CMS-P0015A English Section by Section

Box RX1

BOX RX1

1:12:57 PM Monday, December 24, 2012

Page Order # :

10

Page 1 of 101

Box RX1
BOX INSTRUCTIONS
( RXQ1005 )

BESIDES MEDICARE, IF TRICARE IS THE ONLY "CURRENT" PLAN, GO TO
BOX RXEND - (RXQ1455 ).
ELSE IF THE RESPONDENT IS A PROXY, GO TO RX1 - PDXHIDEC (
RXQ1010 ).
ELSE GO TO RXPD2 - PDEASY ( RXQ1015 ).

ASSIGNMENTS

TECHNICAL NOTES
4

Respondent

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

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.

355

TricareCurrent

There is a "current" Tricare plan =
There is a PLAN where PLAN.PLANTYPE = 6/Tricare &
PLRO where (PLRO.PLROPLAN = PLAN.PLANNUM &
PLRORND = current round & (PLRO.COVTIME =
1/WholeTime or PLRO.COVNOW = 1/Yes)).
Exclude Deleted Plans. See T.N. 52.

356

MHMONotCurrent

There is no "current" Medicare Managed Care plan
(Medicare Advantage plan) =
If there is a PLAN where PLANTYPE = 5/MHMO, there is
no PLRO where (PLROPLAN=PLANNUM &
PLRORND=current round and COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

357

MPDPNotCurrent

There is no "current" MPDP =
If there is a PLAN were PLAN.PLANTYPE = 7/MPDP,
there is no PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND = current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

358

MedicaidNotCurrent

There is no "current" Medicaid Plan =
If there is PLAN where PLAN.PLANTYPE=2/Medicaid,
there is no PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND = current round & (COVTIME =
1/WholeTime or COVNOW = 1/Yes)).
Exclude Deleted Plans. See T.N. 52.

1:12:57 PM Monday, December 24, 2012

Page 2 of 101

Box RX1
359

PublicNotCurrent

There is no "current" Public Plan =
If there is a PLAN where PLAN.PLANTYPE =
3/PublicPlan, there is no PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(COVTIME=1/WholeTime or COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

360

PrivateNotCurrent

There is no "current" Private Plan =
If there is PLAN where PLAN.PLANTYPE =
4/PrivatePlan, there is no PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(COVTIME=1/WholeTime or COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:12:57 PM Monday, December 24, 2012

Page 3 of 101

RX1

RX1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDXHIDEC

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

20

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Do you help (SP) make decisions regarding (his/her) health
insurance coverage?

Int. Instr II:
INPUT FIELDS / ROUTING

1:12:58 PM Monday, December 24, 2012

Page 4 of 101

RX1

Field1:

PDXHIDEC

Cheshire Name:

( RXQ1010 )

HRND.PDXHIDEC

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
RXPD2 - PDEASY ( RXQ1015 )

English text: YES
No

BOX RXEND - (RXQ1455 )

English text: NO
Attribute

Route

Don't know

BOX RXEND - (RXQ1455 )

Refusal

BOX RXEND - (RXQ1455 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:12:59 PM Monday, December 24, 2012

Page 5 of 101

RXPD2

RXPD2

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PDEASY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

30

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

SHOW CARD RX1

Question Text:

Now I have a few questions regarding the Medicare Prescription
Drug benefit.
Overall, how easy or difficult do you think the Medicare Prescription
Drug benefit is to understand?
Would you say it is very easy to understand, somewhat easy,
somewhat difficult, or very difficult to understand?

