS19 - (NSQ1650 )
English text: YES
No
BOX NS19 - (NSQ1650 )
English text: NO
Attribute
Don't know
Route
BOX NS19 - (NSQ1650 )
Refusal
BOX NS19 - (NSQ1650 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:18:20 PM Monday, August 03, 2009
Page 76 of 278
BOX NS19
BOX NS19
Page Order # :
460
BOX INSTRUCTIONS
( NSQ1650 )
IF ALL EVENTS ADDED AT NS16 ARE 'IU' EVENT TYPE, GO TO NS14
NSDATEUPD ( NSQ1412 ).
ELSE IF (SP COVERED BY A MANAGED CARE PLAN ANYTIME DURING
THE CURRENT ROUND) AND (IF THIS PROVIDER IS ASSOCIATED WITH
A MANAGED CARE PLAN IS UNKNOWN), GO TO NS20 - HMOASSOC (
NSQ1660 ).
ELSE IF (SP COVERED BY A MANAGED CARE PLAN ANYTIME DURING
THE CURRENT ROUND) AND (THIS PROVIDER IS NOT ASSOCIATED
WITH A MANAGED CARE PLAN), GO TO NS21 - HMOREFER ( NSQ1670 ).
ELSE GO TO NS22A_IN - NAVIGATOR ( NSQ1679 ).
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.
2
ManagedCarePlan
SP covered by a Managed Care Plan anytime during
current round =
There is a PLRO.PLROPLAN=PLAN.PLANUM &
PLRO.PLRORND=current round &
((PLRO.PPRVHMO=1/Yes) or (PLAN.PLANTYPE =
5/MHMO & PLRO.COVANYTM=1/Yes) or
(PLRO.MCAIDHMO=1/Yes)). See T.N. 52.
128
ProviderHMOUnknown
If Provider is associated with a Managed Care plan is
unknown =
PROV.HMOASSOC=empty.
130
ProviderNotHMO
Provider is not associated with a Managed Care plan =
PROV.HMOASSOC=2/No, DK, or RF.
129
ProviderAssocHMO
Provider is associated with a Managed Care plan =
PROV.HMOASSOC=1/Yes.
241
TypeOfEvent
Type of Event =
EVNT.EVNTTYPE.
DESIGN NOTES
We do not collect event details for 'IU' events.
3:18:20 PM Monday, August 03, 2009
Page 77 of 278
NS20
NS20
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HMOASSOC
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
470
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of Provider, PROV.PROVNAME, selected at NS13.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all managed care plans SP was covered by anytime during
the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Medicaid Managed Care plans, and Private Managed Care plans. If
there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display= If Medicaid Managed Care Plan, display
"Medicaid Managed Care Plan".
Else display health insurance plan name "(PLAN NAME) Managed
Care Plan".
TEXT:
Context Header:
3:18:22 PM Monday, August 03, 2009
Page 78 of 278
NS20
Int. Instr I:
Is (PROVIDER NAME) associated with [your/(SP’s)] [READ
MANAGED CARE PLAN NAME(S) BELOW] plan?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
HMOASSOC
Field1:
( NSQ1660 )
PROV.HMOASSOC
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
NS22A_IN - NAVIGATOR ( NSQ1679 )
English text: YES
No
NS21 - HMOREFER ( NSQ1670 )
English text: NO
Attribute
Don't know
Route
NS21 - HMOREFER ( NSQ1670 )
Refusal
NS21 - HMOREFER ( NSQ1670 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
3:18:25 PM Monday, August 03, 2009
Deleted plans that are not valid for displays or checks =
Page 79 of 278
NS20
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.
2
ManagedCarePlan
SP covered by a Managed Care Plan anytime during
current round =
There is a PLRO.PLROPLAN=PLAN.PLANUM &
PLRO.PLRORND=current round &
((PLRO.PPRVHMO=1/Yes) or (PLAN.PLANTYPE =
5/MHMO & PLRO.COVANYTM=1/Yes) or
(PLRO.MCAIDHMO=1/Yes)). See T.N. 52.
107
PlanIsMCaidHMO
SP is covered by a Medicaid Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=2/Medicaid &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.MCAIDHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
111
PlanIsMCareHMO
SP is covered by a Medicare Managed Care Plan
(Medicare Advantage plan) during the current round =
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
112
PlanIsPrivateHMO
SP is covered by a Private Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
106
HIPlanName
Health Insurance Plan Roster is stored on PLAN.
Plan name = PLAN.PLNAME.
DESIGN NOTES
3:18:25 PM Monday, August 03, 2009
Page 80 of 278
NS21
NS21
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HMOREFER
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
480
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of Provider, PROV.PROVNAME, selected at NS13.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all managed care plans SP was covered by anytime during
the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Medicaid Managed Care plans, and Private Managed Care plans. If
there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display= If Medicaid Managed Care Plan, display
"Medicaid Managed Care Plan".
Else display health insurance plan name "(PLAN NAME) Managed
Care Plan".
TEXT:
Context Header:
3:18:26 PM Monday, August 03, 2009
Page 81 of 278
NS21
Int. Instr I:
[Were you/Was (SP)] referred to (PROVIDER NAME) by [READ
MANAGED CARE PLAN NAME(S) BELOW]?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
HMOREFER
Field1:
( NSQ1670 )
EVNT.HMOREFER
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
NS22A_IN - NAVIGATOR ( NSQ1679 )
English text: YES
No
NS22A - NOGOHMO ( NSQ1672 )
English text: NO
Attribute
Don't know
Route
NS22A_IN - NAVIGATOR ( NSQ1679 )
Refusal
NS22A_IN - NAVIGATOR ( NSQ1679 )
BACKGROUND VARIABLE ASSIGNMENTS
HMOREFER is an EVENT level detail. The response to HMOREFER needs to be copied
to EVNT.HMOREFER for event added at NS16.
HMOREFER
Set EVNT.HMOREFER = NS21 - HMOREFER on
each event added at NS16.
SOFT EDIT CHECKS
HARD EDIT CHECKS
3:18:29 PM Monday, August 03, 2009
Page 82 of 278
NS21
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.
2
ManagedCarePlan
SP covered by a Managed Care Plan anytime during
current round =
There is a PLRO.PLROPLAN=PLAN.PLANUM &
PLRO.PLRORND=current round &
((PLRO.PPRVHMO=1/Yes) or (PLAN.PLANTYPE =
5/MHMO & PLRO.COVANYTM=1/Yes) or
(PLRO.MCAIDHMO=1/Yes)). See T.N. 52.
107
PlanIsMCaidHMO
SP is covered by a Medicaid Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=2/Medicaid &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.MCAIDHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
111
PlanIsMCareHMO
SP is covered by a Medicare Managed Care Plan
(Medicare Advantage plan) during the current round =
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
112
PlanIsPrivateHMO
SP is covered by a Private Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
106
HIPlanName
Health Insurance Plan Roster is stored on PLAN.
Plan name = PLAN.PLNAME.
DESIGN NOTES
3:18:29 PM Monday, August 03, 2009
Page 83 of 278
NS22A
NS22A
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
NOGOHMO
Field 2:
NOGOHMOS
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
486
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:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Medicaid Managed Care plans, and Private Managed Care plans. If
there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display= If Medicaid Managed Care Plan, display
"Medicaid Managed Care Plan".
Else display health insurance plan name "(PLAN NAME) Managed
Care Plan".
TEXT:
Context Header:
Int. Instr I:
3:18:32 PM Monday, August 03, 2009
Page 84 of 278
NS22A
Question Text:
What is the most important reason [you/(SP)] did not see a doctor
associated with [READ MANAGED CARE PLAN NAME(S) BELOW]
or a doctor that [READ MANAGED CARE PLAN NAME(S) BELOW]
would refer [you/(SP)] to?
Int. Instr II:
INPUT FIELDS / ROUTING
3:18:37 PM Monday, August 03, 2009
Page 85 of 278
NS22A
NOGOHMO
Field1:
( NSQ1672 )
EVNT.NOGOHMO
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
Tnogohmo
1
No
No
Number Label
1 PlanNotCoverService
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
NS22A_IN - NAVIGATOR ( NSQ1679 )
English text: PLAN DOES NOT COVER THE SERVICE SP WANTED
DifficultyDelayGettingService
NS22A_IN - NAVIGATOR ( NSQ1679 )
4
English text: DIFFICULTY OR DELAY IN GETTING SERVICES
SPProviderPreference
NS22A_IN - NAVIGATOR ( NSQ1679 )
English text: SP PROVIDER PREFERENCE
ServiceCoverdbyOtherInsurance
NS22A_IN - NAVIGATOR ( NSQ1679 )
5
English text: THIS SERVICE WAS COVERED BY OTHER INSURANCE SP HAS
NotinManagedCareTimeofEvent
NS22A_IN - NAVIGATOR ( NSQ1679 )
6
English text: NOT IN A MANAGED CARE PLAN AT TIME OF EVENT
NoChoiceMedEmergency
NS22A_IN - NAVIGATOR ( NSQ1679 )
3
91
English text: NO CHOICE - MEDICAL EMERGENCY OR OUT OF SERVICE AREA
Other
NS22A - NOGOHMOS ( NSQ1674 )
English text: OTHER
Attribute
Don't know
Route
NS22A_IN - NAVIGATOR ( NSQ1679 )
Refusal
NS22A_IN - NAVIGATOR ( NSQ1679 )
3:18:43 PM Monday, August 03, 2009
Page 86 of 278
NS22A
Field2:
NOGOHMOS
( NSQ1674 )
EVNT.NOGOHMOS
Cheshire Name:
Item Text display:
Display "(SPECIFY)" in the 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
NS22A_IN - NAVIGATOR ( NSQ1679 )
BACKGROUND VARIABLE ASSIGNMENTS
NOGOHMO and NOGOHMOS are EVENT level details.
The response to NOGOHMO needs to be copied to EVNT.NOGOHMO for each event
added at NS16.
The response to NOGOHMOS needs to be copied to EVNT.NOGOHMOS for each event
added at NS16.
NOGOHMO
Set EVNT.NOGOHMO = NS22 - NOGOHMO on
each event added at NS16.
NOGOHMOS
Set EVNT.NOGOHMOS = NS22 - NOGOHMOS on
each event added at NS16.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:18:44 PM Monday, August 03, 2009
Page 87 of 278
NS22A_IN
NS22A_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
489
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 DU, ER, IP, OP, MP events added at NS16.
Display all IU, SD, SL events as "DONE". Do not allow event
details to be collected for these events.
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
3:18:45 PM Monday, August 03, 2009
Page 88 of 278
NS22A_IN
NAVIGATOR
Field1:
( NSQ1679 )
N/A
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
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX NS22A - (NSQ1680 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
NS14 - NSDATEUPD ( NSQ1412 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of event selected at NS16.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:18:46 PM Monday, August 03, 2009
Page 89 of 278
BOX NS22A
BOX NS22A
Page Order # :
490
BOX INSTRUCTIONS
( NSQ1680 )
FOR THE EVENT ADDED AT NS16,
IF TYPE OF EVENT = 'DU', GO TO DU7 - DVPROCDR ( DUQ1170 ).
ELSE IF TYPE OF EVENT = 'ER', GO TO ER5 - CONDTION_ER ( ERQ1160
).
ELSE IF TYPE OF EVENT = 'IP', GO TO IP7 - ANYOPERS ( IPQ1240 ).
ELSE IF TYPE OF EVENT = 'OP', GO TO OP5 - ANYOPERS ( OPQ1160 ).
ELSE IF TYPE OF EVENT = 'MP', GO TO BOX NS22B - (NSQ1685 ).
ELSE GO TO BOX NS23B - (NSQ1700 ).
ASSIGNMENTS
TECHNICAL NOTES
241
TypeOfEvent
Type of Event =
EVNT.EVNTTYPE.
DESIGN NOTES
BOX NS22A calls the DU, ER, IP, OP Utilization sections, depending on
EVNTTYPE of event added at NS16.
MP events are handled by BOX NS23A.
IU, SD, SL events do not get event details.
DU, ER, IP and OP returns to NS at BOX NS23B.
3:18:47 PM Monday, August 03, 2009
Page 90 of 278
BOX NS22B
BOX NS22B
Page Order # :
495
BOX INSTRUCTIONS
( NSQ1685 )
IF (PROVIDER SPECIALTY IS A MEDICAL DOCTOR) AND ((EVENT DATE
OVERLAPS AN EXISTING IP EVENT) OR (EVENT DATE MATCHES AN
EXISTING ER OR OP EVENT) GO TO NS23 - MPSDVIS ( NSQ1691 ).
ELSE GO TO BOX NS23A - (NSQ1695 ).
ASSIGNMENTS
TECHNICAL NOTES
171
ProviderMedicalDoctor
Provider Specialty is a Medical Doctor =
PROV.PROVSPEC=2/MedicalDoctor
350
OverlapERIPOPStay
Event date overlaps an existing IP stay or Event date
matches an existing ER or OP event date =
See general specifications for detailed date logic check.
DESIGN NOTES
3:18:47 PM Monday, August 03, 2009
Page 91 of 278
NS23
NS23
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MPSDVIS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
500
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:
Display name of medical provider, PROV.PROVNAME, for MP event
added at NS16, where PROV.PROVNUM = EVNT.EVNTPROV.
Display date of event for the for MP event added at NS16.
Question display:
EVENT MONTH = Display Month of the MP event added at NS16.
Display name of medical provider, PROV.PROVNAME, for MP
event added at NS16, where PROV.PROVNUM =
EVNT.EVNTPROV.
Display "in" in the second sentence in BOLD.
If event overlaps more than one existing ER, IP, or OP event,
display "any of these places".
Else display "the [READ EVENT LISTED BELOW]".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
3:18:48 PM Monday, August 03, 2009
Display report below question text.
Display ER, IP, and OP events that overlap or match the MP event
added at NS16.
Report Header: OVERLAPPING EVENT DATES
Column 1, header = "EVENT TYPE".
Column 1, display =
Page 92 of 278
NS23
If EVNT.EVNTTYPE = 2/ER, display "Emergency Room".
Else if EVNT.EVNTTYPE = 5/IP, display "Hospital as an Inpatient".
Else if EVNT.EVNTTYPE = 9/OP, display "Outpatient Department".
Column 2, header = "EVENT DATE".
Column 2, display EVENT BEGIN DATE
Column 3, header = "EVENT END DATE".
Column 3, display EVENT END DATE
TEXT:
Context Header:
PROVIDER: (PROVIDER NAME)
EVENT: (EVENT DATE)
Int. Instr I:
Question Text:
We have recorded that in (EVENT MONTH) [you were/(SP) was]
also in [READ EVENT(S) LISTED BELOW]. Was this visit with
(PROVIDER NAME) a visit while [you were/(SP) was] in [the [READ
EVENT LISTED BELOW]/any of these places]?
Int. Instr II:
INPUT FIELDS / ROUTING
3:18:51 PM Monday, August 03, 2009
Page 93 of 278
NS23
( NSQ1691 )
MPSDVIS
Field1:
EVNT.MPSDVIS
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
BOX NS23A - (NSQ1695 )
English text: YES
No
BOX NS23A - (NSQ1695 )
English text: NO
Attribute
Don't know
Route
BOX NS23A - (NSQ1695 )
Refusal
BOX NS23A - (NSQ1695 )
BACKGROUND VARIABLE ASSIGNMENTS
EVNTTYPE
If NS23 - MPSDVIS = 1/Yes, update MP event type
to Separately Billing Doctor, EVNT.EVNTTYPE =
'SD'.
STEVTYPE
If NS23 - MPSDVIS = 1/Yes, update MP Statement
event type to Separately Billing Doctor,
EVNT.STEVTYPE = 2/SD.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
350
OverlapERIPOPStay
Event date overlaps an existing IP stay or Event date
matches an existing ER or OP event date =
See general specifications for detailed date logic check.
DESIGN NOTES
3:18:53 PM Monday, August 03, 2009
Page 94 of 278
BOX NS23A
BOX NS23A
Page Order # :
505
BOX INSTRUCTIONS
( NSQ1695 )
IF NS23 ASKED AND NS23 - MPSDVIS = 1/Yes, GO TO BOX NS23B
(NSQ1700 ).
ELSE GO TO BOX MP2C - (MPQ1220 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
BOX NS23A calls the MP Utilization section.
MP returns to NS at BOX NS23B.
3:18:53 PM Monday, August 03, 2009
Page 95 of 278
BOX NS23B
BOX NS23B
Page Order # :
510
BOX INSTRUCTIONS
( NSQ1700 )
GO TO NS22A_IN - NAVIGATOR ( NSQ1679 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
Return from Utilzation sections at BOX NS23B.
3:18:53 PM Monday, August 03, 2009
Page 96 of 278
NS24
NS24
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_NSDATE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Statement Event Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
515
DISPLAY INSTRUCTIONS:
Context header display:
Display name of Provider, PROV.PROVNAME, selected at NS13.
Question display:
Always display "(S)" in interviewer instructions in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Display all events for this provider where:
EVNT.EVNTTYPE = 'DU', 'ER', 'IP', 'IU', 'OP', 'MP', 'SD', or 'SL', and
EVNT.EVNTPROV = the PROV.PROVNUM selected at NS13, and
EVNT.EVNTDFLG ^= 1/Yes
Display in order of entry.
Roster/Grid display:
3:18:54 PM Monday, August 03, 2009
COL #
HEADER
INSTRUCTIONS
1
Type
Display EVNT.EVNTTYPE.
2
Start Date
Display EVENT DATE in "Mon DD YYYY"
format.
3
Stop Date
If (EVNT.EVNTTYPE = 'IU') or
(EVNT.EVNTTYPE = 'IP' and
EVNT.IPSTATUS ^=1/StillInHospital),
display EVENT END DATE in "Mon DD
YYYY" format..
Else do not display.
Page 97 of 278
NS24
4
Status
If EVNT.EVNTTYPE = 'IP' and
EVNT.IPSTATUS = 1/StillInHospital,
display "ON".
Else if EVNT.VISTTYPE = 2/RepeatVisit,
display "RV".
Else do not display.
5
# Visits
If EVNT.VISTTYPE = 2/RepeatVisit,
display EVNT.RVTIMES.
Else do not display.
6
Round
Display 'R' + EVNT.EVNTRNDC. EX:
R45
If Event Date is out of the Survey
Reference Period, display "ORP".
Else do not display.
7
Report display:
TEXT:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
PROVIDER: (PROVIDER NAME)
Context Header:
Int. Instr I:
Question Text:
SELECT THE EVENT DATE(S) THAT ARE INCLUDED IN THIS
CHARGE BUNDLE.
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
EVENT_NSDATE
( NSQ1705 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
3:18:55 PM Monday, August 03, 2009
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX NS24 - (NSQ1707 )
Page 98 of 278
NS24
BACKGROUND VARIABLE ASSIGNMENTS
Create an XCEV record for each event selected at NS24 to link the event to the charge
bundle being asked about. XCEV record may already exist.
If XCEV record does not exist, create XCEV record:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVBASE and XCEV.XCEVBAS2 = BASE.BASEID.
XCEV.XCEVCOST = COST.COSTNUM of charge bundle being asked about.
XCEV.XCEVEVNT = EVNT.EVNTNUM of event selected at NS24.
Set fields as specified below:
XCEVCOST
Create XCEV where XCEV.XCEVCOST = this
COST.COSTNUM.
XCEVEVNT
Create XCEV where XCEV.XCEVEVNT =
EVNT.EVNTNUM of EVNT selected.
XCEVRNDC
Set XCEV.XCEVRNDC = current round.
DELLINK
If XCEV exists and XCEV.DELLINK = 1/Yes, update
XCEV.DELLINK = empty.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
246
ORPEvent
Existing Event Date is outside survery reference period =
EVNT.EVORPFLAG = 1/ORP.
New event is Out of the Survey Reference Period =
See general specifications for Date check logic for
determing ORP events.
DESIGN NOTES
Interviewer can only select events at this roster.
3:18:55 PM Monday, August 03, 2009
Page 99 of 278
BOX NS24
BOX NS24
Page Order # :
517
BOX INSTRUCTIONS
( NSQ1707 )
IF AT LEAST ONE EVENT SELECTED AT NS24 IS A REPEAT VISIT, GO TO
NS24A - RVLINKS ( NSQ1708 ).
ELSE GO TO NS25 - NSDATEMTCH ( NSQ1710 ).
ASSIGNMENTS
TECHNICAL NOTES
135
RepeatVisitEvent
If Event entered as a Repeat Visit =
EVNT.VISTTYPE=2/RepeatVisit.
DESIGN NOTES
3:18:55 PM Monday, August 03, 2009
Page 100 of 278
NS24A
NS24A
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
RVLINKS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
518
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:
Display name of Provider, PROV.PROVNAME, selected at NS13.
Question display:
Display "(EVENT TYPE)" and "(EVENT MONTH, YEAR)" for the
Repeat Visit Event selected at NS24 being asked about.
Display type of event, EVNT.EVNTTYPE.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
PROVIDER NAME: (PROVIDER NAME)
Int. Instr I:
Question Text:
Int. Instr II:
3:18:56 PM Monday, August 03, 2009
ENTER THE NUMBER OF (EVENT TYPE) VISITS IN (EVENT
MONTH, YEAR) THAT ARE COVERED BY THIS CHARGE.
Page 101 of 278
NS24A
INPUT FIELDS / ROUTING
RVLINKS
Field1:
( NSQ1708 )
XCEV.RVLINKS
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF VISITS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TRvtimes
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
BOX NS24A - (NSQ1709 )
Refusal
BOX NS24A - (NSQ1709 )
FieldSize:
Min Value:
Max Value:
Mask:
1
90
Route
BOX NS24A - (NSQ1709 )
BACKGROUND VARIABLE ASSIGNMENTS
Collect # of visits on XCEV:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVCOST = COST.COSTNUM of charge bundle being asked about.
XCEV.XCEVEVNT = EVNT.EVNTNUM of Repeat Visit event currently being asked about.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:18:57 PM Monday, August 03, 2009
Page 102 of 278
BOX NS24A
BOX NS24A
Page Order # :
519
BOX INSTRUCTIONS
( NSQ1709 )
IF ANOTHER EVENT SELECTED AT NS24 IS A REPEAT VISIT, GO TO
NS24A - RVLINKS ( NSQ1708 ).
ELSE GO TO NS25 - NSDATEMTCH ( NSQ1710 ).
ASSIGNMENTS
TECHNICAL NOTES
135
RepeatVisitEvent
If Event entered as a Repeat Visit =
EVNT.VISTTYPE=2/RepeatVisit.
DESIGN NOTES
3:18:57 PM Monday, August 03, 2009
Page 103 of 278
NS25
NS25
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
NSDATEMTCH
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
520
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:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report below question text.
Display all Events linked to this charge bundle where
XCEV.XCEVEVNT = the EVNT.EVNTNUM and XCEV.XCEVCOST =
the COST.COSTNUM for the Charge Bundle and XCEV.DELLINK
^=1/Yes. Display PMs followed by OM events, HH events and then
other provider service events.
