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

MCBS MAIN STUDY
R55 General Specifications for Blaise/WVS
Version 07.01.0001
8/14/2009

QUESTIONNAIRE FLOW
TABLE OF CONTENTS

1. Specification Components
2. Order Sections are Administered
3. Overview of Collecting COST data

1. SPECIFICATION COMPONENTS
Questionnaire

Refers to the entire set of questions administered to an SP. The
Questionnaire is also referred to as the “Instrument” when
referring to the CAPI program.

Section

Refers to a subset of questions in the Questionnaire. Groups of
related questions in the Questionnaire are organized into sections.
Each section has a SECTION ID (abbreviation). Ex: the HI
Section collects data about the SP’s Health Insurance plans. A
Section may be administered every round, only once a year, are
only when the SP is entering or exiting the study.

Components of the Questionnaire:
Introduction

IN
Introduction
Verifies SP name, collects SP status and respondent information.
Verifies/collects SP’s DOB, marital status, # children in the SP’s
1st round interview.
Verifies SP’s marital status every fall round.

Address Verification

AV
Address Verification
Verifies SP’s home and mailing address.
INTTYPE = 1,4,5,6,7,10: Administered after IN.
INTTYPE = 2,3: Administered directly before CL.

Household

Collects information regarding who lives in the household with the
SP.
ENS Enumeration Summary
Reviews persons who lived in the household in the previous round
and probes whether or not person still lives in the household in the
current round. Also collects new current round household
members. Collects job status for SP and household members.

Health Insurance

Collects information about plans that cover SP’s medical expenses.
HIS Health Insurance Summary
Allows interviewer to add, delete, and update Health insurance
plans collected in previous round.
HI
Health Insurance
Collects information about Medicare, Medicaid, Tricare, Public
and Private Health Insurance Plans.

DM
Collects information about Discount Membership plans.
Utilization

Collects dates for SP’s doctor visits, Hospital stays, etc. Each visit
is referred to as an “event”. Also collects other types of medical
events, such as prescribed medicines and other medical expenses.
The following sections collect events for a specific type of
provider:
DU
Dental
ER
Emergency Room
IP
Inpatient Hospital Stays
OP
Outpatient Department Visits
IU
Institutionalization Stays
HHS Home Health Care Summary
HH Home Health Care
MP Medical Provider Visits
OM Other Medical Expenses
PMS Prescription Medicine Summary
PM Prescription Medicines

Cost Series

Collects information regarding medical statements and charges for
doctor visits and other events:
ST
Statement Section.
Collects data directly from SP’s statements that they have received
from Medicare or other health insurance plan.
PS
Post Statement Section
Identifies if SP has incurred charges for a OME Rent-to-Buy item.
Response to questions in PS determine if event will be asked about
in the NS Section.
NS
No Statement Section.
Collect data from Respondent about the COSTs for a particular
event when a Statement is not available.
CPS Cost Payment Summary Section.
Reviews ST and NS data collected over past 2 rounds and
updates/collects additional COST data not previously reported.
See details below regarding the when COST data is collected for
events.

Summary Sections

Some of the sections above are referred to as a Summary Section.
There are two types of summary sections.
1) A section that allows interviewer to add, delete or update data
collected during the SP’s previous round interview. Data collected
in these sections is written to previous round database records.
HIS Health Insurance Summary
PMS Prescription Medicine Summary
2) A section that summarizes data collected in the previous round
with the purpose of collecting additional current round data. Data
collected in these sections is written to current round database
records.
ENS Enumeration Summary
HHS Home Health Care Summary
CPS Cost Payment Summary

Closing

Collects SP and Proxy address information, Contact and Future
Proxy Information. Includes final instructions to respondent about
future interviews.
AV
Address Verification
Collects/Verifies SP’s home and mailing address.
CL
Closing
Collects/Verifies Proxy, Contact, Future Proxy name and address
information. Collects future interview name and phone number.
Includes final instructions to respondent regarding future
interviews and general closing remarks.
EX
Exit Closing
Is administered to SP’s during their last interview in the study (exit
cases). Includes general closing remarks.