Int. Instr II:

1:12:59 PM Monday, December 24, 2012

Page 6 of 101

RXPD2
INPUT FIELDS / ROUTING
PDEASY

Field1:
Cheshire Name:

( RXQ1015 )

PDRX.PDEASY

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TEasydiff
1
No
No

Number Label
1 VeryEasy

FieldSize:
Min Value:
Max Value:
Mask:

Route
RXPD3 - PDKNOW ( RXQ1020 )

2

English text: VERY EASY
SomewhatEasy

RXPD3 - PDKNOW ( RXQ1020 )

3

English text: SOMEWHAT EASY
SomewhatDifficult

RXPD3 - PDKNOW ( RXQ1020 )

4

English text: SOMEWHAT DIFFICULT
VeryDifficult

RXPD3 - PDKNOW ( RXQ1020 )

English text: VERY DIFFICULT
Attribute

Route

Don't know

RXPD3 - PDKNOW ( RXQ1020 )

Refusal

RXPD3 - PDKNOW ( RXQ1020 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES
1:13:01 PM Monday, December 24, 2012

Page 7 of 101

RXPD2

1:13:01 PM Monday, December 24, 2012

Page 8 of 101

RXPD3

RXPD3

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PDKNOW

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

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:
Int. Instr I:

SHOW CARD RX2

Question Text:

How much do you think you know about the Medicare Prescription
Drug benefit?
Do you know just about everything you need to know, most of what
you need to know, some of what you need to know, a little of what
you need to know, or almost none of what you need to know about
the Medicare Prescription Drug benefit?

Int. Instr II:

1:13:01 PM Monday, December 24, 2012

Page 9 of 101

RXPD3
INPUT FIELDS / ROUTING
PDKNOW

Field1:
Cheshire Name:

( RXQ1020 )

PDRX.PDKNOW

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TKnow
1
No
No

Number Label
1 JustAboutEverythingYouNeedToKnow

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX RXPD2 - (RXQ1025 )

2

English text: JUST ABOUT EVERYTHING YOU NEED TO KNOW
MostOfWhatYouNeedToKnow
BOX RXPD2 - (RXQ1025 )

3

English text: MOST OF WHAT YOU NEED TO KNOW
SomeOfWhatYouNeedToKnow
BOX RXPD2 - (RXQ1025 )

4

English text: SOME OF WHAT YOU NEED TO KNOW
ALittleOfWhatYouNeedToKnow
BOX RXPD2 - (RXQ1025 )

5

English text: A LITTLE OF WHAT YOU NEED TO KNOW
AlmostNoneOfWhatYouNeedToKnow
BOX RXPD2 - (RXQ1025 )
English text: ALMOST NONE OF WHAT YOU NEED TO KNOW

Attribute
Don't know

Route
BOX RXPD2 - (RXQ1025 )

Refusal

BOX RXPD2 - (RXQ1025 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
1:13:03 PM Monday, December 24, 2012

Page 10 of 101

RXPD3

DESIGN NOTES

1:13:03 PM Monday, December 24, 2012

Page 11 of 101

BOX RXPD2

BOX RXPD2

50

Page Order # :

BOX INSTRUCTIONS
( RXQ1025 )

IF SP HAS A "CURRENT" MEDICARE PRESCRIPTION DRUG PLAN, GO TO
BOX RXPD3A - (RXQ1060 ).
ELSE IF SP HAS A "CURRENT" MEDICARE MANAGED CARE PLAN THAT
HAS RX COVERAGE, GO TO RXPD9 - PDCONSDR ( RXQ1045 ).
ELSE IF SP HAS A "CURRENT" PRIVATE PLAN THAT HAS RX
COVERAGE, GO TO RXPD8A - PDCOMPPL ( RXQ1040 ).
ELSE GO TO RXPD20 - PDEXAPLY ( RXQ1140 ).

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.

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.

344

MHMOCurrWithRx

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

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:13:03 PM Monday, December 24, 2012

Page 12 of 101

RXPD8A

RXPD8A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDCOMPPL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

80

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is respondent, display "have".
Else display "has".
If SP is respondent, display "you".
Else display "(SP), or someone for (SP),".