NOTE: This report is shared by other questions. Not all Event types
will be applicable at each screen.
Report header: EVENTS IN CHARGE BUNDLE
Report layout:
Column 1, header =Type
Display EVNT.EVNTTYPE
Column 2, NO HEADER.
If EVNT.RENTPROB=2/Rent and ((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or (EVNT.RENT2BUY = EMPTY)), display
3:18:58 PM Monday, August 03, 2009
Page 104 of 278
NS25
"R".
Else do not display.
Column 3, header = Description
If EVNT.EVNTTYPE = OM then
If EVNT.STOMTYPE = 91, display EVOS.EVOSTEXT on EVOS
where EVOS.EVOSEVNT = this EVNT.EVNTNUM.
Else display EVNT.STOMTYPE response text.
Else if EVNT.EVNTTYPE = PM, display EVNT.PMEDNAME.
Else display PROV.PROVNAME on PROV where PROV.PROVNUM
= this EVNT.EVNTPROV.
Column 4, header = Start Date
If (EVNT.EVNTTYPE = DU, ER, IP, IU, OP, MP, SD or SL) or
(EVNT.EVNTTYPE = OM and
((EVNT.OTHRTYPE ^= 5/OstomySupplies and
^= 6/IncontinenceSupplies and ^= 7/Bandages) or
(EVNT.OTHRTYPE = EMPTY)) and
((EVNT.OMSTATUS ^= 1/AlterationNotComplete) or
(EVNT.OMSTATUS = EMPTY))),
display EVENT DATE in "Mon DD YYYY" format.
Else do not display.
Column 5, header = Stop Date
If (EVNT.EVNTTYPE = IU) or
(EVNT.EVNTTYPE = IP and
EVNT.IPSTATUS ^= 1/StillInHospital) or
(EVNT.EVNTTYPE = OM and EVNT.RENTPROB = 2/Rent and
(EVNT.RENTSTIL = 2/No, DK, or RF) and
((EVNT.RENT2BUY ^= 2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY))),
display EVNT END DATE in "Mon DD YYYY" format.
Else do not display.
Column 6, header = Status
If EVNT.VISTTYPE = 2/RepeatVisit, display “RV”.
Else if
(EVNT.EVNTTYPE = OM and
EVNT.OMSTATUS = 1/AlterationNotComplete) or
(EVNT.EVNTTYPE = IP and EVNT.IPSTATUS =
1/StillInHospital),
display "ON".
Else if EVNT.RENTSTIL = 1/Yes, display "RR".
Else if EVNT.RENT2BUY=2/PurchasedRentToBuy, display "OW".
3:18:59 PM Monday, August 03, 2009
Page 105 of 278
NS25
Else do not display.
Column 7, header = # Visits
If EVNT.VISTTYPE = 2/RepeatVisit, display XCEV.RVLINKS on
XCEV where XCEV.XCEVEVNT = this EVNT.EVNTNUM and
XCEV.XCEVCOST = the COST.COSTNUM for this charge bundle.
Else do not display.
Column 8, header = # Purchases
If (EVNT.EVNTYPE = PM) or
(EVNT.EVNTTYPE = OM and
(EVNT.OTHRTYPE = 5/OstomySupplies,
6/IncontinenceSupplies, or 7/Bandages)),
display XCEV.NUMLINKS on XCEV where
XCEV.XCEVEVNT = this EVNT.EVNTNUM and
XCEV.XCEVCOST = the COST.COSTNUM for this charge
bundle.
Else do not display.
Column 9,
If Event Date is out of Survey Reference Period, display “ORP”.
Else do not display.
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
ARE ALL THE PROVIDER EVENTS FROM THE CHARGE BUNDLE
SHOWN BELOW?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
3:19:02 PM Monday, August 03, 2009
Page 106 of 278
NS25
NSDATEMTCH
Field1:
( NSQ1710 )
TEMP
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
TSTDateMtch
1
No
No
Number Label
1 Yes
2
3
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX NS26 - (NSQ1720 )
English text: YES
NoAddDate
NS13 - PROVIDER_NSDATE ( NSQ1410 )
English text: NO, NEED TO ADD A PROVIDER EVENT
NoDeleteDate
NS26 - EVENT_NSDATEDEL ( NSQ1715 )
English text: NO, NEED TO REMOVE A PROVIDER EVENT
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
246
ORPEvent
Existing Event Date is outside survery reference period =
EVNT.EVORPFLAG = 1/ORP.
New event is Out of the Survey Reference Period =
See general specifications for Date check logic for
determing ORP events.
DESIGN NOTES
3:19:04 PM Monday, August 03, 2009
Page 107 of 278
NS26
NS26
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_NSDATEDEL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Statement Event Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
525
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(S)" in interviewer instructions in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Display all Provider Service events linked to this charge bundle:
There is an EVNT where:
EVNT.EVNTTYPE = 'DU', 'ER', 'IP', 'IU', 'OP', 'MP', 'SD', or 'SL', and
There is an XCEV where:
XCEV,XCEVEVNT = this EVNT.EVNTNUM, and
XCEV.XCEVCOST = COST.COSTNUM for this charge bundle, and
XCEV.DELLINK ^= 1/Yes.
Display in order of entry.
Roster/Grid display:
3:19:04 PM Monday, August 03, 2009
COL #
HEADER
INSTRUCTIONS
1
Type
Display EVNT.EVNTTYPE.
2
Start Date
Display EVENT DATE in "Mon DD YYYY"
format.
3
Stop Date
If (EVNT.EVNTTYPE = 'IU') or
(EVNT.EVNTTYPE = 'IP' and
EVNT.IPSTATUS ^=1/StillInHospital),
display EVENT END DATE in "Mon DD
YYYY" format.
Else do not display.
Page 108 of 278
NS26
4
Status
If EVNT.EVNTTYPE = 'IP' and
EVNT.IPSTATUS = 1/StillInHospital,
display "ON".
Else if EVNT.VISTTYPE = 2/RepeatVisit,
display "RV".
Else do not display.
5
# Visits
If EVNT.VISTTYPE = 2/RepeatVisit,
display XCEV.RVLINKS on XCEV where
XCEV.XCEVEVNT=this
EVNT.EVNTNUM and
XCEV.XCEVCOST=COST.COSTNUM for
this charge bundle.
Else do not display.
6
Round
Display 'R' + EVNT.EVNTRNDC. EX:
R45
7
If Event Date is out of the Survey
Reference Period, display "ORP".
Else do not display.
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
Question Text:
Int. Instr II:
SELECT THE EVENT(S) THAT YOU WOULD LIKE TO REMOVE
FROM THE CHARGE BUNDLE.
INPUT FIELDS / ROUTING
3:19:05 PM Monday, August 03, 2009
Page 109 of 278
NS26
EVENT_NSDATEDEL
Field1:
Cheshire Name:
( NSQ1715 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
NS25 - NSDATEMTCH ( NSQ1710 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on XCEV:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVBASE and XCEV.XCEVBAS2 = BASE.BASEID.
XCEV.XCEVCOST = COST.COSTNUM of charge bundle being asked about.
XCEV.XCEVEVNT = EVNT.EVNTNUM of event selected at NS26
Each Event selected at NS26 will be flagged as "deleted" on XCEV. The event will no
longer being "linked" to the charge bundle being asked about. See detailed instructions
below.
Set XCEV.DELLINK = 1/Yes on XCEV where
XCEV.XCEVCOST = this COST.COSTNUM and
XCEV.XCEVEVNT = EVNT.EVNTNUM of event
selected.
DELLINK
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
246
ORPEvent
Existing Event Date is outside survery reference period =
EVNT.EVORPFLAG = 1/ORP.
New event is Out of the Survey Reference Period =
See general specifications for Date check logic for
determing ORP events.
DESIGN NOTES
3:19:06 PM Monday, August 03, 2009
Page 110 of 278
NS26
Interviewer can only select events at this roster.
3:19:06 PM Monday, August 03, 2009
Page 111 of 278
BOX NS26
BOX NS26
530
Page Order # :
BOX INSTRUCTIONS
( NSQ1720 )
IF NS12 – INCTYPE INCLUDES 2/HHVisits, GO TO NS27 - PROVIDER_HH
( NSQ1725 ).
ELSE GO TO BOX NS33 - (NSQ1785 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
3:19:06 PM Monday, August 03, 2009
Page 112 of 278
NS27
NS27
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PROVIDER_HH
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
535
Display as ' Add a Provider '
Display as ' Edit a Provider '
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:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
WHICH HOME HEALTH PROVIDER IS IN THIS CHARGE BUNDLE?
Question Text:
Int. Instr II:
3:19:07 PM Monday, August 03, 2009
SELECT OR ADD ONLY ONE PROVIDER.
Page 113 of 278
NS27
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
PROVIDER_HH
( NSQ1725 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TProvPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX NS28A - (NSQ1740 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on PROV:
PROV key = PROV.PROVBASE + PROV.PROVNUM
PROV.PROVNUM = Number of Provider selected at N27.
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
Provider name
Set COST.COSTPROV = Provider selected at NS27. See additional instructions below.
COSTPROV
COST.COSTPROV = PROV.PROVNUM of provider
selected at NS27.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
Interviewer can add or select Provider at this roster.
3:19:07 PM Monday, August 03, 2009
Page 114 of 278
BOX NS28A
BOX NS28A
540
Page Order # :
BOX INSTRUCTIONS
( NSQ1740 )
IF (HOME HEALTH PROVIDER WAS ADDED AT NS27) OR (AN EXISTING
PROVIDER WAS SELECTED AT NS27 THAT WAS NOT ASSOCIATED
WITH A HOME HEALTH EVENT), GO TO NS30 - HHEVNTTYPE ( NSQ1755
).
ELSE GO TO BOX NS31B - (NSQ1770 ).
ASSIGNMENTS
TECHNICAL NOTES
245
ProviderNotHHEvent
Provider not associated with Home Health Event =
For this PROV, there is no EVNT where
(EVNT.EVNTPROV=PROV.PROVNUM &
(EVNT.EVNTTYPE = 'HP' or 'HF') & EVNT.EVNTDFLG
^= 1/Yes).
DESIGN NOTES
3:19:07 PM Monday, August 03, 2009
Page 115 of 278
NS30
NS30
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
HHEVNTTYPE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
555
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:
Display name of Provider selected at NS27.
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
PROVIDER: (PROVIDER NAME)
Int. Instr I:
Question Text:
Int. Instr II:
IS THE PROVIDER A HOME HEALTH PROFESSIONAL OR SOME
OTHER TYPE OF HOME HEALTH PROVIDER (HOME HEALTH
AIDE, HOMEMAKER, ETC.)?
INPUT FIELDS / ROUTING
3:19:08 PM Monday, August 03, 2009
Page 116 of 278
NS30
HHEVNTTYPE
Field1:
Cheshire Name:
( NSQ1755 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THHEVNTTYPE
1
No
No
Number Label
1 HP
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
NS31 - NSHHINTRO ( NSQ1760 )
English text: HOME HEALTH PROFESSIONAL
HF
NS31 - NSHHINTRO ( NSQ1760 )
English text: OTHER HOME HEALTH PROVIDER
BACKGROUND VARIABLE ASSIGNMENTS
Set Provider Type based on NS30 - HHEVNTTYPE:
PROVTYPE
If NS30 - HHEVNTTYPE = 1/HP, set
PROV.PROVTYPE = 6/HomeHealthProfessionals.
Else set PROV.PROVTYPE =
7/HomeHealthNotHHMembers.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:19:10 PM Monday, August 03, 2009
Page 117 of 278
NS31
NS31
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
NSHHINTRO
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
560
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:
Before we continue with this statement, I would like to ask you a few
questions about the home health provider I just added.
Int. Instr II:
INPUT FIELDS / ROUTING
3:19:11 PM Monday, August 03, 2009
Page 118 of 278
NS31
NSHHINTRO
Field1:
( NSQ1760 )
TEMP
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
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX NS31A - (NSQ1765 )
English text: CONTINUE
Attribute
Empty
Route
BOX NS31A - (NSQ1765 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:19:13 PM Monday, August 03, 2009
Page 119 of 278
BOX NS31A
BOX NS31A
Page Order # :
565
BOX INSTRUCTIONS
( NSQ1765 )
IF NS30 - HHEVNTTYPE = 1/HP, GO TO HH3 - PROVSPEC ( HHQ1030 ).
ELSE GO TO HH20 - HHFTYPE ( HHQ1330 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
BOX NS31A calls the Home Health Utilization Section.
Event details will be collected on EVNT where EVNT.EVNTPROV =
PROV.PROVNUM of Provider selected at NS27 and EVNT.EVNTTYPE =
HP or HF. The EVNT record will be identified or created while
administering the HH questions.
Home Health returns to NS at BOX NS31B.
3:19:13 PM Monday, August 03, 2009
Page 120 of 278
BOX NS31B
BOX NS31B
Page Order # :
570
BOX INSTRUCTIONS
( NSQ1770 )
LINK HOME HEALTH PROVIDER TO CHARGE BUNDLE .
GO TO NS32 - NSHHMTCH ( NSQ1775 ).
ASSIGNMENTS
Create an XCEV record to link Home Health event to the charge bundle being asked
about. XCEV record may already exist.
If XCEV record does not exist, create XCEV record:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVBASE and XCEV.XCEVBAS2 = BASE.BASEID.
XCEV.XCEVCOST = COST.COSTNUM of charge bundle being asked about.
XCEV.XCEVEVNT = EVNT.EVNTNUM of Home Health event currently being asked about.
Set fields as specified below:
XCEVCOST
Create XCEV where XCEV.XCEVCOST = this
COST.COSTNUM.
XCEVEVNT
Create XCEV where XCEV.XCEVEVNT =
EVNT.EVNTNUM of Home Health EVNT currently
being asked about.
XCEVRNDC
Set XCEV.XCEVRNDC = current round.
DELLINK
If XCEV exists and XCEV.DELLINK = 1/Yes, update
XCEV.DELLINK = empty.
TECHNICAL NOTES
DESIGN NOTES
Return from Home Health Section at BOX NS31B.
3:19:13 PM Monday, August 03, 2009
Page 121 of 278
NS32
NS32
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
NSHHMTCH
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
575
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report below question text.
Display all Events linked to this charge bundle where
XCEV.XCEVEVNT = the EVNT.EVNTNUM and XCEV.XCEVCOST =
the COST.COSTNUM for the Charge Bundle and XCEV.DELLINK
^=1/Yes. Display PMs followed by OM events, HH events and then
other provider service events.
NOTE: This report is shared by other questions. Not all Event types
will be applicable at each screen.
Report header: EVENTS IN CHARGE BUNDLE
Report layout:
Column 1, header =Type
Display EVNT.EVNTTYPE
Column 2, NO HEADER.
If EVNT.RENTPROB=2/Rent and ((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or (EVNT.RENT2BUY = EMPTY)), display
3:19:14 PM Monday, August 03, 2009
Page 122 of 278
NS32
"R".
Else do not display.
Column 3, header = Description
If EVNT.EVNTTYPE = OM then
If EVNT.STOMTYPE = 91, display EVOS.EVOSTEXT on EVOS
where EVOS.EVOSEVNT = this EVNT.EVNTNUM.
Else display EVNT.STOMTYPE response text.
Else if EVNT.EVNTTYPE = PM, display EVNT.PMEDNAME.
Else display PROV.PROVNAME on PROV where PROV.PROVNUM
= this EVNT.EVNTPROV.
Column 4, header = Start Date
If (EVNT.EVNTTYPE = DU, ER, IP, IU, OP, MP, SD or SL) or
(EVNT.EVNTTYPE = OM and
((EVNT.OTHRTYPE ^= 5/OstomySupplies and
^= 6/IncontinenceSupplies and ^= 7/Bandages) or
(EVNT.OTHRTYPE = EMPTY)) and
((EVNT.OMSTATUS ^= 1/AlterationNotComplete) or
(EVNT.OMSTATUS = EMPTY))),
display EVENT DATE in "Mon DD YYYY" format.
Else do not display.
Column 5, header = Stop Date
If (EVNT.EVNTTYPE = IU) or
(EVNT.EVNTTYPE = IP and
EVNT.IPSTATUS ^= 1/StillInHospital) or
(EVNT.EVNTTYPE = OM and EVNT.RENTPROB = 2/Rent and
(EVNT.RENTSTIL = 2/No, DK, or RF) and
((EVNT.RENT2BUY ^= 2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY))),
display EVNT END DATE in "Mon DD YYYY" format.
Else do not display.
Column 6, header = Status
If EVNT.VISTTYPE = 2/RepeatVisit, display “RV”.
Else if
(EVNT.EVNTTYPE = OM and
EVNT.OMSTATUS = 1/AlterationNotComplete) or
(EVNT.EVNTTYPE = IP and EVNT.IPSTATUS =
1/StillInHospital),
display "ON".
Else if EVNT.RENTSTIL = 1/Yes, display "RR".
Else if EVNT.RENT2BUY=2/PurchasedRentToBuy, display "OW".
3:19:15 PM Monday, August 03, 2009
Page 123 of 278
NS32
Else do not display.
Column 7, header = # Visits
If EVNT.VISTTYPE = 2/RepeatVisit, display XCEV.RVLINKS on
XCEV where XCEV.XCEVEVNT = this EVNT.EVNTNUM and
XCEV.XCEVCOST = the COST.COSTNUM for this charge bundle.
Else do not display.
Column 8, header = # Purchases
If (EVNT.EVNTYPE = PM) or
(EVNT.EVNTTYPE = OM and
(EVNT.OTHRTYPE = 5/OstomySupplies,
6/IncontinenceSupplies, or 7/Bandages)),
display XCEV.NUMLINKS on XCEV where
XCEV.XCEVEVNT = this EVNT.EVNTNUM and
XCEV.XCEVCOST = the COST.COSTNUM for this charge
bundle.
Else do not display.
Column 9,
If Event Date is out of Survey Reference Period, display “ORP”.
Else do not display.
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
THE FOLLOWING HOME HEALTH PROVIDER EVENT HAS BEEN
ADDED TO THIS CHARGE BUNDLE.
Question Text:
Int. Instr II:
PLEASE ENTER A COMMENT IF THIS EVENT WAS ENTERED IN
ERROR OR IF ANOTHER HOME HEALTH EVENT SHOULD BE
INCLUDED IN THIS CHARGE BUNDLE.
INPUT FIELDS / ROUTING
3:19:16 PM Monday, August 03, 2009
Page 124 of 278
NS32
NSHHMTCH
Field1:
( NSQ1775 )
TEMP
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
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX NS33 - (NSQ1785 )
English text: CONTINUE
Attribute
Empty
Route
BOX NS33 - (NSQ1785 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
246
ORPEvent
Existing Event Date is outside survery reference period =
EVNT.EVORPFLAG = 1/ORP.
New event is Out of the Survey Reference Period =
See general specifications for Date check logic for
determing ORP events.
DESIGN NOTES
3:19:18 PM Monday, August 03, 2009
Page 125 of 278
BOX NS33
BOX NS33
585
Page Order # :
BOX INSTRUCTIONS
( NSQ1785 )
IF NS12 – INCTYPE INCLUDES 3/OMExpenses, GO TO NS34 - NSOMUPD
( NSQ1790 ).
ELSE GO TO BOX NS40 - (NSQ1840 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
3:19:18 PM Monday, August 03, 2009
Page 126 of 278
NS34
NS34
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
NSOMUPD
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
590
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:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display Report below Question Text.
Display all other medical expense items where:
EVNT.EVNTDFLG^=1/Yes, and
EVNT.EVNTTYPE = OM.
Display in order of entry.
Report Header = OTHER MEDICAL EXPENSE EVENTS
Column 1, Display =
If EVNT.RENTPROB=2/Rent and ((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or (EVNT.RENT2BUY = EMPTY)), display
"R".
Column 2, Header = "OME Type".
Column 2, Display =
3:19:19 PM Monday, August 03, 2009
Page 127 of 278
NS34
If EVNT.STOMTYPE = 91/Other, display Other Specify Text,
EVOS.EVOSTEXT, on EVOS where EVOS.EVOSEVNT = this
EVNT.EVNTNUM.
Else display EVNT.STOMTYPE response text.
Column 3, Header =
"Purchase or Repair/Rental Date".
Column 3, Display =
If ((EVNT.OTHRTYPE ^= 5/OstomySupplies and ^=
6/IncontinenceSupplies and ^= 7/Bandages) or
(EVNT.OTHRTYPE = EMPTY)) and ((EVNT.OMSTATUS ^=
1/AlterationNotComplete) or (EVNT.OMSTATUS = EMPTY)), display
EVNT DATE in "Mon DD YYYY" format.
Else do not display.
Column 4, Header =
"Rental Stop Date".
Column 4, Display =
If EVNT.RENTPROB = 2/Rent and (EVNT.RENTSTIL = 2/No, DK, or
RF) and ((EVNT.RENT2BUY ^= 2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display EVNT END DATE in "Mon
DD YYYY" format.
Else do not display.
Column 5, Header = "Status".
Column 5, Display =
If EVNT.OMSTATUS = 1/AlterationNotComplete, display "ON".
Else if EVNT.RENTSTIL = 1/Yes, display "RR".
Else if EVNT.RENT2BUY = 2/PurchasedRentToBuy, display "OW".
Else do not display.
Column 6, Header = "Round".
Column 6, Display =
If ((EVNT.OTHRTYPE ^= 5/OstomySupplies and EVNT.OTHRTYPE
^= 6/IncontinenceSupplies and EVNT.OTHRTYPE ^= 7/Bandages)
or (EVNT.OTHRTYPE = EMPTY)), display 'R' + EVNT.EVNTRNDC.
EX: R45
Else do not display.
Column 7, Display =
If Event Date is out of the Survey Reference Period, display "ORP".
Else do not display.
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
THE FOLLOWING OME EVENTS HAVE BEEN ENTERED.
Question Text:
Int. Instr II:
DO YOU NEED TO ADD OR EDIT AN OME EVENT FOR THIS
CHARGE BUNDLE?
INPUT FIELDS / ROUTING
3:19:20 PM Monday, August 03, 2009
Page 128 of 278
NS34
NSOMUPD
Field1:
( NSQ1790 )
TEMP
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
TSTOMUpd
1
No
No
Number Label
1 No
FieldSize:
Min Value:
Max Value:
Mask:
Route
NS37 - EVENT_NSOM ( NSQ1812 )
2
English text: NO, DO NOT NEED TO ADD OR EDIT OM EVENT
YesAddEvent
NS36 - NSOMADD ( NSQ1800 )
3
English text: YES, NEED TO ADD AN OME EVENT
YesEditEvent
NS35 - EVENT_NSOMEDIT ( NSQ1795 )
English text: YES, NEED TO EDIT AN OME EVENT
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:19:22 PM Monday, August 03, 2009
Page 129 of 278
NS35
NS35
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_NSOMEDIT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Statement OM Edit Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
Yes
No
No
Add Line
Delete Line
No
No
Grid Functions:
595
Display as ' Edit OME Event '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all other medical expense items where:
EVNT.EVNTDFLG^=1/Yes, and
EVNT.EVNTTYPE = OM.