Supplemental Sections

Refers to a section that is not administered every round. Typically,
Supplemental Sections are administered once a year. However, a
Supplemental Section may be administered once in the entire
study.
The following are examples of Supplemental Sections:
Fall Round
AC
ACCESS TO CARE
HF
HEALTH STATUS AND FUNCTIONING
US
USUAL SOURCE OF CARE

SC
DI
HA

SATISFACTION OF CARE
DEMOGRAPHICS
HOUSING CHARACTERISTICS

Winter Round
KN
BENEFICIARY KNOWLEDGE
AND INFORMATION NEEDS
PD
PRESCRIPTION DRUG – not administered in R53
Summer Round
IA
INCOME AND ASSETS
PA
PATIENT ACTIVATION – not administered R54
RX
DRUG COVERAGE

2. ORDER SECTIONS ARE ADMINISTERED
Component

Abbrev.

Introduction
Address
Verification

IN
AV

Household
Supplemental
Section

ENS
HA

Health Ins

HIS

Health Ins

HI

Insurance Plans

DM

Utilization
Utilization

DU
ER

Utilization

IP

Utilization
Utilization

OP
IU

Utilization
Utilization
Utilization

HHS
HH
MP

Supplemental
Section

AC

Utilization
Utilization
Utilization
COST Series

OM
PMS
PM
ST

COST Series
COST Series

PS
NS

COST Series

CPS

Supplemental
Section

AC

Supplemental
Section

HF

SECTION
Section
Listed in the order the section is Administere
administered.
d in What
Round?
INTRODUCTION
ALL
ADDRESS VERIFICATION
ALL
* Can be called either after IN or
before CL.
ENUMERATION
ALL
HOUSING
FALL
CHARACTERISTICS

Who gets what section based on Interview Type and
SP’s Status.

HEALTH INSURANCE
SUMMARY
HEALTH INSURANCE

ALL

MRES.INTTYPE = 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10
MRES.INTTYPE = 1, 4, 5, 6, 7, or 10 and
MRES.SPALIVE ^= 2/AliveAndInstitute and
MRES.SPALIVE ^= 3/Deceased.
MRES.INTTYPE = 1, 2, 3, 4, 5, 6, 7, 9, or 10
MRES.INTTYPE = 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 and
MRES.SPALIVE ^= 2/AliveAndInstitute and
MRES.SPALIVE ^= 3/Deceased..
MRES.INTTYPE = 1, 4, 7, 9, or 10

ALL

MRES.INTTYPE = 1, 2, 3, 4, 5, 6, 7, 9, or 10

DISCOUNT/SAVINGS
MEMBERSHIP
DENTAL UTILIZATION
EMERGENCY ROOM
UTILIZATION
INPATIENT UTILIZATION

ALL

MRES.INTTYPE = 1, 2, 3, 4, 5, 6, 7, 9, or 10
(exclude MRES.INTTYPE=8)
MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10
MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10

ALL

MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 8, 9, or 10
*MRES.INTTYPE=8 only receive IP questions if
ongoing IP visit from the previous round.

OUTPATIENT UTILIZATION
INSTITUTIONAL
UTILIZATION
HOME HEALTH SUMMARY
HOME HEALTH UTILIZATION
MEDICAL PROVIDER
UTILIZATION
ACCESS TO CARE
SUPPLEMENT

ALL
ALL

MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10
MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10

ALL
ALL
ALL

MRES.INTTYPE = 1, 4, or 9
MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9 , or 10
MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10

FALL

MRES.INTTYPE = 1, 2, 4, 5, or 6 and MRES.SPALIVE
^= 2/AliveAndInstitute and MRES.SPALIVE ^=
3/Deceased.
MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10
MRES.INTTYPE = 1, 4, or 9
MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10
MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10

ALL
ALL

OTHER MEDICAL EXPENSES
PRESCRIBED MEDICINES
PRESCRIBED MEDICINES
STATEMENT CHARGE
SERIES
POST-STATEMENT CHARGE
NO STATEMENT CHARGE
SERIES

ALL
ALL
ALL
ALL
ALL
ALL

MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10
MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10
(exclude MRES.INTTYPE=8)