Multi Field display:

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

Display report above question text.
Display all "current" private plans with RX coverage SP reported
being covered by in the current round.
Report header: PRIVATE PLANS WITH RX COVERAGE
Report layout:
Column 1, header="Plan Name", display PLAN.PLNAME.

TEXT:
Context Header:
Int. Instr I:

1:13:03 PM Monday, December 24, 2012

Page 13 of 101

RXPD8A
[You/(SP)] currently (have/has) drug coverage through [READ
PLAN(S) LISTED ABOVE].

Question Text:

Did [you/(SP), or someone for (SP),] compare the (CURRENT
YEAR) drug coverage offered by [READ PLAN(S) LISTED ABOVE]
with any Medicare Prescription Drug plans?
[EXPLAIN IF NECESSARY: A Medicare Prescription Drug plan
adds drug coverage to Original Medicare.]
Int. Instr II:
INPUT FIELDS / ROUTING

Field1:

PDCOMPPL

Cheshire Name:

( RXQ1040 )

PDRX.PDCOMPPL

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
RXPD9 - PDCONSDR ( RXQ1045 )

English text: YES
No

RXPD9 - PDCONSDR ( RXQ1045 )

English text: NO
Attribute

Route

Don't know

RXPD9 - PDCONSDR ( RXQ1045 )

Refusal

RXPD9 - PDCONSDR ( RXQ1045 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
1:13:05 PM Monday, December 24, 2012

Page 14 of 101

RXPD8A

TECHNICAL NOTES
4

Respondent

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

DESIGN NOTES

1:13:05 PM Monday, December 24, 2012

Page 15 of 101

RXPD9

RXPD9

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDCONSDR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

90

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has a "current" Medicare Managed Care Plan that has RX
coverage, display "[You/(SP)] currently…"
Else do not display.
If SP is respondent, display "have".
Else display "has".
If SP is respondent, display "you".
Else display "(SP), or someone for (SP),".
If Proxy is respondent and SP is male, display "him".
If Proxy is respondent and SP is female, display "her".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:

1:13:05 PM Monday, December 24, 2012

Page 16 of 101

RXPD9
Int. Instr I:
([You/(SP)] currently (have/has] drug coverage through (CURRENT
MEDICARE MANAGED CARE PLAN). Medicare calls this type of
plan a Medicare Advantage plan. Medicare also offers separate
plans that provide only drug coverage.)

Question Text:

Did [you/(SP), or someone for (SP),] consider enrolling (her/him) in a
separate Medicare Prescription Drug plan for (CURRENT YEAR)?
[EXPLAIN IF NECESSARY: A separate Medicare Prescription Drug
plan is typically used together with medical benefits from Original
Medicare.]
Int. Instr II:

INPUT FIELDS / ROUTING

PDCONSDR

Field1:
Cheshire Name:

( RXQ1045 )

PDRX.PDCONSDR

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 RXPD3 - (RXQ1050 )

English text: YES
No

BOX RXPD3 - (RXQ1050 )

English text: NO
Attribute
Don't know

Route
BOX RXPD3 - (RXQ1050 )

Refusal

BOX RXPD3 - (RXQ1050 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
1:13:06 PM Monday, December 24, 2012

Page 17 of 101

RXPD9

HARD EDIT CHECKS

TECHNICAL NOTES
4

Respondent

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

5

SPMale

SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.

6

SPFemale

SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.

52

DeletedPlans

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

344

MHMOCurrWithRx

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

DESIGN NOTES

1:13:06 PM Monday, December 24, 2012

Page 18 of 101

BOX RXPD3

BOX RXPD3

Page Order # :

100

BOX INSTRUCTIONS
( RXQ1050 )

IF SP HAS A "CURRENT" PRIVATE PLAN THAT HAS RX COVERAGE, GO
TO BOX RX2 - (RXQ1215 ).
ELSE GO TO RXPD10 - PDMABENS ( RXQ1055 ).