If (EVNT.OTHRTYPE=5/Ostomy Supplies, 6/Incontinence Supplies,
or 7/Bandages) or (EVNT.OMSTATUS=1/Alteration NotComplete),
display as protected row.
Display in order of entry.
Roster/Grid display:
COL #
1
3:19:23 PM Monday, August 03, 2009
HEADER
INSTRUCTIONS
If EVNT.RENTPROB=2/Rent and
((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
"R".
Else do not display.
Page 130 of 278
NS35
2
OME Type
If EVNT.STOMTYPE = 91/Other, display
Other Specify Text, EVOS.EVOSTEXT,
on EVOS where EVOS.EVOSEVNT =
this EVNT.EVNTNUM.
Else display EVNT.STOMTYPE response
text.
3
Purchase or
Repair/Rental
Date
If ((EVNT.OTHRTYPE ^=
5/OstomySupplies and ^=
6/IncontinenceSupplies & ^=
7/Bandages) or (EVNT.OTHRTYPE =
EMPTY)) & ((EVNT.OMSTATUS ^=
1/AlterationNotComplete) or
(EVNT.OMSTATUS = EMPTY)), display
EVENT DATE in "Mon DD YYYY" format.
Else do not display.
4
Rental Stop Date
If EVNT.RENTPROB = 2/Rent and
(EVNT.RENTSTIL = 2/No, DK, or RF)
and ((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
EVENT END DATE in "Mon DD YYYY"
format.
Else do not display.
5
Status
If EVNT.OMSTATUS =
1/AlterationNotComplete, display "ON".
Else if EVNT.RENTSTIL = 1/Yes, display
"RR".
Else if EVNT.RENT2BUY =
2/PurchasedRentToBuy, display "OW".
Else do not display.
6
Round
If ((EVNT.OTHRTYPE ^=
5/OstomySupplies and ^=
6/IncontinenceSupplies and ^=
7/Bandages) or (EVNT.OTHRTYPE =
EMPTY)), display 'R' +
EVNT.EVNTRNDC. EX: R45
Else do not display.
7
If Event Date is out of the Survey
Reference Period, display "ORP".
Else do not display.
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
Question Text:
Int. Instr II:
SELECT AND EDIT THE OTHER MEDICAL EXPENSE EVENT
THAT NEEDS CORRECTION.
INPUT FIELDS / ROUTING
3:19:23 PM Monday, August 03, 2009
Page 131 of 278
NS35
Field1:
EVENT_NSOMEDIT
( NSQ1795 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
NS34 - NSOMUPD ( NSQ1790 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of event selected at NS35.
If OM event is selected for editing, see STATEMENT OM EDIT ROSTER POP-UP
specifications for pop-up window programming specifications.
Fields updated in Pop-Up window:
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
EVNT.EVENDMM
EVNT.EVENDDD
EVNT.EVENDYY
EVORPFLG
If Event date edited is outside the Survey Reference
Period, set EVNT.EVORPFLG = 1/ORP. See
General Specifications for setting this ORP flag.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, should be on or
before (TODAY).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BEFORE (TODAY). PLEASE REENTER."
Edit #2
If ((EVNT.RENTSTIL = 2/No, DK, or RF) and (EVNT.RENT2BUY ^=
3:19:24 PM Monday, August 03, 2009
Page 132 of 278
NS35
2/PurchasedRentToBuy)), Rental End Date,
EVENDMM/EVENDDD/EVENDYY, should be on or before (TODAY).
If not true, display message "INVALID DATE. RENTAL STOP DATE
MUST BE ON OR BEFORE (TODAY). PLEASE REENTER."
Edit #3
If ((EVNT.RENTSTIL = 2/No, DK, or RF) and (EVNT.RENT2BUY ^=
2/PurchasedRentToBuy)), Rental End Date,
EVENDMM/EVENDDD/EVENDYY, must be on or after the Rental
Start Date, EVBEGMM/EVBEGDD/EVBEGYY.
If not true, display message: "INVALID DATE. RENTAL STOP
DATE MUST BE ON OR AFTER (RENTAL START DATE). PLEASE
REENTER."
Edit #4
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing date entered on this roster.
The following must be true for the event added to be a duplicate of
an existing event:
Both event's EVNTDFLG ^= 1/Yes.
Both event's STOMTYPE match.
Both event's EVENT DATE match. See general specifications for
matching date logic.
Both event's RENTPROB matches, OR
1st Event RENTPROB = 1/Buy and 2nd Event RENTPROB = DK
or RF, OR 1st Event RENTPROB = DK or RF and 2nd Event
RENTPROB = 1/Buy.
The date of the event added should not match any other date on
roster.
If not true, display message "INVALID DATE. THIS DATE HAS
ALREADY BEEN ENTERED. PLEASE REENTER. "
TECHNICAL NOTES
246
ORPEvent
Existing Event Date is outside survery reference period =
EVNT.EVORPFLAG = 1/ORP.
New event is Out of the Survey Reference Period =
See general specifications for Date check logic for
determing ORP events.
DESIGN NOTES
Interviewer can only select events to be edited at this roster.
3:19:24 PM Monday, August 03, 2009
Page 133 of 278
NS36
NS36
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
NSOMADD
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
600
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:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
Question Text:
Int. Instr II:
WHAT TYPE OF OTHER MEDICAL EXPENSE NEEDS TO BE
ADDED?
INPUT FIELDS / ROUTING
3:19:27 PM Monday, August 03, 2009
Page 134 of 278
NS36
NSOMADD
Field1:
( NSQ1800 )
TEMP
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
TSTOMAdd
1
No
No
Number Label
1 Glasses
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM2 - EVENT_OMEYEG ( OMQ1030 )
2
English text: GLASSES/CONTACTS
Hearing
OM4 - EVENT_OMHEAR ( OMQ1110 )
3
English text: HEARING/SPEECH DEVICE
Orthopedic
OM6 - ORTHTYPE ( OMQ1220 )
4
English text: ORTHOPEDIC ITEM
DiabeticSupplies
OM10 - EVENT_OMDIAB ( OMQ1570 )
5
English text: DIABETIC SUPPLIES
Ambulance
OM12 - EVENT_OMAMBL ( OMQ1640 )
6
English text: AMBULANCE/RESCUE
Prothesis
OM14 - EVENT_OMPROS ( OMQ1710 )
7
English text: PROSTHESIS
Alteration
OM29 - ALTRTYPE ( OMQ3040 )
8
English text: ALTERATIONS (HOME/CAR)
Oxygen
OM19A - OXGNTYPE ( OMQ1830 )
9
English text: OXYGEN
KidneyDialysis
OM21A - KDNYTYPE ( OMQ2240 )
English text: KIDNEY DIALYSIS
OtherMedical
OM24 - OTHRTYPE ( OMQ2650 )
10
English text: ALL OTHER MEDICAL SUPPLIES
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
3:19:33 PM Monday, August 03, 2009
Page 135 of 278
NS36
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
NS36 calls Other Medical Expense Section. Multiple OMs for type selected
at NS36 may be added in OM section. EVNT records will be identified or
created for Other Medical Expenses added in OM section.
OM returns to NS at BOX NS36.
3:19:33 PM Monday, August 03, 2009
Page 136 of 278
BOX NS36
BOX NS36
Page Order # :
610
BOX INSTRUCTIONS
( NSQ1810 )
GO TO NS34 - NSOMUPD ( NSQ1790 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
Return to NS from Other Medical Expense Section.
3:19:33 PM Monday, August 03, 2009
Page 137 of 278
NS37
NS37
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_NSOM
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Statement OM Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
612
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all other medical expense items where:
EVNT.EVNTDFLG^=1/Yes, and
EVNT.EVNTTYPE = OM.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
1
2
3:19:34 PM Monday, August 03, 2009
INSTRUCTIONS
If EVNT.RENTPROB=2/Rent and
((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
"R".
Else do not display.
OME Type
If EVNT.STOMTYPE = 91/Other, display
Other Specify Text, EVOS.EVOSTEXT,
on EVOS where EVOS.EVOSEVNT =
this EVNT.EVNTNUM.
Else display EVNT.STOMTYPE response
text.
Page 138 of 278
NS37
3
Purchase or
Repair/Rental
Date
If ((EVNT.OTHRTYPE ^=
5/OstomySupplies and ^=
6/IncontinenceSupplies & ^=
7/Bandages) or (EVNT.OTHRTYPE =
EMPTY)) & ((EVNT.OMSTATUS ^=
1/AlterationNotComplete) or
(EVNT.OMSTATUS = EMPTY)), display
EVENT DATE in "Mon DD YYYY" format.
Else do not display.
4
Rental Stop Date
If EVNT.RENTPROB = 2/Rent and
(EVNT.RENTSTIL = 2/No, DK, or RF)
and ((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
EVENT END DATE in "Mon DD YYYY"
format.
Else do not display.
5
Status
If EVNT.OMSTATUS =
1/AlterationNotComplete, display "ON".
Else if EVNT.RENTSTIL = 1/Yes, display
"RR".
Else if EVNT.RENT2BUY =
2/PurchasedRentToBuy, display "OW".
Else do not display.
6
Round
If ((EVNT.OTHRTYPE ^=
5/OstomySupplies and ^=
6/IncontinenceSupplies and ^=
7/Bandages) or (EVNT.OTHRTYPE =
EMPTY)), display 'R' +
EVNT.EVNTRNDC. EX: R45
Else do not display.
7
If Event Date is out of the Survey
Reference Period, display "ORP".
Else do not display.
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
Question Text:
Int. Instr II:
SELECT OTHER MEDICAL EXPENSES THAT ARE IN THIS
CHARGE BUNDLE.
INPUT FIELDS / ROUTING
3:19:34 PM Monday, August 03, 2009
Page 139 of 278
NS37
EVENT_NSOM
Field1:
( NSQ1812 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX NS37 - (NSQ1813 )
BACKGROUND VARIABLE ASSIGNMENTS
Create an XCEV record for each event selected at NS37 to link the event to the charge
bundle being asked about. XCEV record may already exist.
If XCEV record does not exist, create XCEV record:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVBASE and XCEV.XCEVBAS2 = BASE.BASEID.
XCEV.XCEVCOST = COST.COSTNUM of charge bundle being asked about.
XCEV.XCEVEVNT = EVNT.EVNTNUM of event selected at NS37.
Set fields as specified below:
XCEVCOST
Create XCEV where XCEV.XCEVCOST = this
COST.COSTNUM.
XCEVEVNT
Create XCEV where XCEV.XCEVEVNT =
EVNT.EVNTNUM of EVNT selected.
XCEVRNDC
Set XCEV.XCEVRNDC = current round.
DELLINK
If XCEV exists and XCEV.DELLINK = 1/Yes, update
XCEV.DELLINK = empty.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
246
ORPEvent
3:19:35 PM Monday, August 03, 2009
Existing Event Date is outside survery reference period =
EVNT.EVORPFLAG = 1/ORP.
Page 140 of 278
NS37
New event is Out of the Survey Reference Period =
See general specifications for Date check logic for
determing ORP events.
DESIGN NOTES
Interviewer can only select events at this roster.
3:19:35 PM Monday, August 03, 2009
Page 141 of 278
BOX NS37
BOX NS37
Page Order # :
615
BOX INSTRUCTIONS
( NSQ1813 )
IF AT LEAST ONE OTHER MEDICAL EXPENSE SELECTED AT NS37 IS
RENTED, GO TO NS38 - MONTHCOV ( NSQ1815 ).
ELSE GO TO BOX NS38B - (NSQ1820 ).
ASSIGNMENTS
TECHNICAL NOTES
242
OMRental
Other Medical Expense Item is Rented =
EVNT.RENTPROB = 2/Rent.
DESIGN NOTES
3:19:35 PM Monday, August 03, 2009
Page 142 of 278
NS38
NS38
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
MONTHCOV
Field 2:
MONCOV96
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
618
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:
ORIGINAL CHARGE BUNDLE EVENT: Display original event asked
about at the beginning of NS loop.
OME ITEM TYPE and RENTAL DATES: Display OME TYPE and
rental dates for OM event selected at NS37.
See global display instructions for more details.
Question display:
Multi Field display:
Vertical Alignment
Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
OME ITEM TYPE: (OME ITEM TYPE)
RENTAL DATES: (RENTAL START DATE) - (RENTAL STOP DATE)
Int. Instr I:
3:19:37 PM Monday, August 03, 2009
Page 143 of 278
NS38
Question Text:
HOW MANY MONTHS ARE COVERED BY THIS CHARGE
BUNDLE?
Int. Instr II:
INPUT FIELDS / ROUTING
MONTHCOV
Field1:
( NSQ1815 )
XCEV.MONTHCOV
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
MONTHS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMonthcov
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Empty
Route
NS38 - MONCOV96 ( NSQ1816 )
Don't know
NS38 - MONCOV96 ( NSQ1816 )
Refusal
NS38 - MONCOV96 ( NSQ1816 )
3:19:41 PM Monday, August 03, 2009
FieldSize:
Min Value:
Max Value:
Mask:
1
72
Route
NS38 - MONCOV96 ( NSQ1816 )
Page 144 of 278
NS38
MONCOV96
Field2:
( NSQ1816 )
NONE
Cheshire Name:
WE NEED TO CREATE XCEV.MONCOV96 AND
TRANSLATE MONTHCOV=96 TO MONCOV96=1.
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TMonCov96
1
No
No
Number Label
1 LessThanOneMonth
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX NS38A - (NSQ1817 )
English text: LESS THAN 1 MONTH
Attribute
Empty
Route
BOX NS38A - (NSQ1817 )
BACKGROUND VARIABLE ASSIGNMENTS
Collect # of months on XCEV:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVCOST = COST.COSTNUM of charge bundle being asked about.
XCEV.XCEVEVNT = EVNT.EVNTNUM of OM Rental event being asked about.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
MONTHCOV and MONCOV96 cannot both be EMPTY.
If not true, display message "ENTRY REQUIRED. PLEASE ENTER
NUMBER OF MONTHS OR SELECT "LESS THAN 1 MONTH".
Edit #2
MONTHCOV and MONCOV96 cannot both be FILLED.
If not true, display message "INVALID ENTRY. PLEASE ENTER
NUMBER OF MONTHS OR SELECT "LESS THAN 1 MONTH".
3:19:44 PM Monday, August 03, 2009
Page 145 of 278
NS38
TECHNICAL NOTES
DESIGN NOTES
3:19:44 PM Monday, August 03, 2009
Page 146 of 278
BOX NS38A
BOX NS38A
Page Order # :
620
BOX INSTRUCTIONS
( NSQ1817 )
IF ANOTHER OTHER MEDICAL EXPENSE SELECTED AT NS37 IS
RENTED, GO TO NS38 - MONTHCOV ( NSQ1815 ).
ELSE GO TO BOX NS38B - (NSQ1820 ).
ASSIGNMENTS
TECHNICAL NOTES
242
OMRental
Other Medical Expense Item is Rented =
EVNT.RENTPROB = 2/Rent.
DESIGN NOTES
3:19:44 PM Monday, August 03, 2009
Page 147 of 278
BOX NS38B
BOX NS38B
622
Page Order # :
BOX INSTRUCTIONS
( NSQ1820 )
IF AT LEAST ONE OTHER MEDICAL EXPENSE SELECTED AT NS37 IS
OSTOMY SUPPLIES, INCONTINENCE SUPPLIES OR BANDAGES, GO TO
NS38A - NUMLINKS ( NSQ1821 ).
ELSE GO TO NS39 - NSOMMTCH ( NSQ1830 ).
ASSIGNMENTS
TECHNICAL NOTES
247
OMPurchases
Other Medical Expense Item is Ostomy Supplies,
Incontinence Supplies, or Bandages =
EVNT.OTHRTYPE = 5/OstomySupplies,
6/IncontinenceSupplies, or 7/Bandages.
DESIGN NOTES
3:19:44 PM Monday, August 03, 2009
Page 148 of 278
NS38A
NS38A
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
NUMLINKS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
625
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:
Display OME ITEM TYPE for first/next Ostomy Supplies,
Incontinence Supplies, or Bandages selected at NS37.
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
OME ITEM TYPE: (OME ITEM TYPE)
Int. Instr I:
Question Text:
Int. Instr II:
HOW MANY PURCHASES OF (NAME OF OME ITEM) ARE
COVERED BY THIS CHARGE BUNDLE?
INPUT FIELDS / ROUTING
3:19:45 PM Monday, August 03, 2009
Page 149 of 278
NS38A
NUMLINKS
Field1:
Cheshire Name:
( NSQ1821 )
XCEV.NUMLINKS
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF PURCHASES:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TNumlinks
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
BOX NS38AA - (NSQ1822 )
Refusal
BOX NS38AA - (NSQ1822 )
FieldSize:
Min Value:
Max Value:
Mask:
1
100
Route
BOX NS38AA - (NSQ1822 )
BACKGROUND VARIABLE ASSIGNMENTS
Collect # of purchases on XCEV:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVCOST = COST.COSTNUM of charge bundle being asked about.
XCEV.XCEVEVNT = EVNT.EVNTNUM of OM Ostomy Supplies, Incontinence supplies, or
bandages being asked about.
NS38A is asked of all Ostomy Supplies, Incontinence Supplies and Bandages linked to
charge bundle.
However, in addition to collecting the number of purchases covered by the charge bundle
at NS38A, if the OM event was added at OM24 - OTHRTYPE, we will copy NS38A
NUMLINKS to the current round PMRO.GETNUM on PMRO where PMRO.PMRORND =
current round and PMRO.PMROEVNT = this new OM event.
GETNUM
If OM event was just added at OM24 - OTHRTYPE,
set PMRO.GETNUM = this OM event's NS38A
NUMLINKS. Set on PMRO where
PMRO.PMROEVNT = this OM EVNT.EVNTNUM and
PMRO.PMRORND = current round.
SOFT EDIT CHECKS
3:19:47 PM Monday, August 03, 2009
Page 150 of 278
NS38A
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:19:47 PM Monday, August 03, 2009
Page 151 of 278
BOX NS38AA
BOX NS38AA
628
Page Order # :
BOX INSTRUCTIONS
( NSQ1822 )
IF ANOTHER OTHER MEDICAL EXPENSE SELECTED AT NS37 IS
OSTOMY SUPPLIES, INCONTINENCE SUPPLIES OR BANDAGES, GO TO
NS38A - NUMLINKS ( NSQ1821 ).
ELSE GO TO NS39 - NSOMMTCH ( NSQ1830 ).
ASSIGNMENTS
TECHNICAL NOTES
247
OMPurchases
Other Medical Expense Item is Ostomy Supplies,
Incontinence Supplies, or Bandages =
EVNT.OTHRTYPE = 5/OstomySupplies,
6/IncontinenceSupplies, or 7/Bandages.
DESIGN NOTES
3:19:47 PM Monday, August 03, 2009
Page 152 of 278
NS39
NS39
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
NSOMMTCH
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
630
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report below question text.
Display all Events linked to this charge bundle where
XCEV.XCEVEVNT = the EVNT.EVNTNUM and XCEV.XCEVCOST =
the COST.COSTNUM for the Charge Bundle and XCEV.DELLINK
^=1/Yes. Display PMs followed by OM events, HH events and then
other provider service events.
NOTE: This report is shared by other questions. Not all Event types
will be applicable at each screen.
Report header: EVENTS IN CHARGE BUNDLE
Report layout:
Column 1, header =Type
Display EVNT.EVNTTYPE
Column 2, NO HEADER.
If EVNT.RENTPROB=2/Rent and ((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or (EVNT.RENT2BUY = EMPTY)), display
3:19:48 PM Monday, August 03, 2009
Page 153 of 278
NS39
"R".
Else do not display.
Column 3, header = Description
If EVNT.EVNTTYPE = OM then
If EVNT.STOMTYPE = 91, display EVOS.EVOSTEXT on EVOS
where EVOS.EVOSEVNT = this EVNT.EVNTNUM.
Else display EVNT.STOMTYPE response text.
Else if EVNT.EVNTTYPE = PM, display EVNT.PMEDNAME.
Else display PROV.PROVNAME on PROV where PROV.PROVNUM
= this EVNT.EVNTPROV.
Column 4, header = Start Date
If(EVNT.EVNTTYPE = DU, ER, IP, IU, OP, MP, SD or SL) or
(EVNT.EVNTTYPE = OM and
((EVNT.OTHRTYPE ^= 5/OstomySupplies and
^= 6/IncontinenceSupplies and ^= 7/Bandages) or
(EVNT.OTHRTYPE = EMPTY)) and
((EVNT.OMSTATUS ^= 1/AlterationNotComplete) or
(EVNT.OMSTATUS = EMPTY))),
display EVENT DATE in "Mon DD YYYY" format.
Else do not display.
Column 5, header = Stop Date
If (EVNT.EVNTTYPE = IU) or
(EVNT.EVNTTYPE = IP and
EVNT.IPSTATUS ^= 1/StillInHospital) or
(EVNT.EVNTTYPE = OM and EVNT.RENTPROB = 2/Rent and
(EVNT.RENTSTIL = 2/No, DK, or RF) and
((EVNT.RENT2BUY ^= 2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY))),
display EVNT END DATE in "Mon DD YYYY" format.
Else do not display.
Column 6, header = Status
If EVNT.VISTTYPE = 2/RepeatVisit, display “RV”.
Else if
(EVNT.EVNTTYPE = OM and
EVNT.OMSTATUS = 1/AlterationNotComplete) or
(EVNT.EVNTTYPE = IP and EVNT.IPSTATUS =
1/StillInHospital),
display "ON".
Else if EVNT.RENTSTIL = 1/Yes, display "RR".
Else if EVNT.RENT2BUY=2/PurchasedRentToBuy, display "OW".
3:19:49 PM Monday, August 03, 2009
Page 154 of 278
NS39
Else do not display.
Column 7, header = # Visits
If EVNT.VISTTYPE = 2/RepeatVisit, display XCEV.RVLINKS on
XCEV where XCEV.XCEVEVNT = this EVNT.EVNTNUM and
XCEV.XCEVCOST = the COST.COSTNUM for this charge bundle.
Else do not display.
Column 8, header = # Purchases
If (EVNT.EVNTYPE = PM) or
(EVNT.EVNTTYPE = OM and
(EVNT.OTHRTYPE = 5/OstomySupplies,
6/IncontinenceSupplies, or 7/Bandages)),
display XCEV.NUMLINKS on XCEV where
XCEV.XCEVEVNT = this EVNT.EVNTNUM and
XCEV.XCEVCOST = the COST.COSTNUM for this charge
bundle.
Else do not display.
Column 9,
If Event Date is out of Survey Reference Period, display “ORP”.
Else do not display.