CHARGE PAYMENT
SUMMARY
NOT IMPLEMENTED IN R51
ACCESS TO CARE
SUPPLEMENT

ALL

MRES.INTTYPE = 1, 4, 5, 8, or 9

FALL

MRES.INTTYPE = 3 and
MRES.SPALIVE ^= 2/AliveAndInstitute and
MRES.SPALIVE ^= 3/Deceased
MRES.INTTYPE = 1, 2, 3, 4, 5, or 6 and
MRES.SPALIVE ^= 2/AliveAndInstitute and

HEALTH STATUS AND
FUNCTIONING SUPPLEMENT

FALL

MRES.SPALIVE ^= 3/Deceased
Supplemental
Section

SC

SATISFACTION WITH CARE
SUPPLEMENT

FALL

Supplemental
Section

US

USUAL SOURCE OF CARE
SUPPLEMENT

FALL

Supplemental
Section
Supplemental
Section
Supplemental
Section

DI

DEMOGRAPHICS AND
INCOME
CONTACT INFORMATION
FOR FACILITIES
BENEFICIARY KNOWLEDGE
AND INFORMATION NEEDS

FALL

MRES.INTTYPE = 1, 2, 3, 4, 5, or 6 and
MRES.SPALIVE ^= 2/AliveAndInstitute and
MRES.SPALIVE ^= 3/Deceased
MRES.INTTYPE = 1, 2, 3, 4, 5, or 6 and
MRES.SPALIVE ^= 2/AliveAndInstitute and
MRES.SPALIVE ^= 3/Deceased
MRES.INTTYPE = 3

FALL

MRES.INTTYPE = 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10

AH
KN

MRES.INTTYPE = 1, 2, 4, 5, 6, or 7 and
MRES.SPALIVE ^= 2/AliveAndInstitute and
MRES.SPALIVE ^= 3/Deceased
MRES.INTTYPE = 1, 2, 4, 5, 6, or 7

Supplemental
Section
Supplemental
Section
Supplemental
Section

PD

Supplemental
Section

RX

DRUG COVERAGE
SUPPLEMENT

Address
Verification

AV

ADDRESS VERIFICATION
* Can be called either after IN or
before CL.

ALL

MRES.INTTYPE = 2 or 3 and
MRES.SPALIVE ^= 2/AliveAndInstitute and
MRES.SPALIVE ^= 3/Deceased.

Closing

CL

CLOSING

ALL

(MRES.INTTYPE = 1, 2, 3, 4, 5, 6, 7,or 10) or
(MRES.INTTYPE = 8 or 9 and
MRES.SPALIVE = 3/Deceased).

Closing

EX

SUMMER

End

END

CLOSING FOR EXIT
INTERVIEW
END SECTION

MRES.INTTYPE = 8 or 9 and
MRES.SPALIVE ^= 3/Deceased.
MRES.INTTYPE = 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10

IA
PA

PRESCRIPTION DRUG
SUPPLEMENT
INCOME AND ASSETS
SUPPLEMENT
PATIENT ACTIVATION
SUPPLEMENT
NOT IMPLEMENTED IN R51

WINTER

WINTER
Not in WVS
SUMMER MRES.INTTYPE = 1, 2, 4, 5, 6, 8, 9, or 10

SUMMER MRES.INTTYPE = 1, 2, 4, 5, 6, 8, 9, or 10 and
Not in WVS MRES.SPPROXY = 1/SP and
MRES.SPALIVE ^= 2/AliveAndInstitute and
MRES.SPALIVE ^= 3/Deceased.
SUMMER MRES.INTTYPE = 1, 2, 4, 5, 6, 9, or 10 and
MRES.SPALIVE ^= 2/AliveAndInstitute and
MRES.SPALIVE ^= 3/Deceased

ALL

SUMMARY OF INTERVIEW TYPES:
VALID IN ROUNDS:

MRES.INTTYPE=1/StandardHadPrev
MRES.INTTYPE=2/NewFromFacility
MRES.INTTYPE=3/NewFromSupplement
MRES.INTTYPE=4/StandardSkippedPrev
MRES.INTTYPE=5/LastRndFacSum
MRES.INTTYPE=6/LastRndFacBase
MRES.INTTYPE=7/SupSmp1stTimeUtil
MRES.INTTYPE=8/ExitInterviewHadPrev
MRES.INTTYPE=9/ExitInterviewSkippedPrev
MRES.INTTYPE=10/SupSmp1stTimeUtilSkipped