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.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:13:06 PM Monday, December 24, 2012

Page 19 of 101

RXPD10

RXPD10

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDMABENS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

110

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is respondent, display "you".
Else display "(SP), or someone for (SP),".

Multi Field display:

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

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

Did [you/(SP), or someone for (SP),] compare the (CURRENT
YEAR) drug coverage offered by (your/his/her) (CURRENT
MEDICARE MANAGED CARE PLAN) plan with any other Medicare
Advantage plans in (your/his/her) area?

Int. Instr II:

INPUT FIELDS / ROUTING

1:13:07 PM Monday, December 24, 2012

Page 20 of 101

RXPD10

Field1:

PDMABENS

Cheshire Name:

( RXQ1055 )

PDRX.PDMABENS

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 RXPD4 - (RXQ1085 )

English text: YES
No

BOX RXPD4 - (RXQ1085 )

English text: NO
Attribute

Route

Don't know

BOX RXPD4 - (RXQ1085 )

Refusal

BOX RXPD4 - (RXQ1085 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4

Respondent

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

1:13:08 PM Monday, December 24, 2012

Page 21 of 101

RXPD10
DESIGN NOTES

1:13:08 PM Monday, December 24, 2012

Page 22 of 101

BOX RXPD3A

BOX RXPD3A

Page Order # :

120

BOX INSTRUCTIONS
( RXQ1060 )

IF SP HAS REPORTED BEING AUTOMATICALLY ENROLLED IN A
MEDICARE PRESCRIPTION DRUG PLAN IN ANY PREVIOUS ROUND, GO
TO RXPD12 - PDAUTENR ( RXQ1070 ).
ELSE GO TO RXPD11 - PDEVROLL ( RXQ1065 ).

ASSIGNMENTS

TECHNICAL NOTES
431

PDAutoEnrollPrev

If SP has reported being automatically enrolled in a
Medicare Prescription Drug Plan in any previous round =
PDRX.PDEVROLL = /1Yes where HEST.HESTRND <
current round.

DESIGN NOTES

1:13:08 PM Monday, December 24, 2012

Page 23 of 101

RXPD11

RXPD11

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDEVROLL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

130

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "by Medicare" and "ever" in bold.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Some people were automatically enrolled in a Medicare Prescription
Drug plan. By "automatically enrolled", I mean that the beneficiary
was assiged to a plan by Medicare, as opposed to selecting a plan
on his or her own.
[Were you/Was (SP)] ever automatically enrolled in a Medicare
Prescription Drug plan?

Int. Instr II:

1:13:09 PM Monday, December 24, 2012

Page 24 of 101

RXPD11
INPUT FIELDS / ROUTING
PDEVROLL

Field1:
Cheshire Name:

( RXQ1065 )

PDRX.PDEVROLL

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
RXPD12 - PDAUTENR ( RXQ1070 )

English text: YES
No

RXPD15 - PDCOMPRE ( RXQ1080 )

English text: NO
Attribute
Don't know

Route
RXPD15 - PDCOMPRE ( RXQ1080 )

Refusal

RXPD15 - PDCOMPRE ( RXQ1080 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:13:10 PM Monday, December 24, 2012

Page 25 of 101

RXPD12

RXPD12

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDAUTENR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

140

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "current" in bold.
Display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
If SP has reported being automatically enrolled in a Medicare
Prescription Drug Plan in any previous round, display "[EXPLAIN IF
NECESSARY: Some…"
Else do not display.

Multi Field display:

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

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

[Were you/Was (SP)] automatically enrolled in (your/his/her) current
Medicare Prescription Drug plan - that is, (your/his/her) (CURRENT
MEDICARE PRESCRIPTION DRUG PLAN) plan?