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
ARE ALL THE OTHER MEDICAL EXPENSES FROM THE CHARGE
BUNDLE SHOWN BELOW?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
3:19:51 PM Monday, August 03, 2009
Page 155 of 278
NS39
NSOMMTCH
Field1:
( NSQ1830 )
TEMP
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
TSTOMMTCH
1
No
No
Number Label
1 Yes
2
3
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX NS40 - (NSQ1840 )
English text: YES
NoAddOM
NS34 - NSOMUPD ( NSQ1790 )
English text: NO, NEED TO ADD AN OME EVENT
NoDeleteOM
NS40 - EVENT_NSOMDEL ( NSQ1835 )
English text: NO, NEED TO REMOVE AN OME EVENT
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
246
ORPEvent
Existing Event Date is outside survery reference period =
EVNT.EVORPFLAG = 1/ORP.
New event is Out of the Survey Reference Period =
See general specifications for Date check logic for
determing ORP events.
DESIGN NOTES
3:19:53 PM Monday, August 03, 2009
Page 156 of 278
NS40
NS40
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_NSOMDEL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Statement OM Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
635
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(S)" in interviewer instructions in partenthesis.
Multi Field display:
Roster/Grid Instructions:
Display all OME events linked to this charge bundle:
There is an EVNT where:
EVNT.EVNTTYPE = 'OM', and
There is an XCEV where:
XCEV,XCEVEVNT = this EVNT.EVNTNUM, and
XCEV.XCEVCOST = COST.COSTNUM for this charge bundle, and
XCEV.DELLINK ^= 1/Yes.
Display in order of entry.
Roster/Grid display:
COL #
1
3:19:54 PM Monday, August 03, 2009
HEADER
INSTRUCTIONS
If EVNT.RENTPROB=2/Rent and
EVNT.RENT2BUY ^=
2/PurchasedRentToBuy, display "R".
Else do not display.
Page 157 of 278
NS40
2
OME Type
If EVNT.STOMTYPE = 91/Other, display
Other Specify Text, EVOS.EVOSTEXT,
on EVOS where EVOS.EVOSEVNT =
this EVNT.EVNTNUM.
Else display EVNT.STOMTYPE response
text.
3
Purchase or
Repair/Rental
Date
If (EVNT.OTHRTYPE ^=
5/OstomySupplies and
EVNT.OTHRTYPE ^=
6/IncontinenceSupplies and
EVNT.OTHRTYPE ^= 7/Bandages) and
(EVNT.OMSTATUS ^=
1/AlterationNotComplete), display EVENT
DATE in "Mon DD YYYY" format.
Else do not display.
4
Rental Stop Date
if (EVNT.RENTSTIL = 2/No, DK, or RF)
and (EVNT.RENT2BUY ^=
2/PurchasedRentToBuy), display EVENT
END DATE in "Mon DD YYYY" format.
Else do not display.
5
Status
If EVNT.OMSTATUS =
1/AlterationNotComplete, display "ON".
Else if EVNT.RENTSTIL = 1/Yes, display
"RR".
Else if EVNT.RENT2BUY =
2/PurchasedRentToBuy, display "OW".
Else do not display.
6
# Purchases
If (EVNT.OTHRTYPE =
5/OstomySupplies,
6/IncontinenceSupplies, or 7/Bandages),
display XCEV.NUMLINKS on XCEV
where XCEV.XCEVEVNT = this
EVNT.EVNTNUM and XCEV.XCEVCOST
= this COST.COSTNUM.
Else do not display.
7
Round
If (EVNT.OTHRTYPE ^=
5/OstomySupplies and
EVNT.OTHRTYPE ^=
6/IncontinenceSupplies and
EVNT.OTHRTYPE ^= 7/Bandages),
7/Bandages, display 'R' +
EVNT.EVNTRNDC. EX: R45
Else do not display.
8
If Event Date is out of the Survey
Reference Period, display "ORP".
Else do not display.
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
Question Text:
3:19:54 PM Monday, August 03, 2009
Page 158 of 278
NS40
SELECT THE EVENT(S) THAT YOU WOULD LIKE TO REMOVE
FROM THE CHARGE BUNDLE.
Int. Instr II:
INPUT FIELDS / ROUTING
EVENT_NSOMDEL
Field1:
( NSQ1835 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
NS39 - NSOMMTCH ( NSQ1830 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on XCEV:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVBASE and XCEV.XCEVBAS2 = BASE.BASEID.
XCEV.XCEVCOST = COST.COSTNUM of charge bundle being asked about.
XCEV.XCEVEVNT = EVNT.EVNTNUM of event selected at NS40
Each Event selected at NS40 will be flagged as "deleted" on XCEV. The event will no
longer being "linked" to the charge bundle being asked about. See detailed instructions
below.
Set XCEV.DELLINK = 1/Yes on XCEV where
XCEV.XCEVCOST = this COST.COSTNUM and
XCEV.XCEVEVNT = EVNT.EVNTNUM of event
selected.
DELLINK
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
246
ORPEvent
3:19:55 PM Monday, August 03, 2009
Existing Event Date is outside survery reference period =
EVNT.EVORPFLAG = 1/ORP.
Page 159 of 278
NS40
New event is Out of the Survey Reference Period =
See general specifications for Date check logic for
determing ORP events.
DESIGN NOTES
Interviewer can only select events at this roster.
3:19:55 PM Monday, August 03, 2009
Page 160 of 278
BOX NS40
BOX NS40
Page Order # :
640
BOX INSTRUCTIONS
( NSQ1840 )
IF NS12 – INCTYPE INCLUDES 4/PMS, GO TO NS41 - EVENT_NSPM (
NSQ1850 ).
ELSE GO TO BOX NS45 - (NSQ1990 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
3:19:55 PM Monday, August 03, 2009
Page 161 of 278
NS41
NS41
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_NSPM
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Prescription Medicine 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
650
Display as ' Add a Medicine '
Display as ' Edit a Medicine '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all Prescription Medicine events where:
EVNT.EVNTDFLG ^=1/Yes, and
EVNT.EVNTTYPE='PM'.
Display in alphabetical order.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Medicine
Display prescription medicine name,
EVNT.PMEDNAME.
2
Strength
Display prescription medicine strength
text field, EVNT.PMSTRUNI.
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
3:19:56 PM Monday, August 03, 2009
Page 162 of 278
NS41
Question Text:
SELECT OR ADD ALL PRESCRIPTION MEDICINES THAT ARE IN
THIS CHARGE BUNDLE.
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
EVENT_NSPM
( NSQ1850 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick200
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
200
Route
NS42 - NUMLINKS ( NSQ1860 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of PM event selected at NS41.
If Prescription Medicine added at Prescription Medicine Roster, see PRESCRIPTION
MEDICINE ROSTER POP-UP specifications for pop-up window programming instructions.
Variables populated at the Prescription Medicine Roster:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVNTTYPE
EVNT.PMEDNAME
EVNT.PMSTRUNI
EVNT.EVNTPROV
BASE.LASTEVNT
Event number
Round number
PM
Prescription Medicine name
Prescription Medicine strength text field
02
Highest EVNT.EVNTNUM
If PM added at NS41, create a current round PMRO:
PMRO key = PMRO.PMROBASE + PMRO.PMROEVNT + PMRO.PMRORND
PMRO.PMROEVNT = EVNT.EVNTNUM of PM event selected at NS41.
PMRO.PMRORND = current round.
Set PMRO fields as specified below.
3:19:57 PM Monday, August 03, 2009
Page 163 of 278
NS41
FOR ALL PM'S SELECTED AT NS41 ("SELECTED" refers to any PM selected from
Roster, whether or not PM was just ADDED or PRE-EXISTED on the roster), create an
XCEV record for each PM event selected at NS41 to link the event to the charge bundle
being asked about. XCEV record may already exist.
If XCEV record does not exist, create XCEV record:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVBASE and XCEV.XCEVBAS2 = BASE.BASEID.
XCEV.XCEVCOST = COST.COSTNUM of charge bundle being asked about.
XCEV.XCEVEVNT = EVNT.EVNTNUM of PM event selected at NS41.
Set fields as specified below:
PMROEVNT
If PM added at NS41, create PMRO where
PMRO.PMROEVNT = EVNT.EVNTNUM of event
added.
PMRORND
If PM added at NS41, create PMRO where
PMRO.PMRORND = current round.
PMROTYPE
If PM added at NS41, set PMRO.PMROTYPE = PM.
EVCHGFLG
If PM added at NS41, set EVNT.EVCHGFLG = 1/Yes.
XCEVCOST
For each PM selected at NS41, create XCEV where
XCEV.XCEVCOST = this COST.COSTNUM.
XCEVEVNT
For each PM selected at NS41, create XCEV where
XCEV.XCEVEVNT = EVNT.EVNTNUM of PM
selected (or added).
XCEVRNDC
Set XCEV.XCEVRNDC = current round.
DELLINK
If XCEV exists and XCEV.DELLINK = 1/Yes, update
XCEV.DELLINK = empty.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
Interviewer can add and/or select PMs at this roster. We do not create
PMROs for existing PMs that are selected.
3:19:57 PM Monday, August 03, 2009
Page 164 of 278
NS42
NS42
Page Order # :
Design Screen Type:
Grid
Fields:
Field 1:
NUMLINKS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
660
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:
Multi Field display:
Roster/Grid Instructions:
Display all Prescription Medicine events linked to this charge bundle:
There is an EVNT where:
EVNT.EVNTTYPE = 'PM', and
There is an XCEV where:
XCEV,XCEVEVNT = this EVNT.EVNTNUM, and
XCEV.XCEVCOST = COST.COSTNUM for this charge bundle, and
XCEV.DELLINK ^= 1/Yes.
Display in alphabetical order based on EVNT.PMEDNAME.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Medicine Name
Display the name and strength of the
medicine, EVNT.PMEDNAME + ' ' +
EVNT.PMSTRUNI. Display only.
2
# Purchases
XCEV.NUMLINKS. Input column 1.
Report display:
TEXT:
3:19:58 PM Monday, August 03, 2009
Page 165 of 278
NS42
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Context Header:
Int. Instr I:
Question Text:
HOW MANY PURCHASES OF EACH MEDICINE SHOWN BELOW
ARE COVERED BY THIS CHARGE BUNDLE?
Int. Instr II:
INPUT FIELDS / ROUTING
NUMLINKS
Field1:
Cheshire Name:
Item Text display:
( NSQ1860 )
XCEV.NUMLINKS
GRID COLUMN #2.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TNumlinks
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
BOX NS42 - (NSQ1880 )
Refusal
BOX NS42 - (NSQ1880 )
FieldSize:
Min Value:
Max Value:
Mask:
1
100
Route
BOX NS42 - (NSQ1880 )
BACKGROUND VARIABLE ASSIGNMENTS
Collect # of purchases on XCEV:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVCOST = COST.COSTNUM of charge bundle being asked about.
XCEV.XCEVEVNT = EVNT.EVNTNUM of PM being asked about.
GETNUM
If PM was added at NS41, set PMRO.GETNUM =
this PM event''s NS42 - NUMLINKS. Set on PMRO
where PMRO.PMROEVNT = this PM
EVNT.EVNTNUM and PMRO.PMRORND = current
round.
SOFT EDIT CHECKS
3:20:00 PM Monday, August 03, 2009
Page 166 of 278
NS42
NUMLINKS = 1 - 8, DK, RF.
If not true, display message "THE AMOUNT ENTERED SEEMS
UNLIKELY. PLEASE VERIFY.".
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:20:00 PM Monday, August 03, 2009
Page 167 of 278
BOX NS42
BOX NS42
670
Page Order # :
BOX INSTRUCTIONS
( NSQ1880 )
IF AT LEAST ONE PRESCRIPTION MEDICINE WAS ADDED AT NS41, GO
TO NS43 - NSPMINTRO ( NSQ1920 ).
ELSE GO TO NS44 - NSPMMTCH ( NSQ1941 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
BOX NS42 should only route to NS43 if PM was added as a new PM
event at NS41, not if the PM already existed on roster and was selected.
3:20:00 PM Monday, August 03, 2009
Page 168 of 278
NS43
NS43
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
NSPMINTRO
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
710
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(s)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Before we continue with this statement, I would like to ask you a few
questions about the prescribed medicine(s) I just added. [It would
be very helpful for the following questions if we could look at the
bottle(s) or container(s) for the medicine(s).]
Int. Instr II:
INPUT FIELDS / ROUTING
3:20:01 PM Monday, August 03, 2009
Page 169 of 278
NS43
NSPMINTRO
Field1:
( NSQ1920 )
TEMP
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
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
PM6A_IN - NAVIGATOR ( PMQ1183 )
English text: CONTINUE
Attribute
Empty
Route
PM6A_IN - NAVIGATOR ( PMQ1183 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
NS43 calls PM section. PM will collect event details for all PMs added at
NS41.
PM returns to NS at BOX NS43.
3:20:03 PM Monday, August 03, 2009
Page 170 of 278
BOX NS43
BOX NS43
Page Order # :
720
BOX INSTRUCTIONS
( NSQ1930 )
GO TO NS44 - NSPMMTCH ( NSQ1941 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
Return from PM section at BOX NS43.
3:20:03 PM Monday, August 03, 2009
Page 171 of 278
NS44
NS44
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
NSPMMTCH
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
730
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:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report below question text.
Display all Events linked to this charge bundle where
XCEV.XCEVEVNT = the EVNT.EVNTNUM and XCEV.XCEVCOST =
the COST.COSTNUM for the Charge Bundle and XCEV.DELLINK
^=1/Yes. Display PMs followed by OM events, HH events and then
other provider service events.
NOTE: This report is shared by other questions. Not all Event types
will be applicable at each screen.
Report header: EVENTS IN CHARGE BUNDLE
Report layout:
Column 1, header =Type
Display EVNT.EVNTTYPE
Column 2, NO HEADER.
If EVNT.RENTPROB=2/Rent and ((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or (EVNT.RENT2BUY = EMPTY)), display
3:20:04 PM Monday, August 03, 2009
Page 172 of 278
NS44
"R".
Else do not display.
Column 3, header = Description
If EVNT.EVNTTYPE = OM then
If EVNT.STOMTYPE = 91, display EVOS.EVOSTEXT on EVOS
where EVOS.EVOSEVNT = this EVNT.EVNTNUM.
Else display EVNT.STOMTYPE response text.
Else if EVNT.EVNTTYPE = PM, display EVNT.PMEDNAME.
Else display PROV.PROVNAME on PROV where PROV.PROVNUM
= this EVNT.EVNTPROV.
Column 4, header = Start Date
If (EVNT.EVNTTYPE = DU, ER, IP, IU, OP, MP, SD or SL) or
(EVNT.EVNTTYPE = OM and
((EVNT.OTHRTYPE ^= 5/OstomySupplies and
^= 6/IncontinenceSupplies and ^= 7/Bandages) or
(EVNT.OTHRTYPE = EMPTY)) and
((EVNT.OMSTATUS ^= 1/AlterationNotComplete) or
(EVNT.OMSTATUS = EMPTY))),
display EVENT DATE in "Mon DD YYYY" format.
Else do not display.
Column 5, header = Stop Date
If (EVNT.EVNTTYPE = IU) or
(EVNT.EVNTTYPE = IP and
EVNT.IPSTATUS ^= 1/StillInHospital) or
(EVNT.EVNTTYPE = OM and EVNT.RENTPROB = 2/Rent and
(EVNT.RENTSTIL = 2/No, DK, or RF) and
((EVNT.RENT2BUY ^= 2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY))),
display EVNT END DATE in "Mon DD YYYY" format.
Else do not display.
Column 6, header = Status
If EVNT.VISTTYPE = 2/RepeatVisit, display “RV”.
Else if
(EVNT.EVNTTYPE = OM and
EVNT.OMSTATUS = 1/AlterationNotComplete) or
(EVNT.EVNTTYPE = IP and EVNT.IPSTATUS =
1/StillInHospital),
display "ON".
Else if EVNT.RENTSTIL = 1/Yes, display "RR".
Else if EVNT.RENT2BUY=2/PurchasedRentToBuy, display "OW".
3:20:05 PM Monday, August 03, 2009
Page 173 of 278
NS44
Else do not display.
Column 7, header = # Visits
If EVNT.VISTTYPE = 2/RepeatVisit, display XCEV.RVLINKS on
XCEV where XCEV.XCEVEVNT = this EVNT.EVNTNUM and
XCEV.XCEVCOST = the COST.COSTNUM for this charge bundle.
Else do not display.
Column 8, header = # Purchases
If (EVNT.EVNTYPE = PM) or
(EVNT.EVNTTYPE = OM and
(EVNT.OTHRTYPE = 5/OstomySupplies,
6/IncontinenceSupplies, or 7/Bandages)),
display XCEV.NUMLINKS on XCEV where
XCEV.XCEVEVNT = this EVNT.EVNTNUM and
XCEV.XCEVCOST = the COST.COSTNUM for this charge
bundle.
Else do not display.
Column 9,
If Event Date is out of Survey Reference Period, display “ORP”.
Else do not display.
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
ARE ALL THE PRESCRIBED MEDICINES FROM THE CHARGE
BUNDLE SHOWN BELOW?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
3:20:07 PM Monday, August 03, 2009
Page 174 of 278
NS44
NSPMMTCH
Field1:
( NSQ1941 )
TEMP
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
TSTPMMtch
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 Yes
2
3
Route
BOX NS45 - (NSQ1990 )
English text: YES
NoAddPM
NS41 - EVENT_NSPM ( NSQ1850 )
English text: NO, NEED TO ADD A MEDICINE NAME
NoDeletePM
NS45 - EVENT_NSPMDEL ( NSQ1951 )
English text: NO, NEED TO REMOVE A MEDICINE NAME
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
246
ORPEvent
Existing Event Date is outside survery reference period =
EVNT.EVORPFLAG = 1/ORP.
New event is Out of the Survey Reference Period =
See general specifications for Date check logic for
determing ORP events.
DESIGN NOTES
3:20:09 PM Monday, August 03, 2009
Page 175 of 278
NS45
NS45
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_NSPMDEL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Prescription Medicine Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
740
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(S)" in interviewer instructions in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Display all Prescription Medicine events linked to this charge bundle:
There is an EVNT where:
EVNT.EVNTTYPE = 'PM', and
There is an XCEV where:
XCEV,XCEVEVNT = this EVNT.EVNTNUM, and
XCEV.XCEVCOST = COST.COSTNUM for this charge bundle, and
XCEV.DELLINK ^= 1/Yes.
Display in alphabetical order based on EVNT.PMEDNAME.
Roster/Grid display:
3:20:10 PM Monday, August 03, 2009
COL #
HEADER
INSTRUCTIONS
1
Medicine Name
Display name of PM, EVNT.PMEDNAME.
2
Strength
Display prescription medicine strength
text field, EVNT.PMSTRUNI.
3
# Purchases
Display XCEV.NUMLINKS on XCEV
where XCEV.XCEVEVNT = this
EVNT.EVNTNUM and XCEV.XCEVCOST
= COST.COSTNUM for this charge
bundle.
Page 176 of 278
NS45
Report display:
TEXT:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Context Header:
Int. Instr I:
Question Text:
SELECT THE PRESCRIBED MEDICINE(S) THAT YOU WOULD
LIKE TO REMOVE FROM THE CHARGE BUNDLE.
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
EVENT_NSPMDEL
( NSQ1951 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
NS44 - NSPMMTCH ( NSQ1941 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on XCEV:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVBASE and XCEV.XCEVBAS2 = BASE.BASEID.
XCEV.XCEVCOST = COST.COSTNUM of charge bundle being asked about.
XCEV.XCEVEVNT = EVNT.EVNTNUM of PM event selected at NS45.
Each PM Event selected at NS45 will be flagged as "deleted" on XCEV. The event will no
longer being "linked" to the charge bundle being asked about. See detailed instructions
below.
DELLINK
Set XCEV.DELLINK = 1/Yes on XCEV where
XCEV.XCEVCOST = this COST.COSTNUM and
XCEV.XCEVEVNT = EVNT.EVNTNUM of event
selected.
3:20:10 PM Monday, August 03, 2009
Page 177 of 278
NS45
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
Interviewer can only select PMs at this roster.
3:20:11 PM Monday, August 03, 2009
Page 178 of 278
BOX NS45
BOX NS45
Page Order # :
780
BOX INSTRUCTIONS
( NSQ1990 )
IF TOTAL CHARGE OR COPAY COLLECTED > 0, DK OR RF, GO TO NS64
NSTCHGPAID ( NSQ2695 ).
ELSE GO TO BOX NS64B - (NSQ2701 ).
ASSIGNMENTS
TECHNICAL NOTES
383
TotalChargeCopayColle
cted
Total Charge or Copay Collected > 0, DK or RF =
COST.TOTALAMT > 0, DK or RF.
DESIGN NOTES
3:20:11 PM Monday, August 03, 2009
Page 179 of 278
NS64
NS64
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
NSTCHGPAID
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
1090
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP was covered by TRICARE and any other insurance plan
besides Medicare during the current round, display "such as
TRICARE or an insurance plan".
Else if SP was covered by TRICARE and is not covered by any
other insurance plan besides Medicare during the current round,
display "such as TRICARE"
Else if SP was not covered by TRICARE and was covered by any
other insurance plan besides Medicare during the current round,
display "such as an insurance plan".
Else do not display.
If Total charge was collected for charge bundle then
If (NS5 - TOTALCHG = DK or RF) and event is a rental, display
"the charge".
Else if (NS5 - TOTALCHG = DK or RF) and event is not a rental,
display "the total charge".
Else display "this (NS5 - TOTALCHG)".
Else if CoPayment was collected for charge bundle then
If (NS6 - TOTALCHG = DK or RF), display "the copayment
amount".
Else display "this (NS6 - TOTALCHG)".
Multi Field display:
Roster/Grid Instructions:
3:20:12 PM Monday, August 03, 2009
Page 180 of 278
NS64
Roster/Grid display:
Report display:
TEXT:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
(LINKED CHARGE BUNDLE EVENT) (etc.)
TOTAL CHARGE = $(TOTAL CHARGE)
Context Header:
Int. Instr I:
[[Have you/Has (SP)] or any other source [, such as (an insurance
plan/TRICARE/TRICARE or an insurance plan),] already paid any of
[the charge/the total charge/the copayment amount/this (TOTAL
CHARGE)]?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
NSTCHGPAID
Field1:
( NSQ2695 )
TEMP
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
TTChgpaid2
1
No
No
Number Label
1 SomeonePaid
2
English text: SP OR ANY SOURCE PAID
NothingPaid
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX NS64A - (NSQ2700 )
BOX NS64A - (NSQ2700 )
English text: NOTHING HAS BEEN PAID
Attribute
Don't know
Route
BOX NS64A - (NSQ2700 )
Refusal
BOX NS64A - (NSQ2700 )
3:20:15 PM Monday, August 03, 2009
Page 181 of 278
NS64
BACKGROUND VARIABLE ASSIGNMENTS
TCHGPAID
If NS64 - NSTCHGPAID = 1/SomeonePaid, set
CORO.TCHGPAID = 1/Yes.
Else if NS64 - NSTCHGPAID = 2/NothingPaid, set
CORO.TCHGPAID = 2/No.
Else if NS64 - NSTCHGPAID = DK, set
CORO.TCHGPAID = DK.