ALL
ALL
FALL ONLY
ALL
ALL
ALL
WINTER ONLY
SUMMER ONLY
SUMMER ONLY
SUMMER ONLY

OVERVIEW OF ROUNDS ADMINISTERED TO SP:
SP’s
1 Year
st

Winter Rounds

SP’s
2nd Year

SP’s
3 Year
rd

SP’s
4 Year
th

SP’s
5 Year
th

MRES.INTTYPE = 7
IN
ENS
HIS, HI, DM
DU, ER, IP, OP, IU,
HH, MP, OM,
PM
ST, PS, NS
Supplemental Sections
CL

MRES.INTTYPE = 1
IN
ENS
HIS, HI, DM
DU, ER, IP, OP, IU,
HHS, HH, MP, OM,
PMS, PM
ST, PS, NS,CPS
Supplemental Sections
CL

MRES.INTTYPE = 1
IN
ENS
HIS, HI, DM
DU, ER, IP, OP, IU,
HHS, HH, MP, OM,
PMS, PM
ST, PS, NS,CPS
Supplemental Sections
CL

MRES.INTTYPE = 1
IN
ENS
HIS, HI, DM
DU, ER, IP, OP, IU,
HHS, HH, MP, OM,
PMS, PM
ST, PS, NS,CPS
Supplemental Sections
CL

MRES.INTTYPE = 1
IN
ENS
HIS, HI, DM
DU, ER, IP, OP, IU,
HHS, HH, MP, OM,
PMS, PM
ST, PS, NS, CPS
Supplemental Sections
CL

MRES.INTTYPE = 1
IN
ENS
HIS, HI, DM
DU, ER, IP, OP, IU,
HHS, HH, MP, OM,
PMS, PM
ST, PS, NS,CPS
Supplemental Sections
CL

MRES.INTTYPE = 1
IN
ENS
HIS, HI, DM
DU, ER, IP, OP, IU,
HHS, HH, MP, OM,
PMS, PM
ST, PS, NS,CPS
Supplemental Sections
CL

MRES.INTTYPE = 8
IN
IP – Ongoing IP only.
Supplemental Sections
EX or CL

Summer Rounds

Or if Previous Round Skipped
in 1st year,
MRES.INTTYPE = 10
IN
ENS
HIS, HI, DM
DU, ER, IP, OP, IU,
HH, MP, OM,
PM
ST, PS, NS
Supplemental Sections
CL

Fall Rounds
MRES.INTTYPE = 3
IN
ENS
HI
DM
Supplemental Sections
CL

MRES.INTTYPE = 1
IN
ENS
HIS, HI, DM
DU, ER, IP, OP, IU,
HHS, HH, MP, OM,
PMS, PM
ST, PS, NS,CPS
Supplemental Sections
CL

Or if Previous Round Skipped,
MRES.INTTYPE = 9
IN
ENS
HIS
HI, DM
UTS
DU, ER, IP, OP, IU, HHS, HH,
MP, OM, PMS, PM
ST, PS, NS
CPS
Supplemental Sections
EX or CL

LAST ROUND

MRES.INTTYPE = 1
IN
ENS
HIS, HI, DM
DU, ER, IP, OP, IU,
HHS, HH, MP, OM,
PMS, PM
ST, PS, NS,CPS
Supplemental Sections
CL

MRES.INTTYPE = 1
IN
ENS
HIS, HI, DM
DU, ER, IP, OP, IU,
HHS, HH, MP, OM,
PMS, PM
ST, PS, NS,CPS
Supplemental Sections
CL

FIRST ROUND

1) SP’s cannot skip their 1st round interview. They will either be interviewed in the community or in a facility,
but not both. If SP is in a facility for their 1st round interview, they will be assigned INTTYPE = 2 the 1st time
they enter the community..
3) If SP skips a round any time after their 2nd round in the study, they will be assigned MRES.INTTYPE = 4.
4) If SP moves to a facility and then returns to the community, they will be assigned one of three interview
types, MRES.INTTYPE = 5 or 6.