1:13:10 PM Monday, December 24, 2012

Page 26 of 101

RXPD12
([EXPLAIN IF NECESSARY: Some people with Medicare were
automatically enrolled in a Medicare Prescription Drug plan. By
"automatically enrolled," I mean that the beneficiary was assigned to
a plan by Medicare as opposed to selecting a plan on his or her
own.])
Int. Instr II:
INPUT FIELDS / ROUTING
PDAUTENR

Field1:
Cheshire Name:

( RXQ1070 )

PDRX.PDAUTENR

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
RXPD14 - PDSWITCH ( RXQ1075 )

English text: YES
No

RXPD14 - PDSWITCH ( RXQ1075 )

English text: NO
Attribute
Don't know

Route
RXPD14 - PDSWITCH ( RXQ1075 )

Refusal

RXPD14 - PDSWITCH ( RXQ1075 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

1:13:11 PM Monday, December 24, 2012

Page 27 of 101

RXPD12
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.

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.

431

PDAutoEnrollPrev

If SP has reported being automatically enrolled in a
Medicare Prescription Drug Plan in any previous round =
PDRX.PDEVROLL = /1Yes where HEST.HESTRND <
current round.

DESIGN NOTES

1:13:11 PM Monday, December 24, 2012

Page 28 of 101

RXPD14

RXPD14

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PDSWITCH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

150

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 today, did you know that people who are automatically
enrolled by Medicare in a Medicare Prescription Drug plan can
switch plans at any time without a penalty?

Int. Instr II:
INPUT FIELDS / ROUTING

1:13:12 PM Monday, December 24, 2012

Page 29 of 101

RXPD14

Field1:

PDSWITCH

Cheshire Name:

( RXQ1075 )

PDRX.PDSWITCH

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TPDPNLTY
1
No
No

Number Label
1 YesDidKnow
2

English text: YES DID KNOW
NoDidNotKnow

FieldSize:
Min Value:
Max Value:
Mask:

Route
RXPD15 - PDCOMPRE ( RXQ1080 )
RXPD15 - PDCOMPRE ( RXQ1080 )

English text: NO DID NOT KNOW
Attribute

Route

Don't know

RXPD15 - PDCOMPRE ( RXQ1080 )

Refusal

RXPD15 - PDCOMPRE ( RXQ1080 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:13:13 PM Monday, December 24, 2012

Page 30 of 101

RXPD15

RXPD15

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDCOMPRE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

160

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is respondent, display "you".
Else display "(SP), or someone for (SP),".
Display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.

Multi Field display:

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

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

Did [you/(SP), or someone for (SP),] compare (CURRENT YEAR)
drug coverage offered by [your/(SP's) (CURRENT MEDICARE
PRESCRIPTION DRUG PLAN) plan with any other Medicare
Prescription Drug plans?

Int. Instr II:

1:13:13 PM Monday, December 24, 2012

Page 31 of 101

RXPD15
INPUT FIELDS / ROUTING
PDCOMPRE

Field1:
Cheshire Name:

( RXQ1080 )

PDRX.PDCOMPRE

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 RXPD4 - (RXQ1085 )

English text: YES
No

BOX RXPD4 - (RXQ1085 )

English text: NO
Attribute
Don't know

Route
BOX RXPD4 - (RXQ1085 )

Refusal

BOX RXPD4 - (RXQ1085 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4

Respondent

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

1:13:15 PM Monday, December 24, 2012

Page 32 of 101

RXPD15
MRES.RROSTNUM='01'.
52

DeletedPlans

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

342

MPDPCurrent

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

DESIGN NOTES

1:13:15 PM Monday, December 24, 2012

Page 33 of 101

BOX RXPD4

BOX RXPD4

Page Order # :

170

BOX INSTRUCTIONS
( RXQ1085 )

IF (RXPD12 - PDAUTENR = 1/Yes) OR (RXPD15 - PDCOMPRE = 2/No, DK,
OR RF), GO TO BOX RX2 - (RXQ1215 ).
ELSE GO TO RXPD18 - PDOPTPRE ( RXQ1090 ).