Else if NS64 - NSTCHGPAID = RF, set
CORO.TCHGPAID = RF.
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.
258
TricarePlan
SP covered by TRICARE during the current round =
There is a PLAN where PLAN.PLANTYPE = 6/Tricare
& PLRO where (PLRO.PLROPLAN = PLAN.PLANNUM &
PLRO.PLRORND = current round & PLRO.COVTIME^=
empty).
Exclude Deleted Plans. See T.N. 52.
259
InsurancePlan
SP covered by Insurance plan other than Medicare
during current round =
PLAN where (PLANTYPE = 2/Medicaid, 3/PublicPlan, or
4/PrivatePlan) & PLRO where
(PLROPLAN=PLAN.PLANNUM & PLRORND=current
round & COVTIME^=empty).
Exclude Deleted Plans. See T.N. 52.
268
CoPaymentCollected
CoPayment was collected for Charge Bundle =
For this COST, there is a CORO where
(CORO.COROCOST = COST.COSTNUM &
CORO.CORORND = current round & CORO.TOTALTYP
= 2/CoPayment).
If administering CPS, check most recent CORO where
CORO.TOTALTYP ^= empty.
269
TotalChargeCollected
Total Charge was collected for Charge Bundle =
For this COST, there is a CORO where
(CORO.COROCOST=COST.COSTNUM &
CORO.CORORND=current round &
CORO.TOTALTYP=1/TotalCharge).
If administering CPS, check most recent CORO where
CORO.TOTALTYP ^= empty.
242
OMRental
Other Medical Expense Item is Rented =
EVNT.RENTPROB = 2/Rent.
DESIGN NOTES
3:20:15 PM Monday, August 03, 2009
Page 182 of 278
BOX NS64A
BOX NS64A
Page Order # :
1092
BOX INSTRUCTIONS
( NSQ2700 )
IF SP OR ANY SOURCE HAS PAID, GO TO BOX NS64B - (NSQ2701 ).
ELSE IF (NOTHING HAS BEEN PAID) OR (RESPONDENT DOES NOT
KNOW IF ANYTHING HAS BEEN PAID), GO TO BOX NS78B - (NSQ2923 ).
ELSE GO TO BOX NS80 - (NSQ2930 ).
ASSIGNMENTS
TECHNICAL NOTES
231
SPOrAnySourcePaid
SP or any source paid =
For this COST, there is a CORO where
(CORO.COROCOST=COST.COSTNUM &
CORO.CORORND=current round & CORO.TCHGPAID =
1/Yes).
232
NothingPaid
Nothing paid or Respondent does not know if anything
has been paid =
CORO.TCHGPAID = 2/No or DK on CORO where
(CORO.COROCOST = this COST.COSTNUM and
CORO.CORORND = current round).
DESIGN NOTES
3:20:15 PM Monday, August 03, 2009
Page 183 of 278
BOX NS64B
BOX NS64B
3:20:15 PM Monday, August 03, 2009
Page Order # :
1093
Page 184 of 278
BOX NS64B
BOX INSTRUCTIONS
( NSQ2701 )
CREATE SOURCE OF PAYMENT ROSTER .
GO TO NS65 - NSADDSOP1 ( NSQ2702 ).
ASSIGNMENTS
TSOP table is loaded once for each new Charge Bundle being asked about in NS.
TSOP key = TSOP.TSOPBASE + TSOP.TSOPNUM.
Before proceeding, delete all TSOP records and load all eligible Sources of Payments:
1st Record:
Always store SP/FAMILY:
TSOP.TSOPTEXT = "SP/FAMILY"
TSOP.TSOPTYPE = 1/SPFamily
2nd Record:
Always store Provider discount:
TSOP.TSOPTEXT = "PROVIDER DISCOUNT/COURTESY"
TSOP.TSOPTYPE = 2/ProvDiscount
3rd Record:
Always store Medicare:
TSOP.TSOPTEXT = "MEDICARE".
TSOP.TSOPTYPE = 6/Medicare
TSOP.TSOPPLAN = '01'
TSOP.TSOPPTYP = 1/Medicare
TSOP.TSOPDISP = "(MCAR)".
Next, store all Medicare HMOs SP was covered by during the survey reference period (not
flagged as deleted).
If there is a PLAN with PLAN.PLANTYPE = 5/MHMO and a PLRO where PLRO.PLRORND
>= (current round -2), store MHMO plan:
TSOP.TSOPTEXT = PLAN.PLNAME
TSOP.TSOPTYPE = 8/MHMO
TSOP.TSOPPLAN = PLAN.PLANNUM of MHMO plan
TSOP.TSOPPTYP = PLAN.PLANTYPE of MHMO plan
TSOP.TSOPDISP = "(MHMO)".
Repeat for all MHMO plans.
Next, store VA if elibigle.
If (INTTYPE=8/ExitInterviewHadPrev and previous round HRND.VACOVER=1/Yes) or
(INTTYPE ^= 8/ExitInterviewHadPrev and current round HRND.VACOVER=1/Yes), store
VA:
TSOP.TSOPTEXT = "V.A. - DEPT. OF VETERANS AFFAIRS"
TSOP.TSOPTYPE = 5/VA.
Next, store MEDICARE SUBSIDY:
TSOP.TSOPTEXT = "MEDICARE SUBSIDY"
TSOP.TSOPTYPE = 11/MedicareSubsidy.
Next, store EXTRA HELP:
TSOP.TSOPTEXT = "EXTRA HELP"
TSOP.TSOPTYPE = 12/ExtraHelp.
3:20:15 PM Monday, August 03, 2009
Page 185 of 278
BOX NS64B
Next, store Medicaid, Public, Private, and Tricare plans SP was covered by during the
survey reference period (not flagged as deleted).
If there is a PLAN with (PLAN.PLANTYPE = 2/Medicaid, 3/PublicPlan, 4/PrivatePlan,
6/Tricare or 7/MPDP) and a PLRO where PLRO.PLRORND >= (current round -2), store
Plan:
TSOP.TSOPTEXT =
If PLAN.PLANTYPE = 2/Medicaid, TSOP.TSOPTEXT = 'MEDICAID/MEDICAID HMO';
Else if PLAN.PLANTYPE = 6/Tricare, TSOP.TSOPTEXT = "TRICARE".
Else TSOP.TSOPTEXT = PLAN.PLNAME;
If PLAN.PLANTYPE = 7/MPDP, set TSOP.TSOPTYPE = 10/MedicarePartD.
Else set TSOP.TSOPTYPE = 3/PlanNotMHMO
TSOP.TSOPPLAN = PLAN.PLANNUM of HI plan.
TSOP.TSOPPTYP = PLAN.PLANTYPE of HI plan.
TSOP.TSOPDISP =
If PLAN.PLANTYPE = 2/Medicaid, TSOP.TSOPDISP = "(MCAD)".
Else if PLAN.PLANTYPE = 3/PublicPlan, TSOP.TSOPDISP = "(PUBL)".
Else if PLAN.PLANTYPE = 4/PrivatePlan, TSOP.TSOPDISP = "(PRIV)".
Else if PLAN.PLANTYPE = 6/Tricare, TSOP.TSOPDISP = "(TRIC)".
Else if PLAN.PLANTYPE = 7/MPDP, TSOP.TSOPDISP = "(MPDP)".
Repeat for all Medicaid, Public, Private, Tricare and Medicare Prescription Drug plans.
Next, store Discount Membership Plans SP was covered by during the current round:
If there is a DMEM and a DMRO where DMRO.DMRORND = current round, store Discount
Membership plan:
TSOP.TSOPTEXT = DMEM.DMNAMEX
TSOP.TSOPTYPE = 9/DM
TSOP.TSOPDMEM = DMEM.DMEMNUM
Repeat for all DMEMs.
Next, store all Other Sources of Payments (not flagged as deleted).
Store OSOP:
TSOP.TSOPTEXT = OSOP.OSOPTEXT
TSOP.TSOPTYPE = 4/OSOP
TSOP.TSOPOSOP = OSOP.OSOPNUM
TSOP.TSOPDISP = "(OTHER)".
Repeat for all OSOPs.
TSOPNUM
Beginning with 01, create TSOP where
TSOP.TSOPNUM = highest TSOP.TSOPNUM + 01.
TSOPTEXT
Set TSOP.TSOPTEXT as specified above.
TSOPTYPE
Set TSOP.TSOPTYPE as specified above.
LOADFLAG
Set TSOP.LOADFLAG = 1/Yes.
TSOPPTYP
If SOP is a Health Insurance plan, set
TSOP.TSOPPYPE = PLAN.PLANTYPE.
TSOPPLAN
If SOP is a Health Insurance plan, set
TSOP.TSOPPLAN = PLAN.PLANNUM.
TSOPOSOP
If SOP is an Other Source of Payment, set
TSOP.TSOPOSOP = OSOP.OSOPNUM.
TSOPDISP
Set TSOP.TSOPDISP as specified above.
TSOPDMEM
If SOP is a Discount Membership plan, set
TSOP.TSOPDMEM = DMEM.DMEMNUM.
TECHNICAL NOTES
52
DeletedPlans
3:20:15 PM Monday, August 03, 2009
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
Page 186 of 278
BOX NS64B
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 Advantage: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.
252
DeletedOSOPs
Deleted OSOPs that are not valid for displays or checks =
Any OSOP where (OSOP.OSOPHIDE=1/Yes or
OSOP.LOSEOSFG ^=EMPTY) is a deleted OSOP.
117
DeletedDM
Deleted Discount Membership plans that are not valid for
displays or checks =
Any DMEM where (DMEM.LOSEDMFG ^= EMPTY) is a
deleted DM.
38
DMCurrentRnd
SP reported having a Discount Membership plan anytime
during the current round =
There is a DMEM and DMRO where
(DMRO.DMRODMEM = DMEM.DMEMNUM and
DMRO.DMRORND = current round and DMRO.DMHAVE
= 1/Yes).
Exclude Deleted DM's. See T.N. 117.
DESIGN NOTES
3:20:15 PM Monday, August 03, 2009
Page 187 of 278
NS65
NS65
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
NSADDSOP1
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
1095
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report above question text.
Display all eligible Source of Payments stored on TSOP based on
the following logic:
Do not display TSOP.TSOPTYPE = 11/MedicareSubsidy and
12/ExtraHelp.
Display all remaining Sources of Payments in the following order
based on TSOP.TSOPTYPE:
= 1/SPFamily
= 2/ProvDiscount
= 6/Medicare
= 8/MHMO
= 10/MedicarePartD
= 5/VA
= 3/PlanNotMHMO
= 4/OSOP
= 9/DM
3:20:16 PM Monday, August 03, 2009
Page 188 of 278
NS65
If there is more than Source of Payment per Source of Payment
Type, display in order of entry in TSOP.
Report header: SOURCES OF PAYMENT
Report layout:
Column 1, header="SOP NAME".
Column 1, display = TSOP.TSOPTEXT.
Column 2, header = "SOP TYPE".
Column 2, display =
If TSOP.TSOPDISP ^= empty, display TSOP.TSOPDISP.
Else do not display.
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
(LINKED CHARGE BUNDLE EVENT) (etc.)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
ARE ALL OF THE SOURCES OF PAYMENT FOR THIS CHARGE
BUNDLE LISTED BELOW?
Question Text:
SELECT "NO" TO ADD A SOURCE OF PAYMENT.
Int. Instr II:
INPUT FIELDS / ROUTING
NSADDSOP1
Field1:
( NSQ2702 )
TEMP
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
TYesNo
1
No
No
Number Label
1 Yes
2
English text: YES
No
FieldSize:
Min Value:
Max Value:
Mask:
Route
NS67 - TSOPAMT ( NSQ2720 )
NS66 - SOP_NS1 ( NSQ2703 )
English text: NO
BACKGROUND VARIABLE ASSIGNMENTS
3:20:18 PM Monday, August 03, 2009
Page 189 of 278
NS65
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
NS65 is called from CPS when adding SOPs. TSOP will already be loaded
in CPS section.
3:20:18 PM Monday, August 03, 2009
Page 190 of 278
NS66
NS66
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
SOP_NS1
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Source Of Payment Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1100
Display as ' Add Source of Payment '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all eligible Source of Payments stored on TSOP based on
the following logic:
Do not display TSOP.TSOPTYPE = 11/MedicareSubsidy and
12/ExtraHelp.
Display all remaining Sources of Payments in the following order
based on TSOP.TSOPTYPE:
= 1/SPFamily
= 2/ProvDiscount
= 6/Medicare
= 8/MHMO
= 10/MedicarePartD
= 5/VA
= 3/PlanNotMHMO
= 4/OSOP
= 9/DM
If there is more than Source of Payment per Source of Payment
Type, display in order of entry in TSOP.
Display all loaded Source of Payments as protected rows.
Roster/Grid display:
COL #
1
3:20:18 PM Monday, August 03, 2009
HEADER
SOP Name
INSTRUCTIONS
Display TSOP.TSOPTEXT.
Page 191 of 278
NS66
2
SOP Type
If TSOP.TSOPDISP ^= empty, display
TSOP.TSOPDISP.
Else do not display.
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
(LINKED CHARGE BUNDLE EVENT) (etc.)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
ADD ALL ADDITIONAL SOURCES OF PAYMENT FOR THIS
CHARGE BUNDLE.
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
SOP_NS1
( NSQ2703 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TSOPPick
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
NS67 - TSOPAMT ( NSQ2720 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on TSOP:
TSOP key = TSOP.TSOPBASE + TSOP.TSOPNUM.
TSOP.TSOPNUM = Number of Source of Payment selected at NS66.
If adding SOP, see SOURCE OF PAYMENT ROSTER POP-UP specifications for pop-up
window programming instructions.
Fields collected in Pop-Up window:
TSOP.TSOPNUM
TSOP.TSOPTEXT
3:20:19 PM Monday, August 03, 2009
Page 192 of 278
NS66
TSOP.TSOPISHI
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If MEDICAID is already on the Source of Payment roster, TSOPISHI
should ^= 1/Medicaid.
If not true, display "An add has failed. It was a duplicate."
Edit #2
If TRICARE is already on the Source of Payment roster, TSOPISHI
should ^= 9/Tricare.
If not true, display "An add has failed. It was a duplicate."
TECHNICAL NOTES
263
MedicaidSOP
Medicaid already on SOP roster =
There is a TSOP where TSOP.TSOPPTYP=2/Medicaid.
264
TricareSOP
Tricare already on SOP roster =
There is a TSOP where TSOP.TSOPPTYP = 6/Tricare.
DESIGN NOTES
3:20:19 PM Monday, August 03, 2009
Page 193 of 278
NS67
NS67
Page Order # :
Design Screen Type:
Grid
Fields:
Field 1:
TSOPAMT
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
1110
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all eligible Source of Payments stored on TSOP based on
the following logic:
Do not display TSOP.TSOPTYPE = 11/MedicareSubsidy and
12/ExtraHelp.
Display all remaining Sources of Payments in the following order
based on TSOP.TSOPTYPE:
= 1/SPFamily
= 2/ProvDiscount
= 6/Medicare
= 8/MHMO
= 10/MedicarePartD
= 5/VA
= 3/PlanNotMHMO
= 4/OSOP
= 9/DM
If there is more than Source of Payment per Source of Payment
Type, display in order of entry in TSOP.
Roster/Grid display:
COL #
1
3:20:20 PM Monday, August 03, 2009
HEADER
SOP Name
INSTRUCTIONS
Display TSOP.TSOPTEXT. Display Only.
Page 194 of 278
NS67
2
SOP Type
If TSOP.TSOPDISP ^= empty, display
TSOP.TSOPDISP.
Else do not display.
Display only.
3
SOP Payment
TSOP.TSOPAMT. Input field 1.
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
(LINKED CHARGE BUNDLE EVENT) (etc.)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
Question Text:
Who (else) paid? How much did (SOURCE) pay?
Int. Instr II:
ENTER ALL PAYMENT AMOUNTS. CORRECT PAYMENT
AMOUNTS AS NECESSARY.
INPUT FIELDS / ROUTING
3:20:22 PM Monday, August 03, 2009
Page 195 of 278
NS67
TSOPAMT
Field1:
( NSQ2720 )
TSOP.TSOPAMT
Cheshire Name:
SQL tblTSOP is not transformed to TSOP in Cheshire.
Item Text display:
GRID COLUMN #3
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Real
TTsopamt
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Empty
Route
BOX NS67A - (NSQ2780 )
Don't know
BOX NS67A - (NSQ2780 )
Refusal
BOX NS67A - (NSQ2780 )
FieldSize:
Min Value:
Max Value:
Mask:
0.01
999999.99
Dollars
Route
BOX NS67A - (NSQ2780 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
TSOPAMT = 0.50 - 999,999.99, DK, RF.
If not true, display message: "UNLIKELY RESPONSE. PLEASE
VERIFY."
HARD EDIT CHECKS
At least one TSOPAMT = DK or RF or the sum of all TSOPAMT
values for this cost > 0.00.
If not true, display message "THE SUM OF ALL PAYMENT
AMOUNTS MUST BE GREATER THAN $0.00 OR AT LEAST ONE
PAYMENT AMOUNT MUST BE 'DON'T KNOW' OR 'REFUSED'."
TECHNICAL NOTES
DESIGN NOTES
3:20:23 PM Monday, August 03, 2009
Page 196 of 278
BOX NS67A
BOX NS67A
Page Order # :
1120
BOX INSTRUCTIONS
( NSQ2780 )
IF AT LEAST ONE SOURCE OF PAYMENT WAS ADDED AT NS66, GO TO
BOX NS67B - (NSQ2810 ).
ELSE GO TO BOX NS69F - (NSQ2836 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
3:20:23 PM Monday, August 03, 2009
Page 197 of 278
BOX NS67B
BOX NS67B
Page Order # :
1140
BOX INSTRUCTIONS
( NSQ2810 )
IF AT LEAST ONE SOURCE OF PAYMENT ADDED AT NS66 IS A HEALTH
INSURANCE PLAN, GO TO NS67BINT - PLANINTRO_NS ( NSQ2815 ).
ELSE GO TO BOX NS69B - (NSQ2827 ).
ASSIGNMENTS
TECHNICAL NOTES
248
SOPPlan
Source of Payment is a HI Plan =
Medicaid: TSOP.TSOPISHI=1/Medicaid
Public: TSOP.TSOPISHI=2/PublicPlan
Private: TSOP.TSOPISHI=3/PrivatePlan
MHMO: TSOP.TSOPISHI=7/MHMO
Tricare: TSOP.TSOPISHI=9/Tricare.
MPDP: TSOP.TSOPISHI=10/MedicarePartD
DESIGN NOTES
3:20:23 PM Monday, August 03, 2009
Page 198 of 278
NS67BINT
NS67BINT
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
PLANINTRO_NS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1145
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:
Always display "(s)" in parentheses.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Before we continue, I would like to ask you a few questions about
the health insurance plan(s) you just added.
Int. Instr II:
INPUT FIELDS / ROUTING
3:20:24 PM Monday, August 03, 2009
Page 199 of 278
NS67BINT
PLANINTRO_NS
Field1:
( NSQ2815 )
TEMP
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
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
NS67B_IN - NAVIGATOR ( NSQ2816 )
English text: CONTINUE
Attribute
Empty
Route
NS67B_IN - NAVIGATOR ( NSQ2816 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:20:26 PM Monday, August 03, 2009
Page 200 of 278
NS67B_IN
NS67B_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1146
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 HI SOPs added at NS66.
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
3:20:27 PM Monday, August 03, 2009
Page 201 of 278
NS67B_IN
NAVIGATOR
Field1:
Cheshire Name:
( NSQ2816 )
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 NS67C - (NSQ2820 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
BOX NS69B - (NSQ2827 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
248
SOPPlan
Source of Payment is a HI Plan =
Medicaid: TSOP.TSOPISHI=1/Medicaid
Public: TSOP.TSOPISHI=2/PublicPlan
Private: TSOP.TSOPISHI=3/PrivatePlan
MHMO: TSOP.TSOPISHI=7/MHMO
Tricare: TSOP.TSOPISHI=9/Tricare.
MPDP: TSOP.TSOPISHI=10/MedicarePartD
DESIGN NOTES
3:20:29 PM Monday, August 03, 2009
Page 202 of 278
BOX NS67C
BOX NS67C
3:20:29 PM Monday, August 03, 2009
Page Order # :
1150
Page 203 of 278
BOX NS67C
BOX INSTRUCTIONS
( NSQ2820 )
CREATE A NEW HEALTH INSURANCE PLAN FOR FIRST/NEXT SOURCE
OF PAYMENT ADDED AT NS66 .
IF SOURCE OF PAYMENT IS A MEDICARE MANAGED CARE PLAN AND
SP HAS A MEDICARE MANAGED CARE PLAN THAT IS CURRENT, GO TO
NS68 - NSMHMOCHNG1 ( NSQ2821 ).
ELSE IF SOURCE OF PAYMENT IS A MEDICARE MANAGED CARE PLAN
AND SP DOES NOT HAVE A MEDICARE MANAGED CARE PLAN THAT IS
CURRENT, GO TO NS69 - NSSOPCURR1 ( NSQ2822 ).
ELSE IF SOURCE OF PAYMENT IS A MEDICARE PRESCRIPTION DRUG
PLAN AND SP HAS A MEDICARE PRESCRIPTION DRUG PLAN THAT IS
CURRENT, GO TO NS69A - NSMPDPCHNG ( NSQ2823 ).
ELSE IF SOURCE OF PAYMENT IS MEDICARE PRESCRIPTION DRUG
PLAN AND SP DOES NOT HAVE A MEDICARE PRESCRIPTION DRUG
PLAN THAT IS CURRENT, GO TO NS69B - NSSOPCURR2 ( NSQ2824 ).
ELSE IF SOURCE OF PAYMENT IS MEDICAID, GO TO HI6 - COVTIME (
HIQ4770 ).
ELSE IF SOURCE OF PAYMENT IS A PUBLIC PLAN, GO TO HI13 COVTIME ( HIQ5780 ).
ELSE IF SOURCE OF PAYMENT IS A PRIVATE PLAN, GO TO HI21 COVTIME ( HIQ6230 ).
ELSE GO TO HIT2 - COVTIME ( HIQ5330 ).
ASSIGNMENTS
If SOP added is an MHMO, Public plan, Private plan, or Medicare Prescription Drug plan
create a new PLAN and current round PLRO record. See detailed instructions below.
If SOP added is Medicaid 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. Update existing PLAN flags = empty and create a current round PLRO record.
See detailed instructions below.
Else if there is no PLAN where PLAN.PLANTYPE=2/Medicaid, ccreate a new PLAN and
current round PLRO record. Set PLAN.PLNAME = MEDICAID. See detailed instructions
below.
If SOP added is Tricare 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. Update existing PLAN flags = empty and create a current round PLRO record.
See detailed instructions below.
Else if there is no PLAN where PLAN.PLANTYPE=6/Tricare, create a new PLAN and
current round PLRO record. Set PLAN.PLNAME = TRICARE. See detailed instructions
below.