OVERVIEW OF SECTIONS THAT CALL PART OR ALL OF OTHER SECTIONS:

HI
DM
DU
ER

A
PORTION
IS
CALLED
BY
ST, NS
ST, NS
ST, NS
ST, NS

IP
OP

ST, NS
ST, NS

SECTION

HHS

CALLS
SECTION

JUMPS OUT
OF
SECTION
AT

ADMINISTERS Q. TO
Q.

RETURNS
TO
SECTION
AT

AC

BOX ER5

AC6A to BOX AC1C

BOX ER6

Fall Round only.
If ER visit added in current
round, ER access to care
details are asked in AC
section.

AC

BOX OP6

AC9 to BOX AC1E

BOX OP7

Fall Round only.
If OP visit added in current
round, OP access to care
details are asked in AC
section.

HH

BOX HHS3

BOX HH1BB to BOX
HH3

BOX HHS5

If previous round Home
Health professional still
providing care in the
current round, call HH to
collect current round HH
details.

HHS3

BOX HH1BB to BOX
HH3

BOX HHS5

If previous round Home
Health friend still
providing care in the
current round, call HH to
collect current round HH
details.

DESCRIPTION

HH
MP

ST, NS
ST, NS

AC

BOX MP6A

AC20 to BOX AC1G

MP18

Fall Round only.
If MP visit added in
current round, MP access
to care details are asked in
AC section.

AC

ER, OP,
MP
ST, NS
ST, NS
NS, CPS

HI

BOX ST67C

HI6 to BOX HIT1

BOX ST69A

BOX ST67C

HIT2 to BOX HI7

BOX ST69A

BOX ST67C

HI13 to BOX HI12

BOX ST69A

BOX ST67C

HI21 to BOX HI19

BOX ST69A

Added Medicaid SOP,
collect plan details.
Added Tricare SOP,
collect plan details.
Added Public Plan SOP,
collect plan details.
Added Private Plan SOP,
collect plan details.

OM
PM
ST

ST69

HIMC6 to BOX HIMC2

BOX ST69A

Added MHMO SOP that is
current, collect plan
details.

DM

BOX ST69C

DM4 to BOX DM3

BOX ST69D

Added DM SOP, collect
details.

DU

BOX ST22A

DU7 to BOX DU3A

BOX ST23B

Added Dental Visit to
charge bundle, collect
event details.

ER

BOX ST22A

ER5 to BOX ER2A

BOX ST23B

Added Emergency Room
visit to charge bundle,
collect event details.

IP

BOX ST22A

IP7 to BOX IP4A

BOX ST23B

Added Inpatient Stay to
charge bundle, collect
event details.

OP

BOX ST22A

OP5 to BOX OP2A

BOX ST23B

Added Outpatient Dept.
visit to charge bundle,
collect event details.

MP

BOX ST23A

BOX MP2C to BOX
MP2D

BOX ST23B

Added Medical Provider
Visit to charge bundle,
collect event details.

HH

BOX ST31A

HH3 to BOX HH3

BOX ST31B

Added Home Health
Provider/Professional to
charge bundle, collect
event details.

HH20 to BOX HH3

BOX ST31B

Added Home Health
Provider/Friend to charge
bundle, collect event
details.

OM2 to BOX OM1AA2

BOX ST36

Added OM to charge
bundle, collect event
details.

OM4 to BOX OM1BB2

BOX ST36

Added OM to charge
bundle, collect event
details.

OM6 to BOX OM1EE1

BOX ST36

Added OM to charge
bundle, collect event
details.

OM10 to BOX OM1FF2

BOX ST36

Added OM to charge
bundle, collect event
details.

OM12 to BOX OM1GG2

BOX ST36

Added OM to charge
bundle, collect event
details.

OM14 to BOX OM1HH2

BOX ST36

Added OM to charge
bundle, collect event
details.

OM19A to BOX
OM1KK1

BOX ST36

Added OM to charge
bundle, collect event
details.

OM

ST36

NS

CPS

OM21A to BOX
OM1NN1

BOX ST36

Added OM to charge
bundle, collect event
details.

OM24 to BOX OM
1QQ1

BOX ST36

Added OM to charge
bundle, collect event
details.

OM29 to BOX OM25A

BOX ST36

Added OM to charge
bundle, collect event
details.
Added PM to charge
bundle, collect event
details.