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.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:13:15 PM Monday, December 24, 2012

Page 34 of 101

RXPD18

RXPD18

Page Order # :

Design Screen Type:

List

Fields:

Field 1:

PDOPTPRE

Field 2:

PDOPTDUC

Field 3:

PDOPTFOR

Field 4:

PDOPTVEN

Field 5:

PDOPTREC

Field 6:

PDOPTGAP

Field 7:

PDOPTPAY

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

180

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If proxy is respondent, display "you or (SP)".
Else display "you".
If SP has a "current" Medicare Managed Care Plan that has RX
coverage, display "(CURRENT MEDICARE MANAGED CARE
PLAN)".
Else display the name of the "current" Medicare Prescription Drug
plan, PLAN.PLNAME.
If proxy is respondent, display "for (SP)".
Else do not display.

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:
Roster/Grid display:

1:13:16 PM Monday, December 24, 2012

Page 35 of 101

RXPD18
Report display:

TEXT:
Context Header:
Int. Instr I:
The next questions are about different things [you or (SP)/you] may
have thought about when considering [your/(SP's)] options for
(CURRENT YEAR) drug coverage.

Question Text:

At the time that [you/(SP)] decided to have (CURRENT YEAR) drug
coverage through [(CURRENT MEDICARE MANAGED CARE
PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did
you consider [for (SP)]…
Int. Instr II:
INPUT FIELDS / ROUTING

Field1:

PDOPTPRE

Cheshire Name:

( RXQ1090 )

PDRX.PDOPTPRE

Item Text display:

Display "a." before the question text.

Item Text:

the cost of the plan's monthly premium?

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
RXPD18 - PDOPTDUC ( RXQ1095 )

English text: YES
No

RXPD18 - PDOPTDUC ( RXQ1095 )

English text: NO
Attribute

Route

Don't know

RXPD18 - PDOPTDUC ( RXQ1095 )

Refusal

RXPD18 - PDOPTDUC ( RXQ1095 )

1:13:17 PM Monday, December 24, 2012

Page 36 of 101

RXPD18

Field2:

PDOPTDUC

Cheshire Name:

( RXQ1095 )

PDRX.PDOPTDUC

Item Text display:

Display "b." before the question text.

Item Text:

the plan's deductible?

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
RXPD18 - PDOPTFOR ( RXQ1100 )

English text: YES
No

RXPD18 - PDOPTFOR ( RXQ1100 )

English text: NO
Attribute

Route

Don't know

RXPD18 - PDOPTFOR ( RXQ1100 )

Refusal

RXPD18 - PDOPTFOR ( RXQ1100 )

1:13:20 PM Monday, December 24, 2012

Page 37 of 101

RXPD18

Field3:

PDOPTFOR

Cheshire Name:

( RXQ1100 )

PDRX.PDOPTFOR

Item Text display:

Display "c." before the question text.

Item Text:

the plan's list of covered medicines, or formulary?

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
RXPD18 - PDOPTVEN ( RXQ1105 )

English text: YES
No

RXPD18 - PDOPTVEN ( RXQ1105 )

English text: NO
Attribute

Route

Don't know

RXPD18 - PDOPTVEN ( RXQ1105 )

Refusal

RXPD18 - PDOPTVEN ( RXQ1105 )

1:13:22 PM Monday, December 24, 2012

Page 38 of 101

RXPD18

Field4:

PDOPTVEN

Cheshire Name:

( RXQ1105 )

PDRX.PDOPTVEN

Item Text display:

Display "d." before the question text.

Item Text:

the convenience of the pharmacies that the plan allows

[you(SP)] to use?