PLAN KEY = PLAN.PLANBASE + PLAN.PLANNUM
3:20:29 PM Monday, August 03, 2009
Page 204 of 278
BOX NS67C
PLRO KEY = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
Set PLAN/PLRO fields as instructed below:
PLANNUM
If creating a new PLAN, create PLAN where
PLAN.PLANNUM = highest PLAN.PLANNUM + 01.
PLANRNDC
If creating a new PLAN, set PLAN.PLANRNDC =
current round.
PLANTYPE
Set PLANTYPE based on TSOPISHI:
=1/Medicaid, PLANTYPE=2/Medicaid.
=2/PublicPlan, PLANTYPE=3/PublicPlan.
=3/PrivatePlan, PLANTYPE=4/PrivatePlan.
=7/MHMO, PLANTYPE=5/MHMO.
=9/Tricare, PLANTYPE=6/Tricare.
=10/MedicarePartD, PLANTYPE=7/MPDP.
PLNAME
If creating a new PLAN,
If SOP is Medicaid, set PLAN.PLNAME =
"MEDICAID".
Else if SOP is Tricare, set PLAN.PLNAME =
"TRICARE".
Else set PLAN.PLNAME = TSOP.TSOPTEXT.
PLROPLAN
Create PLRO where PLRO.PLROPLAN = new
PLAN.PLANNUM.
PLRORND
PLRO.PLRORND = current round.
COVANYTM
If TSOP.TSOPISHI = 7/MHMO or 10/MedicarePartD,
set PLRO.COVANYTM = 1/Yes.
TSOPTYPE
If TSOP.TSOPISHI = 1/Medicaid, 2/PublicPlan,
3/PrivatePlan, 9/Tricare, set TSOP.TSOPTYPE =
3/PlanNotMHMO.
Else if TSOP.TSOPISHI = 7/MHMO, set
TSOP.TSOPTYPE = 8/MHMO.
Else if TSOP.TSOPISHI=10/MedicarePartD, set
TSOP.TSOPTYPE =10/MedicarePartD.
TSOPPTYP
Set TSOP.TSOPPTYP = PLAN.PLANTYPE.
TSOPPLAN
Set TSOP.TSOPPLAN = PLAN.PLANNUM.
TSOPDISP
Set TSOP.TSOPDISP based on PLAN.PLANTYPE:
= 2/Medicaid, TSOPDISP = "(MCAD)".
= 3/PublicPlan, TSOPDISP = "(PUBL)".
= 4/PrivatePlan, TSOPDISP = "(PRIV)".
= 5/MHMO, TSOPDISP = “(MHMO)”.
= 6/Tricare, TSOPDISP = "(TRIC)".
=7/MPDP, TSOPDISP = "(MPDP)".
PLANDFLG
If restarting Medicaid or Tricare plan, set
PLAN.PLANDFLG = empty.
LOSEPLFG
If restarting Medicaid or Tricare plan, set
PLAN.LOSEPLFG = empty.
PLSOPFLG
If creating new PLAN, set PLAN.PLSOPFLG = 1/Yes.
TECHNICAL NOTES
248
SOPPlan
3:20:29 PM Monday, August 03, 2009
Source of Payment is a HI Plan =
Medicaid: TSOP.TSOPISHI=1/Medicaid
Public: TSOP.TSOPISHI=2/PublicPlan
Private: TSOP.TSOPISHI=3/PrivatePlan
MHMO: TSOP.TSOPISHI=7/MHMO
Page 205 of 278
BOX NS67C
Tricare: TSOP.TSOPISHI=9/Tricare.
MPDP: TSOP.TSOPISHI=10/MedicarePartD
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
(Medicare Advantage 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.
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
BOX NS67C calls HI section for Medicaid, Tricare, Public Plans, and
Private Plans added to SOP roster.
NS68 and NS69 collects status of MHMO plan added to SOP roster.
NS69 calls HI section for MHMO plan if "current".
HI returns to NS at BOX NS69A.
NS69A and NS69B collect the status of MPDP plan added to SOP roster.
NS does not call HI section for MPDP plan details.
3:20:29 PM Monday, August 03, 2009
Page 206 of 278
NS68
NS68
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
NSMHMOCHNG1
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
1151
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
NS68 is asked when a MHMO is added at the SOP roster and there
is already a current MHMO reported in the current round. The
purpose of NS68 is to remind the respondent of the current MHMO
already reported and determine if the plan status has changed.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
I recorded previously that (CURRENT MEDICARE MANAGED
CARE PLAN NAME) was [your/(SP's)] current Medicare Managed
Care Plan. Has this information changed?
Int. Instr II:
INPUT FIELDS / ROUTING
3:20:30 PM Monday, August 03, 2009
Page 207 of 278
NS68
NSMHMOCHNG1
Field1:
( NSQ2821 )
TEMP
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
NS69 - NSSOPCURR1 ( NSQ2822 )
English text: YES
No
BOX NS69A - (NSQ2825 )
English text: NO
Attribute
Don't know
Route
BOX NS69A - (NSQ2825 )
Refusal
BOX NS69A - (NSQ2825 )
BACKGROUND VARIABLE ASSIGNMENTS
COVCURNT
If NS68 - NSMHMOCHNG1 = 2/No, DK, RF, set
current round PLRO.COVCURNT = 2/No on MHMO
PLAN added to SOP roster.
SOFT EDIT CHECKS
Edit #1:
NS68 - NSMHMOCHNG1 = 1/Yes.
If not true, display message "INFORMATION FOR THIS PLAN WILL
NOT BE COLLECTED NOW."
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
3:20:33 PM Monday, August 03, 2009
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 208 of 278
NS68
65
MHMOCurrent
SP has a current Medicare Managed Care plan
(Medicare Advantage 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
3:20:33 PM Monday, August 03, 2009
Page 209 of 278
NS69
NS69
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
NSSOPCURR1
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1152
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 SP is alive and not institutionalized, display "currently".
Else do not display.
Display name of Medicare Managed Care Plan Name,
PLAN.PLNAME, added at NS66 Source of Payment Roster.
If SP is deceased or institutionalized, display "on (DATE OF
DEATH/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:
3:20:34 PM Monday, August 03, 2009
[Are you/Is (SP)/Was (SP)] (currently) covered or enrolled in (NS66
SOP MEDICARE MANAGED CARE PLAN NAME) [on (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)]?
Page 210 of 278
NS69
Int. Instr II:
INPUT FIELDS / ROUTING
NSSOPCURR1
Field1:
Cheshire Name:
( NSQ2822 )
TEMP
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
HIMC6 - MHMORX ( HIQ4020 )
VERIFY IN HI.
English text: YES
No
BOX NS69A - (NSQ2825 )
English text: NO
Attribute
Don't know
Route
BOX NS69A - (NSQ2825 )
Refusal
BOX NS69A - (NSQ2825 )
BACKGROUND VARIABLE ASSIGNMENTS
COVCURNT
Set PLRO.COVCURNT on PLRO where
PLRO.PLROPLAN = PLAN.PLANNUM of MHMO
added at SOP roster and PLRO.PLRORND = current
round:
If NS69 - STSOPCURR1 = 1/Yes, set
PLRO.COVCURNT = 1/Yes.
Else set PLRO.COVCURNT = 2/No.
COVCURNT
If NS68 - STMHMOCHNG1 = 1/Yes and NS69
STSOPCURR1 = 1/Yes, update
PLRO.PLROCOVURNT = 2/No on PLRO where
PLRO.PLROPLAN = PLAN.PLANNUM of pre
existing current MHMO and PLRO.PLRORNDC =
current round.
3:20:37 PM Monday, August 03, 2009
Page 211 of 278
NS69
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
NS69 calls HI section for MHMOs if MHMO added is current.
HI returns to NS at BOX NS69A.
3:20:37 PM Monday, August 03, 2009
Page 212 of 278
NS69A
NS69A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
NSMPDPCHNG
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1153
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:
NS69A is asked when a MPDP is added at the SOP roster and
there is already a current MPDP reported in the current round. The
purpose of NS69A is to remind the respondent of the current MPDP
already reported and determine if the plan status has changed.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
I recorded previously that (CURRENT MEDICARE PRESCRIPTION
DRUG PLAN) was [your/(SP's)] current Medicare Prescription Drug
Care Plan.
Has this information changed?
Int. Instr II:
3:20:38 PM Monday, August 03, 2009
Page 213 of 278
NS69A
INPUT FIELDS / ROUTING
NSMPDPCHNG
Field1:
( NSQ2823 )
TEMP
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
NS69B - NSSOPCURR2 ( NSQ2824 )
English text: YES
No
English text: NO
BOX NS69A - (NSQ2825 )
Attribute
Don't know
Route
BOX NS69A - (NSQ2825 )
Refusal
BOX NS69A - (NSQ2825 )
BACKGROUND VARIABLE ASSIGNMENTS
COVCURNT
If NS69A - NSMDPDCHNG = 2/No, DK, RF, set
current round PLRO.COVCURNT = 2/No for MPDP
PLAN added to SOP roster.
SOFT EDIT CHECKS
Edit #1:
NS69A - STMPDPCHNG = 1/Yes.
If not true, display message "INFORMATION FOR THIS PLAN WILL
NOT BE COLLECTED NOW."
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
3:20:41 PM Monday, August 03, 2009
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
Page 214 of 278
NS69A
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
3:20:41 PM Monday, August 03, 2009
Page 215 of 278
NS69B
NS69B
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
NSSOPCURR2
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1154
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 SP is alive and not institutionalized, display "currently".
Else do not display.
Display name of Medicare Prescription Drug Plan, PLAN.PLNAME,
added at NS66 Source of Payment Roster.
If SP is deceased or institutionalized, display "on (DATE OF
DEATH/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:
3:20:43 PM Monday, August 03, 2009
[Are you/Is (SP)/Was (SP)] (currently) covered or enrolled in (NS66
SOP MEDICARE PRESCRIPTION DRUG PLAN) [on (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)]?
Page 216 of 278
NS69B
Int. Instr II:
INPUT FIELDS / ROUTING
NSSOPCURR2
Field1:
Cheshire Name:
( NSQ2824 )
TEMP
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 NS69A - (NSQ2825 )
English text: YES
No
BOX NS69A - (NSQ2825 )
English text: NO
Attribute
Don't know
Route
BOX NS69A - (NSQ2825 )
Refusal
BOX NS69A - (NSQ2825 )
BACKGROUND VARIABLE ASSIGNMENTS
COVCURNT
Set PLRO.COVCURNT on PLRO where
PLRO.PLROPLAN = PLAN.PLANNUM of MPDP
added at SOP roster and PLRO.PLRORND = current
round:
If NS69B - STSOPCURR2 = 1/Yes, set
PLRO.COVCURNT = 1/Yes.
Else set PLRO.COVCURNT = 2/No.
COVCURNT
If NS69A - STMPDPCHNG = 1/Yes and NS69B
STSOPCURR2 = 1/Yes, update
PLRO.PLROCOVURNT = 2/No on PLRO where
PLRO.PLROPLAN = PLAN.PLANNUM of pre
existing current MPDP and PLRO.PLRORNDC =
current round.
SOFT EDIT CHECKS
3:20:46 PM Monday, August 03, 2009
Page 217 of 278
NS69B
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
3:20:46 PM Monday, August 03, 2009
Page 218 of 278
BOX NS69A
BOX NS69A
Page Order # :
1155
BOX INSTRUCTIONS
( NSQ2825 )
GO TO NS67B_IN - NAVIGATOR ( NSQ2816 ).
ASSIGNMENTS
TECHNICAL NOTES
248
SOPPlan
Source of Payment is a HI Plan =
Medicaid: TSOP.TSOPISHI=1/Medicaid
Public: TSOP.TSOPISHI=2/PublicPlan
Private: TSOP.TSOPISHI=3/PrivatePlan
MHMO: TSOP.TSOPISHI=7/MHMO
Tricare: TSOP.TSOPISHI=9/Tricare.
MPDP: TSOP.TSOPISHI=10/MedicarePartD
DESIGN NOTES
HI returns to NS at BOX NS69A.
3:20:46 PM Monday, August 03, 2009
Page 219 of 278
BOX NS69B
BOX NS69B
Page Order # :
1157
BOX INSTRUCTIONS
( NSQ2827 )
IF AT LEAST ONE SOURCE OF PAYMENT ADDED AT NS66 IS A
DISCOUNT MEMBERSHIP PLAN, GO TO NS69C - DMEMINTRO_NS (
NSQ2828 ).
ELSE GO TO BOX NS69E - (NSQ2834 ).
ASSIGNMENTS
TECHNICAL NOTES
374
SOPDmem
Source of Payment is a Discount Membership Plan =
TSOP.TSOPISHI = 8/DM.
DESIGN NOTES
3:20:46 PM Monday, August 03, 2009
Page 220 of 278
NS69C
NS69C
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
DMEMINTRO_NS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1158
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:
Always display "(s)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Before we continue, I would like to ask you a few questions about
the discount membership plan(s) you just added.
Int. Instr II:
INPUT FIELDS / ROUTING
3:20:47 PM Monday, August 03, 2009
Page 221 of 278
NS69C
DMEMINTRO_NS
Field1:
( NSQ2828 )
TEMP
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
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
NS69C_IN - NAVIGATOR ( NSQ2829 )
English text: CONTINUE
Attribute
Empty
Route
NS69C_IN - NAVIGATOR ( NSQ2829 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:20:49 PM Monday, August 03, 2009
Page 222 of 278
NS69C_IN
NS69C_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1159
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 DM's added at NS66 SOP roster.
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
3:20:50 PM Monday, August 03, 2009
Page 223 of 278
NS69C_IN
NAVIGATOR
Field1:
( NSQ2829 )
N/A
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
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX NS69C - (NSQ2830 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
BOX NS69E - (NSQ2834 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:20:51 PM Monday, August 03, 2009
Page 224 of 278
BOX NS69C
BOX NS69C
Page Order # :
1160
BOX INSTRUCTIONS
( NSQ2830 )
CREATE A NEW DISCOUNT MEMBERSHIP PLAN FOR THE SOURCE OF
PAYMENT ADDED AT NS66 .
GO TO DM4 - DMSERVIC ( DMQ1070 ).
.
ASSIGNMENTS
DM details are collected on DMEM and DMRO:
DMEM key = DMEM.DMEMBASE + DMEM.DMEMNUM
DMEM.DMEMNUM = Number of DM created at BOX ST69C.
DMRO key = DMRO.DMROBASE + DMRO.DMRODMEM + DMRO.DMRORND
DMRO.DMRODMEM = DMEM.DMEMNUM of DM created at BOX NS69C.
DMRO.DMRORND = current round.
DMEMNUM
DMEM.DMEMNUM = highest DMEM.DMEMNUM +
01.
DMEMRNDC
DMEM.DMEMRNDC = current round.
DMRODMEM
DMRO.DMRODMEM = DMEM.DMEMNUM.
DMRORND
DMRO.DMRORND = curent round.
DMHAVE
DMRO.DMHAVE = 1/Yes.
DMNAMEX
DMEM.DMNAMEX = TSOP.TSOPTEXT.
DMSOPFLG
DMEM.DMSOPFLG = 1/Yes.
TSOPTYPE
TSOP.TSOPTYPE = 9/DM.
TSOPDMEM
TSOP.TSOPDMEM = DMEM.DMEMNUM.
TECHNICAL NOTES
DESIGN NOTES
Calls DM section for Discount Membership plans added to SOP roster.
DM returns to NS at BOX NS69D.
3:20:51 PM Monday, August 03, 2009
Page 225 of 278
BOX NS69D
BOX NS69D
Page Order # :
1165
BOX INSTRUCTIONS
( NSQ2832 )
GO TO NS69C_IN - NAVIGATOR ( NSQ2829 ).
ASSIGNMENTS
TECHNICAL NOTES
374
SOPDmem
Source of Payment is a Discount Membership Plan =
TSOP.TSOPISHI = 8/DM.
DESIGN NOTES
DM returns to NS at BOX NS69D.
3:20:51 PM Monday, August 03, 2009
Page 226 of 278
BOX NS69E
BOX NS69E
Page Order # :
1167
BOX INSTRUCTIONS
( NSQ2834 )
IF AN "OTHER SOURCE OF PAYMENT" ADDED AT NS66, CREATE AN
OSOP FOR EACH SOURCE OF PAYMENT ADDED AT NS66 THAT IS AN
"OTHER SOURCE OF PAYMENT" . .
GO TO BOX NS69F - (NSQ2836 ).
ASSIGNMENTS
Other Source of Payment details will be collected on OSOP:
OSOP key = OSOP.OSOPBASE + OSOP.OSOPNUM
OSOP.OSOPNUM = Number of Other Source of Payment generated at BOX NS69E.
Create OSOP record for each OTHER SOURCE OF PAYMENT added at NS66.
Set OSOP fields as specified below.
OSOPNUM
OSOP.OSOPNUM = highest OSOP.OSOPNUM + 01.
OSOPRNDC
OSOP.OSOPRNDC = current round.
OSOPTEXT
OSOP.OSOPTEXT = TSOP.TSOPTEXT.
TSOPTYPE
TSOP.TSOPTYPE = 4/OSOP.
TSOPOSOP
TSOP.TSOPOSOP = OSOP.OSOPNUM.
TSOPDISP
TSOP.TSOPDISP = "(OTHER)".
TECHNICAL NOTES
248
SOPPlan
Source of Payment is a HI Plan =
Medicaid: TSOP.TSOPISHI=1/Medicaid
Public: TSOP.TSOPISHI=2/PublicPlan
Private: TSOP.TSOPISHI=3/PrivatePlan
MHMO: TSOP.TSOPISHI=7/MHMO
Tricare: TSOP.TSOPISHI=9/Tricare.
MPDP: TSOP.TSOPISHI=10/MedicarePartD
DESIGN NOTES
3:20:51 PM Monday, August 03, 2009
Page 227 of 278
BOX NS69F
BOX NS69F
Page Order # :
1168
BOX INSTRUCTIONS
( NSQ2836 )
IF (TOTAL CHARGE ^= DK AND TOTAL CHARGE ^= RF) AND (AT LEAST
ONE PAYMENT ENTERED AT NS67 = DK OR RF) AND (AT LEAST ONE
PAYMENT ENTERED AT NS67 ^= DK AND ^= RF) AND (TOTAL OF ALL
NON-MISSING PAYMENTS ENTERED AT NS67 > TOTAL CHARGE), GO TO
NS71 - AMTSCORR ( NSQ2860 ).
ELSE IF (TOTAL CHARGE ^= DK AND TOTAL CHARGE ^= RF) AND (ALL
PAYMENTS ENTERED AT NS67 ^= DK AND ^= RF) AND (THE ABSOLUTE
VALUE OF THE DIFFERENCE BETWEEN THE TOTAL PAYMENTS
ENTERED AT NS67 AND TOTAL CHARGE IS > $1.00), GO TO NS70
AMTSCORR ( NSQ2840 ).
ELSE GO TO BOX NS77C - (NSQ2910 ).
ASSIGNMENTS
TECHNICAL NOTES
270
TotalCharge
Total Charge =
COST.TOTALAMT.
When collecting Total charge in the current round, Total
Charge is first collected in CORO.TOTALCHG on CORO
where CORO.CORORND = current round and
CORO.COROCOST = this COST.COSTNUM and then is
copied to COST.TOTALAMT.
255
TotalPayments
Total of non-missing Payments entered in SOP grid =
For each TSOP where (TSOP.TSOPAMT ^= DK and
TSOP.TSOPAMT ^= RF and TSOP.TSOPAMT ^=
EMPTY), then Total Payments = Total Payments +
TSOP.TSOPAMT.
DESIGN NOTES
3:20:51 PM Monday, August 03, 2009
Page 228 of 278
NS70
NS70
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
AMTSCORR
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
1170
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Total Payments = If (TSOP.TSOPAMT ^= DK and
TSOP.TSOPAMT ^= RF and TSOP.TSOPAMT ^= EMPTY), Total
Payments = Total Payments + TSOP.TSOPAMT.
If Total Payments > Total Charge then
Display "overpaid".
DIFFERENCE = Display the remainder of (Total Payments - Total
Charge)
Else then
Display "unpaid".
DIFFERENCE = Display the remainder of (Total Charge - Total
Payments).
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report above question text.
Display all Source of Payments where TSOP.TSOPAMT ^= empty in
the following order based on TSOP.TSOPTYPE:
= 1/SPFamily
= 2/ProvDiscount
=11/MedicareSubsidy
=12/ExtraHelp
3:20:53 PM Monday, August 03, 2009
Page 229 of 278
NS70
= 6/Medicare
= 8/MHMO
=10/MedicarePartD
= 5/VA
= 3/PlanNotMHMO
= 4/OSOP
= 9/DM
If there is more than Source of Payment per Source of Payment
Type, display in order of entry in TSOP.
Not all TSOP.TSOPTYPEs will be applicable.
Report header:
"ALL PAYMENTS"
Report layout:
Column 1, header="SOP NAME".
Column 1, display = TSOP.TSOPTEXT.
Column 2, header = "PAYMENT".
Column 2, display =
If TSOP.TSOPAMT = DK, display "DK".
Else if TSOP.TSOPAMT = RF, display "RF".
Else display TSOP.TSOPAMT.
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
(LINKED CHARGE BUNDLE EVENT) (etc.)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
Question Text:
There seems to be (some amount still unpaid/more payments than
the total charge).
[REVIEW WITH RESPONDENT.] The total of all payments is
$(TOTAL PAYMENTS). The amount (unpaid/overpaid) is
$(DIFFERENCE BETWEEN PAYMENTS AND TOTAL CHARGE).
Is that correct?
Int. Instr II:
INPUT FIELDS / ROUTING
3:20:54 PM Monday, August 03, 2009
Page 230 of 278
NS70
AMTSCORR
Field1:
( NSQ2840 )
CORO.AMTSCORR
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
TAmtscorr
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 YesEntriesCorrect
Route
BOX NS77C - (NSQ2910 )
2
English text: ENTRIES ABOVE ARE CORRECT
NoAddCorrectSOP
NS65 - NSADDSOP1 ( NSQ2702 )
3
English text: NO, SOP NEEDS ADDITION OR CORRECTION
AmountRemainingIncorrect
NS72 - ENTERCOM ( NSQ2870 )
English text: AMOUNT REMAINING SEEMS INCORRECT
Attribute
Don't know
Route
BOX NS77C - (NSQ2910 )
Refusal
BOX NS77C - (NSQ2910 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
255
TotalPayments
Total of non-missing Payments entered in SOP grid =
For each TSOP where (TSOP.TSOPAMT ^= DK and
TSOP.TSOPAMT ^= RF and TSOP.TSOPAMT ^=
EMPTY), then Total Payments = Total Payments +
TSOP.TSOPAMT.
DESIGN NOTES
3:20:57 PM Monday, August 03, 2009
Page 231 of 278
NS71
NS71
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
AMTSCORR
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
1190
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report above question text.