PM

ST43

BOX PM1A-1 to BOX
PM3A

BOX ST43

ST

NS2

ST5 to BOX ST80

BOX NSBEG

Respondent "has
statement". Collect
statement information in
ST.

NS4

ST5 to BOX ST80

BOX NSBEG

Respondent "has
statement". Collect
statement information in
ST.

NS81

ST5 to BOX ST80

BOX NSBEG

Respondent "has
statement". Collect
statement information in
ST.

BOX NS67C

HI6 to BOX HIT1

BOX NS69A

BOX NS67C

HIT2 to BOX HI7

BOX NS69A

BOX NS67C

HI13 to BOX HI12

BOX NS69A

BOX NS67C

HI21 to BOX HI19

BOX NS69A

NS69

HIMC6 to BOX HIMC2

BOX NS69A

Added Medicaid SOP,
collect plan details.
Added Tricare SOP,
collect plan details.
Added Public Plan SOP,
collect plan details.
Added Private Plan SOP,
collect plan details.
Added MHMO SOP that is
current, collect plan
details.

DM

BOX NS69C

DM4 to BOX DM3

BOX NS69D

Added DM SOP, collect
details.

DU

BOX NS22A

DU7 to BOX DU3A

BOX NS23B

Added Dental Visit to
charge bundle, collect
event details.

ER

BOX NS22A

ER5 to BOX ER2A

BOX NS23B

Added Emergency Room
visit to charge bundle,
collect event details.

IP

BOX NS22A

IP7 to BOX IP4A

BOX NS23B

Added Inpatient Stay to
charge bundle, collect
event details.

HI

OP

BOX NS22A

OP5 to BOX OP2A

BOX NS23B

Added Outpatient Dept.
visit to charge bundle,
collect event details.

MP

BOX NS23A

BOX MP2C to BOX
MP2D

BOX NS23B

Added Medical Provider
Visit to charge bundle,
collect event details.

HH

BOX NS31A

HH3 to BOX HH3

BOX NS31B

Added Home Health
Provider/Professional to
charge bundle, collect
event details.

HH20 to BOX HH3

BOX NS31B

Added Home Health
Provider/Friend to charge
bundle, collect event
details.

OM2 to BOX OM1AA2

BOX NS36

Added OM to charge
bundle, collect event
details.

OM4 to BOX OM1BB2

BOX NS36

Added OM to charge
bundle, collect event
details.

OM6 to BOX OM1EE1

BOX NS36

Added OM to charge
bundle, collect event
details.

OM10 to BOX OM1FF2

BOX NS36

Added OM to charge
bundle, collect event
details.

OM12 to BOX OM1GG2

BOX NS36

Added OM to charge
bundle, collect event
details.

OM14 to BOX OM1HH2

BOX NS36

Added OM to charge
bundle, collect event
details.

OM19A to BOX
OM1KK1

BOX NS36

Added OM to charge
bundle, collect event
details.

OM21A to BOX
OM1NN1

BOX NS36

Added OM to charge
bundle, collect event
details.

OM24 to BOX OM
1QQ1

BOX NS36

Added OM to charge
bundle, collect event
details.

OM29 to BOX OM25A

BOX NS36

Added OM to charge
bundle, collect event
details.

BOX PM1A-1 to BOX
PM3A

BOX NS43

Added PM to charge
bundle, collect event
details.

OM

PM

NS36

NS43

CPS

ST

NS

HI

DM

CPS2

ST5 to BOX ST80

BOX
CPSBEG

Respondent "has
statement". Collect
statement information in
ST.

BOX CPS12

ST65 to BOX ST80

BOX
CPSBEG

ST Charge bundle,
Indicated someone paid,
collect SOPs in ST.

BOX CPS16

ST65 to BOX ST80

BOX
CPSBEG

ST Charge bundle, need to
update payments, update
SOPs in ST.

BOX CPS10

NS65 to BOX NS80

BOX
CPSBEG

NS Charge bundle,
Indicated someone paid,
collect SOPs in NS.

BOX CPS14

NS65 to BOX NS80

BOX
CPSBEG

NS Charge bundle, need to
update payments, update
SOPs in NS.

BOX CPS27C

HI6 to BOX HIT1

BOX CPS29A

BOX CPS27C

HIT2 to BOX HI7

BOX CPS29A

BOX CPS27C

HI13 to BOX HI12

BOX CPS29A

BOX CPS27C

HI21 to BOX HI19

BOX CPS29A

CPS29

HIMC6 to BOX HIMC2

BOX CPS29A

BOX CPS29C

DM4 to BOX DM3

BOX CPS29D

Added Medicaid SOP,
collect plan details.
Added Tricare SOP,
collect plan details.
Added Public Plan SOP,
collect plan details.
Added Private Plan SOP,
collect plan details.
Added MHMO SOP that is
current, collect plan
details.
Added DM SOP, collect
details.

3. OVERVIEW OF COLLECTING COST DATA
NOTE: This section of General Specifications is in progress.

ST – Statement Section:
The purpose of the ST section is to collect COST data from statements provided by the respondent. New events may be added in ST
and linked to the statement as well as existing events may be linked to statement. A single event may be linked to multiple statements.
Multiple events may be linked to a single statement.

PS – Post Statement Section
The purpose of PS is to determine if the respondent has charge data to report for an OM Rent-To-Buy.

NS – No Statement Secton:
The purpose of the NS section is to collect COST data for any new event added in the current round that is not linked to a statement
added in the ST section.
We do not collect NS COST data about events reported in the current round
1) OM alterations not complete
2) IU events
3) IP events if the SP is still in the hospital.
4) HH provider events if services were not provided in the current round other than Meals-on-Wheels.
5) OM supplies where number of purchases = 0, DK, RF.
6) PM’s where number of purchases = 0, DK, RF.
We do collect NS COST data about the following events entered prior to the current round:
1) Ongoing IP stays, SP reported being discharged from IP in the current round.
2) On-going OM Rentals
3) OM Rent-To-Buys
4) On-going HH provider services
5) OM Rent-To-Buys if respondent has charge data to report (indicated in PS section)

CPS – Cost Payment Summary
The purpose of CPS is to collect missing COST data for charge bundles generated in the past two rounds. CPS charge bundles flagged
to be asked about in the current round CPS section have the following fields set:
COST.CPROUND = current round.
COST.CPREASN = 1 through 8
If during the current round interview, the respondent provides COST data for an event linked to a current round CPS charge bundle or
indicates that an event was reported in error, the CPS charge bundle linked to the event is no longer asked about in CPS.
CPS charge bundles will not get asked about in the current round if:
1) A HH event is linked to the CPS charge bundle and is also asked about in the current round HHS.section and the respondent
reports that the HH event was "entered in error".
2) Any event linked to the CPS charge bundle has EVNTDFLG=1/Yes.
3) Any event linked to the CPS charge bundle is also linked to a statement entered in the current round ST section.
4) Any event linked to the CPS charge bundle is one of the following types of events and COST data is collected about this
event in the current round NS section:
a) On-going OM rental
b) OM supplies
c) PM purchases
d) On-going HH event

These types of events are linked to a single EVNT record. If SP reports that an OM rental is still being rented, reports that they have
purchased OM supplies in the current round, reports that they have purchased a PM in the current round, or reports that a HH provider
continues to provide care in the current round, a new EVNT record is not created. Instead, a current round PMRO or HERO record
linked to the EVNT record is created.
If one of these event types is linked to a CPS charge bundle and is also linked to a statement in the current round ST section, the event
will not get asked about in CPS.
If one of these event types is linked to a CPS charge bundles and is not linked to a statement in the current round ST section, the event
will first be asked about in NS. In NS, if the respondent reports that the SP expects to receive something in the mail (NS2EXMCMAIL = 1) or that the event was entered in error (EXMCMAIL = 3), we will not collect COST data in NS for this event.
Therefore, this event will be asked about in CPS. Otherwise, we will collect NS COST data for these events (EXMCMAIL ^= 1 and
^= 3) and these events will not get asked about in CPS.
The exception to this rule is an event that is asked about in NS that does not get asked NS1-NSEXMCAIL. These events will be also
be asked about in CPS. In addition, if administering CPS for a CPS charge bundle and CPS routes NS to collect charge data, when NS
probes if other events are included in the charges, if an event is linked to this charge bundle that is also linked to another CPS charge
bundle, the event will still get asked about in CPS.