Display all Source of Payments where TSOP.TSOPAMT ^= empty in
the following order based on TSOP.TSOPTYPE:
= 1/SPFamily
= 2/ProvDiscount
=11/MedicareSubsidy
=12/ExtraHelp
= 6/Medicare
= 8/MHMO
=10/MedicarePartD
= 5/VA
= 3/PlanNotMHMO
= 4/OSOP
= 9/DM
If there is more than Source of Payment per Source of Payment
Type, display in order of entry in TSOP.
Not all TSOP.TSOPTYPEs will be applicable.
3:20:58 PM Monday, August 03, 2009
Page 232 of 278
NS71
Report header:
"ALL PAYMENTS"
Report layout:
Column 1, header="SOP NAME".
Column 1, display = TSOP.TSOPTEXT.
Column 2, header = "PAYMENT".
Column 2, display =
If TSOP.TSOPAMT = DK, display "DK".
Else if TSOP.TSOPAMT = RF, display "RF".
Else display TSOP.TSOPAMT.
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
(LINKED CHARGE BUNDLE EVENT) (etc.)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
Question Text:
Int. Instr II:
THE AMOUNTS ENTERED FOR THE SOURCES OF PAYMENT
EQUAL OR EXCEED THE TOTAL CHARGE, WITH AT LEAST ONE
SOP BEING A MISSING AMOUNT. VERIFY ALL AMOUNTS AS
ENTERED.
INPUT FIELDS / ROUTING
3:21:01 PM Monday, August 03, 2009
Page 233 of 278
NS71
AMTSCORR
Field1:
( NSQ2860 )
CORO.AMTSCORR
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
TAmtscorr
1
No
No
Number Label
1 YesEntriesCorrect
2
3
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX NS77C - (NSQ2910 )
English text: ENTRIES ABOVE ARE CORRECT
NoAddCorrectSOP
NS65 - NSADDSOP1 ( NSQ2702 )
English text: NO, SOP NEEDS ADDITION OR CORRECTION
AmountRemainingIncorrect
NS72 - ENTERCOM ( NSQ2870 )
English text: AMOUNT REMAINING SEEMS INCORRECT
Attribute
Don't know
Route
BOX NS77C - (NSQ2910 )
Refusal
BOX NS77C - (NSQ2910 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:21:04 PM Monday, August 03, 2009
Page 234 of 278
NS72
NS72
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
ENTERCOM
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
1200
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If NO payments entered at NS67 = DK or RF, display "THE TOTAL
OF NON-MEDICARE…".
Else do not display.
Total Payments = If (TSOP.TSOPAMT ^= DK and
TSOP.TSOPAMT ^= RF and TSOP.TSOPAMT ^= EMPTY), Total
Payments = Total Payments + TSOP.TSOPAMT.
If Total Payments > Total Charge then
Display "OVERPAID".
DIFFERENCE = Display the remainder of (Total Payments - Total
Charge)
Else then
Display "UNPAID".
DIFFERENCE = Display the remainder of (Total Charge - Total
Payments).
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report above question text.
Display all Source of Payments where TSOP.TSOPAMT ^= empty in
the following order based on TSOP.TSOPTYPE:
3:21:05 PM Monday, August 03, 2009
Page 235 of 278
NS72
= 1/SPFamily
= 2/ProvDiscount
=11/MedicareSubsidy
=12/ExtraHelp
= 6/Medicare
= 8/MHMO
=10/MedicarePartD
= 5/VA
= 3/PlanNotMHMO
= 4/OSOP
= 9/DM
If there is more than Source of Payment per Source of Payment
Type, display in order of entry in TSOP.
Not all TSOP.TSOPTYPEs will be applicable.
Report header:
"ALL PAYMENTS"
Report layout:
Column 1, header="SOP NAME".
Column 1, display = TSOP.TSOPTEXT.
Column 2, header = "PAYMENT".
Column 2, display =
If TSOP.TSOPAMT = DK, display "DK".
Else if TSOP.TSOPAMT = RF, display "RF".
Else display TSOP.TSOPAMT.
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
(LINKED CHARGE BUNDLE EVENT) (etc.)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
Question Text:
Int. Instr II:
[THE TOTAL OF PAYMENTS IS $(TOTAL PAYMENTS). THE
AMOUNT (UNPAID/OVERPAID) IS $(DIFFERENCE BETWEEN
PAYMENTS AND TOTAL CHARGE).]
USE COMMENTS TO EXPLAIN WHY THE AMOUNT REMAINING
SEEMS INCORRECT.
INPUT FIELDS / ROUTING
3:21:06 PM Monday, August 03, 2009
Page 236 of 278
NS72
ENTERCOM
Field1:
( NSQ2870 )
TEMP
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
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX NS77C - (NSQ2910 )
English text: CONTINUE
Attribute
Empty
Route
BOX NS77C - (NSQ2910 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
255
TotalPayments
Total of non-missing Payments entered in SOP grid =
For each TSOP where (TSOP.TSOPAMT ^= DK and
TSOP.TSOPAMT ^= RF and TSOP.TSOPAMT ^=
EMPTY), then Total Payments = Total Payments +
TSOP.TSOPAMT.
270
TotalCharge
Total Charge =
COST.TOTALAMT.
When collecting Total charge in the current round, Total
Charge is first collected in CORO.TOTALCHG on CORO
where CORO.CORORND = current round and
CORO.COROCOST = this COST.COSTNUM and then is
copied to COST.TOTALAMT.
DESIGN NOTES
3:21:08 PM Monday, August 03, 2009
Page 237 of 278
BOX NS77C
BOX NS77C
3:21:08 PM Monday, August 03, 2009
Page Order # :
1240
Page 238 of 278
BOX NS77C
BOX INSTRUCTIONS
( NSQ2910 )
CREATE PAYMENTS FOR AMOUNTS ENTERED AT NS67 .
GO TO BOX NS77D - (NSQ2915 ).
ASSIGNMENTS
Payments details are stored on PAYM:
PAYM key = PAYM.PAYMBASE + PAYM.PAYMCOST + PAYM.PAYMNUM.
PAYM.PAYMCOST = COST.COSTNUM of this charge bundle being asked about.
PAYM.PAYMNUM = Unique Number assigned to unique payer linked to this charge bundle.
PAYM records are only created for payers where TSOP.TSOPAMT ^= NULL.
TSOP.TSOPAMT may be >= 0, DK, or RF.
Only one PAYM record will be created per unique payer per charge bundle, regardless of
PAYM.PAYMRNDC.
DETAILS:
For each payer where TSOP.TSOPAMT >=0, DK, or RF:
If TSOP.TSOPPAYM ^= NULL then do;
There is a PAYM record linked to this charge bundle for this payer where
TSOP.TSOPPAYM = PAYM.PAYMCOST + PAYM.PAYMNUM and PAYM.PAYMCOST =
this charge bundle COST.COSTNUM.
Update existing PAYM.PAYMAMT = TSOP.TSOPAMT.
Else if there is a PAYM where PAYM.PAYMCOST = this charge bundle COST.COSTNUM
and
((TSOP.TSOPTYPE = 1/SPFamily and PAYM.PAYMTYPE = 1/SPFamily) or
(TSOP.TSOP TYPE = 2/ProvDiscount and PAYM.PAYMTYPE = 2/ProvDiscount) or
(TSOP.TSOPTYPE = 5/VA and PAYM.PAYMTYPE = 5/VA) or
(TSOP.TSOPTYPE = 6/Medicare and PAYM.PAYMTYPE = 6/Medicare) or
(TSOP.TSOPTYPE = 7/OtherMilitaryPlanNotVA and PAYM.PAYMTYPE =
7/OtherMilitaryPlanNotVA) or
(TSOP.TSOPTYPE = 11/MedicareSubsidy and PAYM.PAYMTYPE =
11/MedicareSubsidy) or
(TSOP.TSOPTYPE = 12/ExtraHelp and PAYM.PAYMTYPE = 12/ExtraHelp) or
((TSOP.TSOPTYPE = 4/OSOP and PAYM.PAYMTYPE = 4/OSOP) and
(TSOP.TSOPOSOP = PAYM.PAYMOSOP)) or
((TSOP.TSOPTYPE = 9/DM and PAYM.PAYMTYPE = 9/DM) and (TSOP.TSOPDMEM =
PAYM.PAYMDMEM)) or
((TSOP.TSOPTYPE = 3/PlanNotMHMO and PAYM.PAYMTYPE = 3/PlanNotMHMO)
and (TSOP.TSOPPLAN = PAYM.PAYMPLAN)) or
((TSOP.TSOPTYPE = 8/MHMO and PAYM.PAYMTYPE = 8/MHMO) and
(TSOP.TSOPPLAN = PAYM.PAYMPLAN)) or
((TSOP.TSOPTYPE = 10/MedicarePartD and PAYM.PAYMTYPE = 10/MedicarePartD)
and (TSOP.TSOPPLAN = PAYM.PAYMPLAN))), then do:
This PAYM record is linked to the current round charge bundle for this payer.
Update PAYM.PAYMAMT = TSOP.TSOPAMT.
Else do;
Create a new current round PAYM record for this payer.
Set PAYM.PAYMAMT = TSOP.TSOPAMT.
Set additional fields on PAYM as specified below.
PAYMCOST
3:21:08 PM Monday, August 03, 2009
If creating a new PAYM record, create PAYM where
Page 239 of 278
BOX NS77C
PAYM.PAYMCOST = this COST.COSTNUM.
PAYMNUM
If creating a new PAYM record, set
PAYM.PAYMNUM = highest PAYM.PAYMNUM for
PAYM.PAYMCOST + 01.
PAYMRNDC
If creating a new PAYM record, set
PAYM.PAYMRNDC = current round.
PAYMTYPE
If creating a new PAYM record, set
PAYM.PAYMTYPE = TSOP.TSOPTYPE.
PAYMPLAN
If creating a new PAYM record, if TSOP.TSOPTYPE
= 3/PlanNotMHMO, 8/MHMO or 10/MedicarePartD,
set PAYM.PAYMPLAN = TSOP.TSOPPLAN.
PAYMOSOP
If creating a new PAYM record, if TSOP.TSOPTYPE
= 4/OSOP, set PAYM.PAYMOSOP =
TSOP.TSOPOSOP.
PAYMISHI
If creating a new PAYM record, if TSOP.TSOPISHI
^= empty, set PAYM.PAYMISHI = TSOP.TSOPISHI.
PAYMAMT
PAYM.PAYMAMT = TSOP.TSOPAMT.
PAYMDMEM
If creating a new PAYM record, if TSOP.TSOPTYPE
= 9/DM, set PAYM.PAYMDMEM =
TSOP.TSOPDMEM.
TECHNICAL NOTES
DESIGN NOTES
3:21:08 PM Monday, August 03, 2009
Page 240 of 278
BOX NS77D
BOX NS77D
Page Order # :
1245
BOX INSTRUCTIONS
( NSQ2915 )
IF THE SP OR FAMILY MADE A PAYMENT AND PAYMENT IS GREATER
THAN $5.00, GO TO NS78 - EXPPAYBK ( NSQ2920 ).
ELSE GO TO BOX NS80 - (NSQ2930 ).
ASSIGNMENTS
TECHNICAL NOTES
234
SPFamilyPayment
SP/Family Payment =
For this COST, there is PAYM where (PAYM.PAYMCOST
= COST.COSTNUM & PAYM.PAYMTYPE = 1/SPFamily
& PAYM.PAYMDFLG^-1/Yes).
SP/family payment = PAYM.PAYMAMT.
DESIGN NOTES
3:21:08 PM Monday, August 03, 2009
Page 241 of 278
NS78
NS78
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
EXPPAYBK
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
1250
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display SP/Family payment.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
(LINKED CHARGE BUNDLE EVENT) (etc.)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
Question Text:
I have recorded that [you have/(SP) has] paid $(SP/FAMILY
PAYMENT). Do you expect any source to pay [you/(SP)] back any
or all of that amount?
Int. Instr II:
INPUT FIELDS / ROUTING
3:21:10 PM Monday, August 03, 2009
Page 242 of 278
NS78
( NSQ2920 )
EXPPAYBK
Field1:
Cheshire Name:
CORO.EXPPAYBK
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 NS78A - (NSQ2922 )
English text: YES
No
BOX NS78A - (NSQ2922 )
English text: NO
Attribute
Don't know
Route
BOX NS78A - (NSQ2922 )
Refusal
BOX NS78A - (NSQ2922 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
234
SPFamilyPayment
SP/Family Payment =
For this COST, there is PAYM where (PAYM.PAYMCOST
= COST.COSTNUM & PAYM.PAYMTYPE = 1/SPFamily
& PAYM.PAYMDFLG^-1/Yes).
SP/family payment = PAYM.PAYMAMT.
DESIGN NOTES
3:21:12 PM Monday, August 03, 2009
Page 243 of 278
BOX NS78A
BOX NS78A
Page Order # :
1251
BOX INSTRUCTIONS
( NSQ2922 )
IF NS78 - EXPPAYBK = 1/Yes AND ((CURRENTLY ADMINISTERING CPS
AND CHARGES WERE FIRST COLLECTED 2 ROUNDS PREVIOUS TO
CURRENT ROUND) OR (CURRENTLY ADMINISTERING CPS AND
CHARGES WERE FIRST COLLECTED IN R50) OR (SP IS IN THE EXIT
SAMPLE)), GO TO NS80 - EXPAYUNT ( NSQ2926 ).
ELSE GO TO BOX NS80 - (NSQ2930 ).
ASSIGNMENTS
TECHNICAL NOTES
16
ExitSample
SP is in the Exit Sample =
(MRES.INTTYPE = 8/ExitInterviewHadPrev or
9/ExitInterviewSkipPrev) on MRES where
MRES.MRESRND = current round.
271
COST2RoundsOld
Charges first collected 2 rounds previous to current round
=
COST.COSTRNDC = (current round - 2).
425
COSTRound50
Charges first collected in R50 =
COST.EXMCR50 = 1/Yes.
DESIGN NOTES
3:21:12 PM Monday, August 03, 2009
Page 244 of 278
BOX NS78B
BOX NS78B
Page Order # :
1252
BOX INSTRUCTIONS
( NSQ2923 )
IF (CURRENTLY ADMINISTERING CPS AND CHARGES WERE FIRST
COLLECTED 2 ROUNDS PREVIOUS TO CURRENT ROUND) OR
(CURRENTLY ADMINISTERING CPS AND CHARGES WERE FIRST
COLLECTED IN R50) OR (SP IS IN THE EXIT SAMPLE), GO TO NS79
EXPAYOUT ( NSQ2924 ).
ELSE GO TO BOX NS80 - (NSQ2930 ).
ASSIGNMENTS
TECHNICAL NOTES
16
ExitSample
SP is in the Exit Sample =
(MRES.INTTYPE = 8/ExitInterviewHadPrev or
9/ExitInterviewSkipPrev) on MRES where
MRES.MRESRND = current round.
271
COST2RoundsOld
Charges first collected 2 rounds previous to current round
=
COST.COSTRNDC = (current round - 2).
425
COSTRound50
Charges first collected in R50 =
COST.EXMCR50 = 1/Yes.
DESIGN NOTES
3:21:12 PM Monday, August 03, 2009
Page 245 of 278
NS79
NS79
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
EXPAYOUT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1253
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:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
(LINKED CHARGE BUNDLE EVENT) (etc.)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
Question Text:
Do you expect anyone to pay any of this amount?
Int. Instr II:
INPUT FIELDS / ROUTING
3:21:13 PM Monday, August 03, 2009
Page 246 of 278
NS79
EXPAYOUT
Field1:
( NSQ2924 )
CORO.EXPAYOUT
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
NS80 - EXPAYUNT ( NSQ2926 )
English text: YES
No
BOX NS80 - (NSQ2930 )
English text: NO
Attribute
Don't know
Route
BOX NS80 - (NSQ2930 )
Refusal
BOX NS80 - (NSQ2930 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:21:16 PM Monday, August 03, 2009
Page 247 of 278
NS80
NS80
Page Order # :
Design Screen Type:
Quantity Unit
Fields:
Field 1:
EXPAYUNT
Field 2:
EXPAYPCT
Field 3:
EXPAYAMT
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
1258
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:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
(LINKED CHARGE BUNDLE EVENT) (etc.)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
Question Text:
How much do you expect wil be paid?
Int. Instr II:
INPUT FIELDS / ROUTING
3:21:18 PM Monday, August 03, 2009
Page 248 of 278
NS80
EXPAYUNT
Field1:
( NSQ2926 )
CORO.EXPAYUNT
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
TExpayunt
1
No
No
Number Label
1 Percentage
2
English text: PERCENTAGE
Dollars
FieldSize:
Min Value:
Max Value:
Mask:
Route
NS80 - EXPAYPCT ( NSQ2927 )
NS80 - EXPAYAMT ( NSQ2928 )
English text: DOLLARS
Attribute
Don't know
Route
BOX NS80 - (NSQ2930 )
Refusal
BOX NS80 - (NSQ2930 )
3:21:22 PM Monday, August 03, 2009
Page 249 of 278
NS80
Field2:
EXPAYPCT
( NSQ2927 )
CORO.EXPAYPCT
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
PERCENTAGE:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Real
TExpaypctReal
1
No
No
Number Label
1 [Continuous answer.]
Field3:
EXPAYAMT
FieldSize:
Min Value:
Max Value:
Mask:
0.0
100
Percent
Route
BOX NS80 - (NSQ2930 )
( NSQ2928 )
CORO.EXPAYPCT
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
DOLLARS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Real
TExpayamt
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
0.49
999999.99
Dollars
Route
BOX NS80 - (NSQ2930 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
3:21:23 PM Monday, August 03, 2009
Page 250 of 278
NS80
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:21:23 PM Monday, August 03, 2009
Page 251 of 278
BOX NS80
BOX NS80
Page Order # :
1260
BOX INSTRUCTIONS
( NSQ2930 )
IF CURRENTLY ADMINISTERING CPS, GO TO BOX CPSBEG - (CPS1010
).
ELSE GO TO BOX NSL1 - (NSQ2932 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
If administering CPS, BOX NS80 routes back to the beginning of CPS to
reevaluate which COST BUNDLES still need to be asked about in CPS.
3:21:23 PM Monday, August 03, 2009
Page 252 of 278
BOX NSL1
BOX NSL1
3:21:23 PM Monday, August 03, 2009
Page Order # :
1265
Page 253 of 278
BOX NSL1
BOX INSTRUCTIONS
( NSQ2932 )
IF (CHARGE DATA WAS COLLECTED IN NS FOR THIS NS CHARGE
BUNDLE) AND (NS CHARGE BUNDLE IS LINKED TO ONLY ONE EVENT)
AND (THE TOTAL CHARGE ^= DK AND TOTAL CHARGE ^= RF) AND (SP
OR ANY OTHER SOURCE HAS PAID) AND ((EVENT LINKED TO NS
CHARGE BUNDLE HAS EVNT.EVNTTYPE = 'PM' AND THERE ARE OTHER
CURRENT ROUND PRESCRIPTION MEDICINE EVENTS NOT LINKED TO A
CURRENT ROUND CHARGE BUNDLE) OR (EVENT LINKED TO NS
CHARGE BUNDLE HAS EVNT.EVNTTYPE = 'DU', 'ER', 'OP', 'MP', 'SD', OR
'SL' AND THERE ARE OTHER CURRENT ROUND EVENTS WITH THE
SAME EVENT TYPE FOR THIS PROVIDER NOT LINKED TO A CURRENT
ROUND CHARGE BUNDLE)), GO TO NSL1 - NSEVSAME ( NSQ2934 ).
ELSE GO TO BOX NSBEG - (NSQ1010 ).
ASSIGNMENTS
TECHNICAL NOTES
436
NSChargeDataCollecte
d
If charge data was collected in NS for this NS charge
bundle =
COST.NSEXMCMAIL = 2/No or NULL (not asked).
437
NSLinkedOneEvent
NS charge bundle linked to only one event =
There is only one XCEV where XCEV.XCEVCOST =
COST.COSTNUM for this charge bundle and
XCEV.XCEVRNDC = current round and XCEV.DELLINK
^= 1/Yes.
270
TotalCharge
Total Charge =
COST.TOTALAMT.
When collecting Total charge in the current round, Total
Charge is first collected in CORO.TOTALCHG on CORO
where CORO.CORORND = current round and
CORO.COROCOST = this COST.COSTNUM and then is
copied to COST.TOTALAMT.
231
SPOrAnySourcePaid
SP or any source paid =
For this COST, there is a CORO where
(CORO.COROCOST=COST.COSTNUM &
CORO.CORORND=current round & CORO.TCHGPAID =
1/Yes).
438
OtherNSPMEvents
To check for other current round PM events not linked to
a current round charge bundle, use logic at BOX NSBEG
to identify other PM events that still need to be asked
about in NS.
439
OtherNSVisits
To check for other events for this Provider not linked to a
current round charge bundle, use logic at BOX NSBEG to
identify other events that still need to be asked about in
NS. EVNT.EVNTPROV must match this
EVNT.EVNTPROV.
DESIGN NOTES
3:21:23 PM Monday, August 03, 2009
Page 254 of 278
NSL1
NSL1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
NSEVSAME
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1270
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 event linked to NS charge bundle is a PM event (there will only be
one event), display "prescribed medicine".
Else display "visits to (PROVIDER NAME)".
If Total charge was collected for charge bundle, display "total
charge was (TOTAL CHARGE)".
Else if CoPaymenet was collected for charge bundle, display
"copayment was (TOTAL CHARGE)".
If event linked to NS charge bundle is a PM event, display
"purchase".
Else display "visit".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report above question text.
Display all Source of Payments where TSOP.TSOPAMT ^= empty in
the following order based on TSOP.TSOPTYPE:
= 1/SPFamily
= 2/ProvDiscount
=11/MedicareSubsidy
=12/ExtraHelp
3:21:25 PM Monday, August 03, 2009
Page 255 of 278
NSL1
= 6/Medicare
= 8/MHMO
=10/MedicarePartD
= 5/VA
= 3/PlanNotMHMO
= 4/OSOP
= 9/DM
If there is more than Source of Payment per Source of Payment
Type, display in order of entry in TSOP.
Not all TSOP.TSOPTYPEs will be applicable.
Report header:
"ALL PAYMENTS"
Report layout:
Column 1, header="SOP NAME".
Column 1, display = TSOP.TSOPTEXT.
Column 2, header = "PAYMENT".
Column 2, display =
If TSOP.TSOPAMT = DK, display "DK".
Else if TSOP.TSOPAMT = RF, display "RF".
Else display TSOP.TSOPAMT.
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
Int. Instr I:
Question Text:
You told me earlier that [you/(SP)] had other [visits to (PROVIDER
NAME)/prescribed medicine purchases].
Are any other [visits to (PROVIDER NAME)/prescribed medicine
purchases] the same -- that is the [total charge was (TOTAL
CHARGE)/copayment was (TOTAL CHARGE)] per (visit/purchase)
with the following payments: [READ PAYMENTS LISTED ABOVE]?
Int. Instr II:
INPUT FIELDS / ROUTING
3:21:26 PM Monday, August 03, 2009
Page 256 of 278
NSL1
( NSQ2934 )
NSEVSAME
Field1:
Cheshire Name:
COST.NSEVSAME
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 NSL2 - (NSQ2936 )
English text: YES
No
BOX NSBEG - (NSQ1010 )
English text: NO
Attribute
Don't know
Route
BOX NSBEG - (NSQ1010 )
Refusal
BOX NSBEG - (NSQ1010 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
255
TotalPayments
3:21:29 PM Monday, August 03, 2009
Total of non-missing Payments entered in SOP grid =
For each TSOP where (TSOP.TSOPAMT ^= DK and
TSOP.TSOPAMT ^= RF and TSOP.TSOPAMT ^=
EMPTY), then Total Payments = Total Payments +
TSOP.TSOPAMT.
Page 257 of 278
NSL1
268
CoPaymentCollected
CoPayment was collected for Charge Bundle =
For this COST, there is a CORO where
(CORO.COROCOST = COST.COSTNUM &
CORO.CORORND = current round & CORO.TOTALTYP
= 2/CoPayment).
If administering CPS, check most recent CORO where
CORO.TOTALTYP ^= empty.
269
TotalChargeCollected
Total Charge was collected for Charge Bundle =
For this COST, there is a CORO where
(CORO.COROCOST=COST.COSTNUM &
CORO.CORORND=current round &
CORO.TOTALTYP=1/TotalCharge).
If administering CPS, check most recent CORO where
CORO.TOTALTYP ^= empty.
440
NSPMEvent
If event linked to NS charge bundle is a PM event (there
will only be one event) =
EVNT.EVNTTYPE = 'PM'.
DESIGN NOTES
3:21:29 PM Monday, August 03, 2009
Page 258 of 278
BOX NSL2
BOX NSL2
Page Order # :
1275
BOX INSTRUCTIONS
( NSQ2936 )
IF EVENT LINKED TO NS CHARGE BUNDLE HAS EVNT.EVNTTYPE = 'PM',
GO TO NSL3 - EVENT_PMSAME ( NSQ2938 ).
ELSE GO TO NSL5 - EVENT_VISITSAME ( NSQ2944 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
3:21:29 PM Monday, August 03, 2009
Page 259 of 278
NSL3
NSL3
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_PMSAME
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Prescription Medicine Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1280
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all Prescription Medicine events not already linked to a
current round charge bundle where:
((EVNT.EVNTDFLG ^= 1/Yes and EVNT.EVERRFLG ^= 1/Yes),
AND
(There is NO XCEV where (XCEV.XCEVEVNT = EVNT.EVNTNUM
and XCEV.XCEVRNDC = current round and XCEV.DELLINK =
empty))),
AND
((EVNT.EVNTTYPE = PM) and
((there is PMRO where PMRO.PMROEVNT = EVNT.EVNTNUM and
PMRO.PMRORND = current round and PMRO.GETNUM > 0 and
PMRO.GETNUM ^= DK and PMRO.GETNUM ^= RF) or
(there is a PMRO where PMRO.PMROEVNT = EVNT.EVNTNUM and
PMRO.PMRORND = previous round and (PMRO.GETNUM is > 0
and PMRO.GETNUM ^= DK and PMRO.GETNUM ^= RF) and
PMRO.PMSUMFLG = 1/Yes and PMRO.PMRODFLG ^= 1/Yes))))
Display in alphabetical order.
3:21:30 PM Monday, August 03, 2009
Page 260 of 278
NSL3
COL #
Roster/Grid display:
HEADER
INSTRUCTIONS
1
Medicine
Display prescription medicine name,
EVNT.PMEDNAME.
2
Strength
Display prescription medicine strength
text field, EVNT.PMSTRUNI.
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Which ones are the same?
Int. Instr II:
REVIEW LIST WITH RESPONDENT AND SELECT ALL
PRESCRIPTION MEDICINES WHERE THE COSTS AND
PAYMENTS ARE THE SAME.
INPUT FIELDS / ROUTING
Field1:
EVENT_PMSAME
( NSQ2938 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick200
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
200
Route
NSL4 - NUMLINKS ( NSQ2942 )
BACKGROUND VARIABLE ASSIGNMENTS
The purpose of NSL3 is to identify any other PM events that still need to be asked about in
NS that may have the same total charge and payments as the most recent charge bundle
asked about at NSL1. For each PM event selected at NSL3, we will create a new charge
bundle and we will copy all charge data and payment data that was collected for the most
recent charge bundle asked about at NSL1 to each charge bundle created at NSL3. A new
charge bundle is created for each PM event selected at NSL3.
DETAILS:
3:21:31 PM Monday, August 03, 2009
Page 261 of 278
NSL3
For all PM's selected at NSL3, create a new COST record that matches the COST record
for the most recent charge bundle asked about at NSL1.
COST Key = COST.COSTBASE + COST.COSTNUM.
COST.COSTNUM = Set to new number of charge bundle created for PM event selected at
NSL3.
Copy all fields on COST from the most recent charge bundle asked about at NSL1 to each
charge bundle created at NSL3.
Update COST.ORIGNSEV = EVNT.EVNTNUM of PM selected at NSL3.
Set COST.ORIGCOST = COST.COSTNUM of most recent charge bundle asked about at
NSL1.
For all PM's selected at NSL3, create a new CORO record that matches the CORO record
for the most recent charge bundle asked about at NSL1.
CORO Key = CORO.COROBASE + CORO.COROCOST + CORO.CORORND.
CORO.COROCOST = Set to new COST.COSTNUM of charge bundle created for PM event
selected at NSL3.
CORO.CORORND = current round.
Copy all fields on CORO from the most recent charge bundle asked about at NSL1 to each
charge bundle created at NSL3.
For all PM's selected at NSL3, create an XCEV record to link the PM event to the charge
bundle created at NSL3:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVBASE and XCEV.XCEVBAS2 = BASE.BASEID.
XCEV.XCEVCOST = Set to new COST.COSTNUM of charge bundle created for PM event
selected at NSL3.
XCEV.XCEVEVNT = EVNT.EVNTNUM of PM event selected at NSL3.
Do not copy XCEV fields from most recent charge bundle asked about at NSL1 to the
charge bundle(s) created at NSL3.
For all PM's selected at NSL3, create new PAYM record(s) that match the PAYM record(s)
linked to the most recent charge bundle asked about at NSL1.
PAYM key = PAYM.PAYMBASE + PAYM.PAYMCOST + PAYM.PAYMNUM.
PAYM.PAYMCOST = set to new COST.COSTNUM of charge bundle created for PM event
selected at NSL3.
PAYM.PAYMNUM = matches PAYM.PAYMNUM for PAYM linked to most recent charge
bundle asked about at NSL1.
Copy all fields on PAYM linked to the most recent charge bundle asked about at NSL1 to
each PAYM linked to the charge bundle created at NSL3.
COSTNUM
For each PM selected at NSL3, create COST where
COST.COSTNUM = BASE.LASTCOST + 001. This
assumes that BASE.LASTCOST is incremented
each time a COST record is generated in the field.
ORIGCOST
Set COST.ORIGCOST = COST.COSTNUM of NSL1
charge bundle.
ORIGNSEV
Set COST.ORIGNSEV = EVNT.EVNTNUM of PM
selected at NSL3.
COST FIELDS
Copy all other COST fields from the NSL1 charge
bundle to this charge bundle created at NSL3.
3:21:31 PM Monday, August 03, 2009
Page 262 of 278
NSL3
COROCOST
For each PM selected at NSL3, create a CORO
where CORO.COROCOST = COST.COSTNUM of
this charge bundle created at NSL3.
CORORND
CORO.CORORND = current round.
CORO FIELDS
Copy all other CORO fields from the NSL1 charge
bundle to this charge bundle created at NSL3.
XCEVCOST
For each PM selected at NSL3, create an XCEV
where XCEV.XCEVCOST = COST.COSTNUM of
this charge bundle created at NSL3.
XCEVEVNT
For each PM selected at NSL3, create a XCEV
where XCEV.XCEVEVNT = EVNT.EVNTNUM of PM
selected at NSL3.
XCEVRNDC
XCEV.XCEVRNDC = current round.
PAYMCOST
For each PM selected at NSL3, create PAYM(s)
where PAYM.PAYMCOST = COST.COSTNUM of
this charge bundle created at NSL3.
PAYMNUM
For each PM selected at NSL3, create PAYM(s)
where PAYM.PAYMNUM = PAYM.PAYMNUM for
PAYM(s) linked to the NSL1 charge bundle.
PAYM FIELDS
Copy all other PAYM fields from PAYM(s) linked to
the NSL1 charge bundle to the PAYM(s) linked to
this charge bundle created at NSL3.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:21:31 PM Monday, August 03, 2009
Page 263 of 278
NSL4
NSL4
Page Order # :
Design Screen Type:
Grid
Fields:
Field 1:
NUMLINKS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1290
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:
Multi Field display:
Roster/Grid Instructions:
Display all Prescription Medicine events selected at NSL3.
Display in alphabetical order based on EVNT.PMEDNAME.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Medicine Name
Display the name and strength of the
medicine, EVNT.PMEDNAME + ' ' +
EVNT.PMSTRUNI. Display only.
2
# Purchases
XCEV.NUMLINKS. Input column 1.
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
How many times are the same?
Int. Instr II:
ENTER THE NUMBER OF PURCHASES OF EACH MEDICINE
SHOWN BELOW THAT ARE THE SAME.
3:21:32 PM Monday, August 03, 2009
Page 264 of 278
NSL4
INPUT FIELDS / ROUTING
NUMLINKS
Field1:
XCEV.NUMLINKS
Cheshire Name:
Item Text display:
( NSQ2942 )
GRID COLUMN #2.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TNumlinks
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
BOX NSBEG - (NSQ1010 )
Refusal
BOX NSBEG - (NSQ1010 )
FieldSize:
Min Value:
Max Value:
Mask:
1
100
Route
BOX NSBEG - (NSQ1010 )
BACKGROUND VARIABLE ASSIGNMENTS
Collect # of purchases on XCEV:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVCOST = COST.COSTNUM of charge bundle being asked about.
XCEV.XCEVEVNT = EVNT.EVNTNUM of PM being asked about.
SOFT EDIT CHECKS
NUMLINKS = 1 - 8, DK, RF.
If not true, display message "THE AMOUNT ENTERED SEEMS
UNLIKELY. PLEASE VERIFY.".
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:21:33 PM Monday, August 03, 2009
Page 265 of 278
NSL5
NSL5
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_VISITSAME
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Statement Event Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1295
DISPLAY INSTRUCTIONS:
Context header display:
Display name of Provider, PROV.PROVNAME, for event linked to
most recent charge bundle asked about at NSL1.
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all events for this provider that are not already linked to a
current round charge bundle, where:
((EVNT.EVNTPROV = EVNT.EVNTPROV and EVNT.EVNTTYPE =
EVNT.EVNTTYPE on event linked to most recent charge bundle
asked about at NSL1),
AND
(EVNT.EVNTDFLG ^= 1/Yes and EVNT.EVERRFLG ^= 1/Yes),
AND
(There is NO XCEV where (XCEV.XCEVEVNT = EVNT.EVNTNUM
and XCEV.XCEVRNDC = current round and XCEV.DELLINK =
empty)),
AND
((EVNT.EVNTTYPE = DU, ER, OP, MP, SD, or SL) and
(EVNT.EVNTRNDC = current round.))
)
3:21:34 PM Monday, August 03, 2009
Page 266 of 278
NSL5
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Type
Display EVNT.EVNTTYPE.
2
Start Date
Display EVENT DATE in "Mon DD YYYY"
format.
3
Stop Date
If (EVNT.EVNTTYPE = 'IP' and
EVNT.IPSTATUS ^=1/StillInHospital),
display EVENT END DATE in "Mon DD
YYYY" format..
Else do not display.
4
Status
If EVNT.EVNTTYPE = 'IP' and
EVNT.IPSTATUS = 1/StillInHospital,
display "ON".
Else if EVNT.VISTTYPE = 2/RepeatVisit,
display "RV".
Else do not display.
5
# Visits
If EVNT.VISTTYPE = 2/RepeatVisit,
display EVNT.RVTIMES.
Else do not display.
6
Round
Display 'R' + EVNT.EVNTRNDC. EX:
R45
7
If Event Date is out of the Survey
Reference Period, display "ORP".
Else do not display.
Report display:
TEXT:
Context Header:
EVENT: (ORIGINAL CHARGE BUNDLE EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
PROVIDER: (PROVIDER NAME)
Int. Instr I:
Question Text:
Which ones are the same?
Int. Instr II:
REVIEW LIST WITH THE RESPONDENT AND SELECT ALL
PROVIDER EVENTS WHERE THE COST AND PAYMENTS ARE
THE SAME.
INPUT FIELDS / ROUTING
3:21:34 PM Monday, August 03, 2009
Page 267 of 278
NSL5
Field1:
EVENT_VISITSAME
( NSQ2944 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX NSL5 - (NSQ2946 )
BACKGROUND VARIABLE ASSIGNMENTS
The purpose of NSL5 is to identify any other DU, ER, IP, IU, OP, MP, SD or SL event linked
to the same provider as the NSL1 event that still needs to be asked about in NS and may
have the same total charge and payments as the most recent charge bundle asked about
in NS. For each event selected at NSL5, we will create a new charge bundle and we will
copy all charge data and payment data that was collected for the most recent charge
bundle asked about at NSL1 to each charge bundle created at NSL5. A new charge
bundle is created for each event selected at NSL5.
DETAILS:
For all evnts selected at NSL5, create a new COST record that matches the COST record
for the most recent charge bundle asked about at NSL1.
COST Key = COST.COSTBASE + COST.COSTNUM.
COST.COSTNUM = Set to new number of charge bundle created for event selected at
NSL5.
Copy all fields on COST from the most recent charge bundle asked about at NSL1 to each
charge bundle created at NSL5.
Update COST.ORIGNSEV = EVNT.EVNTNUM of event selected at NSL5.
Set COST.ORIGCOST = COST.COSTNUM of most recent charge bundle asked about at
NSL1.
For all events selected at NSL5, create a new CORO record that matches the CORO
record for the most recent charge bundle asked about at NSL1.
CORO Key = CORO.COROBASE + CORO.COROCOST + CORO.CORORND.
CORO.COROCOST = Set to new COST.COSTNUM of charge bundle created for event
selected at NSL5.
CORO.CORORND = current round.
Copy all fields on CORO from the most recent charge bundle asked about in NS at NSL1 to
3:21:35 PM Monday, August 03, 2009
Page 268 of 278
NSL5
each charge bundle created at NSL5.
For all events selected at NSL5, create an XCEV record to link the event to the charge
bundle
created at NSL5:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVBASE and XCEV.XCEVBAS2 = BASE.BASEID.
XCEV.XCEVCOST = Set to new COST.COSTNUM of charge bundle created for event
selected at NSL5.
XCEV.XCEVEVNT = EVNT.EVNTNUM of event selected at NSL5.
Do not copy XCEV fields from most recent charge bundle asked about at NSL1 to the
charge bundle(s) created at NSL5.
For all events selected at NSL5, create new PAYM record(s) that match the PAYM
record(s) linked to the most recent charge bundle asked about at NSL1.
PAYM key = PAYM.PAYMBASE + PAYM.PAYMCOST + PAYM.PAYMNUM.
PAYM.PAYMCOST = set to new COST.COSTNUM of charge bundle created for event
selected at NSL5.
PAYM.PAYMNUM = matches PAYM.PAYMNUM for PAYM linked to most recent charge
bundle asked about at NSL1.
Copy all fields on PAYM linked to the most recent charge bundle asked about at NSL1 to
each PAYM linked to the charge bundle created at NSL5.
COSTNUM
For each event selected at NSL5, create COST
where COST.COSTNUM = BASE.LASTCOST +
001. This assumes that BASE.LASTCOST is
incremented each time a COST record is generated
in the field.
ORIGCOST
Set COST.ORIGCOST = COST.COSTNUM of NSL1
charge bundle.
ORIGNSEV
Set COST.ORIGNSEV = EVNT.EVNTNUM of event
selected at NSL5.
COST FIELDS
Copy all other COST fields from the NSL1 charge
bundle to this charge bundle created at NSL5.
COROCOST
For each event selected at NSL5, create a CORO
where CORO.COROCOST = COST.COSTNUM of
this charge bundle created at NSL5.
CORORND
CORO.CORORND = current round.
CORO FIELDS
Copy all other CORO fields from the NSL1 charge
bundle to this charge bundle created at NSL5.
XCEVCOST
For each event selected at NSL5, create an XCEV
where XCEV.XCEVCOST = COST.COSTNUM of
this charge bundle created at NSL5.
XCEVEVNT
For each event selected at NSL5, create a XCEV
where XCEV.XCEVEVNT = EVNT.EVNTNUM of
event selected at NSL5.
XCEVRNDC
XCEV.XCEVRNDC = current round.
PAYMCOST
For each event selected at NSL5, create PAYM(s)
where PAYM.PAYMCOST = COST.COSTNUM of
this charge bundle created at NSL5.
3:21:35 PM Monday, August 03, 2009
Page 269 of 278
NSL5
PAYMNUM
For each event selected at NSL5, create PAYM(s)
where PAYM.PAYMNUM = PAYM.PAYMNUM for
PAYM(s) linked to the NSL1 charge bundle.
PAYM FIELDS
Copy all other PAYM fields from PAYM(s) linked to
the NSL1 charge bundle to the PAYM(s) linked to
this charge bundle created at NSL5.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:21:35 PM Monday, August 03, 2009
Page 270 of 278
BOX NSL5
BOX NSL5
Page Order # :
1300
BOX INSTRUCTIONS
( NSQ2946 )
IF AT LEAST ONE EVENT SELECTED AT NSL5 IS A REPEAT VISIT, GO TO
NSL6 - RVLINKS ( NSQ2948 ).
ELSE GO TO BOX NSBEG - (NSQ1010 ).
ASSIGNMENTS
TECHNICAL NOTES
135
RepeatVisitEvent
If Event entered as a Repeat Visit =
EVNT.VISTTYPE=2/RepeatVisit.
DESIGN NOTES
3:21:35 PM Monday, August 03, 2009
Page 271 of 278
NSL6
NSL6
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
RVLINKS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1305
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:
Display name of Provider, PROV.PROVNAME, for event linked to
most recent charge bundle asked about at NSL1.
Question display:
Display "(EVENT TYPE)" and "(EVENT MONTH, YEAR)" for the
Repeat Visit Event selected at NSL5 being asked about.
Display type of event, EVNT.EVNTTYPE.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
EVENT: (EVENT)
TOTAL CHARGE = $(TOTAL CHARGE)
PROVIDER NAME: (PROVIDER NAME)
Int. Instr I:
Question Text:
How many times are the same for (EVENT)?
Int. Instr II:
ENTER THE NUMBER OF (EVENT TYPE) VISITS IN (EVENT
MONTH, YEAR) THAT ARE THE SAME.
3:21:36 PM Monday, August 03, 2009
Page 272 of 278
NSL6
INPUT FIELDS / ROUTING
RVLINKS
Field1:
( NSQ2948 )
XCEV.RVLINKS
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF VISITS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TRvtimes
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
BOX NSL6 - (NSQ2950 )
Refusal
BOX NSL6 - (NSQ2950 )
FieldSize:
Min Value:
Max Value:
Mask:
1
90
Route
BOX NSL6 - (NSQ2950 )
BACKGROUND VARIABLE ASSIGNMENTS
Collect # of visits on XCEV:
XCEV key = XCEV.XCEVBASE + XCEV.XCEVCOST + XCEV.XCEVBAS2 +
XCEV.XCEVEVNT
XCEV.XCEVCOST = COST.COSTNUM of charge bundle being asked about.
XCEV.XCEVEVNT = EVNT.EVNTNUM of Repeat Visit event currently being asked about.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:21:38 PM Monday, August 03, 2009
Page 273 of 278
BOX NSL6
BOX NSL6
Page Order # :
1310
BOX INSTRUCTIONS
( NSQ2950 )
IF ANOTHER EVENT SELECTED AT NSL5 IS A REPEAT VISIT, GO TO
NSL6 - RVLINKS ( NSQ2948 ).
ELSE GO TO BOX NSBEG - (NSQ1010 ).
ASSIGNMENTS
TECHNICAL NOTES
135
RepeatVisitEvent
If Event entered as a Repeat Visit =
EVNT.VISTTYPE=2/RepeatVisit.
DESIGN NOTES
3:21:38 PM Monday, August 03, 2009
Page 274 of 278
NS81
NS81
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
NSTATEMENT
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
1335
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP was covered by TRICARE and any other insurance plan
besides Medicare during the current round, display "MEDICARE,
INSURANCE, OR TRICARE".
Else if SP was covered by TRICARE and is not covered by any
other insurance plan besides Medicare during the current round,
display "MEDICARE OR TRICARE"
Else if SP was not covered by TRICARE and was covered by any
other insurance plan besides Medicare during the current round,
display "MEDICARE OR INSURANCE".
Else display "MEDICARE".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
3:21:39 PM Monday, August 03, 2009
YOU HAVE ENTERED ALL CHARGE/PAYMENT DATA FOR ALL
EVENTS REPORTED. DO YOU HAVE ANY (MEDICARE,
INSURANCE, OR TRICARE/MEDICARE OR TRICARE/MEDICARE
OR INSURANCE/MEDICARE) STATEMENTS THAT YOU HAVE
Page 275 of 278
NS81
NOT YET ENTERED?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
NSTATEMENT
Field1:
( NSQ2960 )
TEMP
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
ST5 - ST_CHARGEBUNDLE ( STQ1120 )
English text: YES
No
BOX NSEND - (NSQ3010 )
English text: NO
Attribute
Don't know
Route
BOX NSEND - (NSQ3010 )
Refusal
BOX NSEND - (NSQ3010 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
3:21:42 PM Monday, August 03, 2009
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
Page 276 of 278
NS81
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
258
TricarePlan
SP covered by TRICARE during the current round =
There is a PLAN where PLAN.PLANTYPE = 6/Tricare
& PLRO where (PLRO.PLROPLAN = PLAN.PLANNUM &
PLRO.PLRORND = current round & PLRO.COVTIME^=
empty).
Exclude Deleted Plans. See T.N. 52.
259
InsurancePlan
SP covered by Insurance plan other than Medicare
during current round =
PLAN where (PLANTYPE = 2/Medicaid, 3/PublicPlan, or
4/PrivatePlan) & PLRO where
(PLROPLAN=PLAN.PLANNUM & PLRORND=current
round & COVTIME^=empty).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
3:21:42 PM Monday, August 03, 2009
Page 277 of 278
BOX NSEND
BOX NSEND
Page Order # :
1340
BOX INSTRUCTIONS
( NSQ3010 )
GO TO NEXT SECTION .
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
3:21:42 PM Monday, August 03, 2009
Page 278 of 278
| File Type | application/pdf |
| Author | hubbard_r |
| File Modified | 2010-04-06 |
| File Created | 0000-00-00 |