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
RXPD18 - PDOPTREC ( RXQ1110 )

English text: YES
No

RXPD18 - PDOPTREC ( RXQ1110 )

English text: NO
Attribute
Don't know

Route
RXPD18 - PDOPTREC ( RXQ1110 )

Refusal

RXPD18 - PDOPTREC ( RXQ1110 )

1:13:24 PM Monday, December 24, 2012

Page 39 of 101

RXPD18

Field5:

PDOPTREC

Cheshire Name:

( RXQ1110 )

PDRX.PDOPTREC

Item Text display:

Display "e." before the question text.

Item Text:

someone's recommendation of the plan?

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
RXPD18 - PDOPTGAP ( RXQ1115 )

English text: YES
No

RXPD18 - PDOPTGAP ( RXQ1115 )

English text: NO
Attribute

Route

Don't know

RXPD18 - PDOPTGAP ( RXQ1115 )

Refusal

RXPD18 - PDOPTGAP ( RXQ1115 )

1:13:26 PM Monday, December 24, 2012

Page 40 of 101

RXPD18

Field6:

PDOPTGAP

Cheshire Name:

( RXQ1115 )

PDRX.PDOPTGAP

Item Text display:

Display "f." before the question text.

Item Text:

the gap in coverage or "donut hole"?

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
RXPD18 - PDOPTPAY ( RXQ1120 )

English text: YES
No

RXPD18 - PDOPTPAY ( RXQ1120 )

English text: NO
Attribute

Route

Don't know

RXPD18 - PDOPTPAY ( RXQ1120 )

Refusal

RXPD18 - PDOPTPAY ( RXQ1120 )

1:13:28 PM Monday, December 24, 2012

Page 41 of 101

RXPD18

Field7:

( RXQ1120 )

PDOPTPAY

Cheshire Name:

PDRX.PDOPTPAY

Item Text display:

Display "g." before the question text.

Item Text:

the dollar amount [you/(SP)] would pay for prescribed

medicines (you use/he uses/she uses)?

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 RXPD4A - (RXQ1125 )

English text: YES
No

BOX RXPD4A - (RXQ1125 )

English text: NO
Attribute
Don't know

Route
BOX RXPD4A - (RXQ1125 )

Refusal

BOX RXPD4A - (RXQ1125 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

1:13:29 PM Monday, December 24, 2012

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 42 of 101

RXPD18
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.

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.

344

MHMOCurrWithRx

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

DESIGN NOTES

1:13:30 PM Monday, December 24, 2012

Page 43 of 101

BOX RXPD4A

BOX RXPD4A

Page Order # :

190

BOX INSTRUCTIONS
( RXQ1125 )

IF RESPONDENT ANSWERED "YES" TO MORE THAN ONE QUESTION AT
RXPD18, GO TO RXPD18A - PDOPMOST ( RXQ1130 ).
ELSE GO TO RXPD18B - PDRECLIS ( RXQ1137 ).

ASSIGNMENTS

TECHNICAL NOTES
434

RXPD18Yes

If respondent answered "YES" to more than one question
at RXPD18 =
More than one of the following fields = 1/Yes:
RXPD18 - PDOPTPRE
RXPD18 - PDOPTDUC
RXPD18 - PDOPTFOR
RXPD18 - PDOPTVEN
RXPD18 - PDOPTREC
RXPD18 - PDOPTGAP
RXPD18 - PDOPTPAY

DESIGN NOTES

1:13:30 PM Monday, December 24, 2012

Page 44 of 101

RXPD18A

RXPD18A

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PDOPMOST

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

200

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If proxy is respondent, display "you or (SP)".
Else display "you".

Multi Field display:

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

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

Which of these was the most important consideration when [you or
(SP)]/you] thought about [your/(SP's)] options for (CURRENT YEAR)
prescription drug coverage?
[READ ITEMS BELOW IF NECESSARY.]

Int. Instr II:

INPUT FIELDS / ROUTING

1:13:30 PM Monday, December 24, 2012

Page 45 of 101

RXPD18A

1:13:32 PM Monday, December 24, 2012

Page 46 of 101

RXPD18A

Field1:

PDOPMOST

Cheshire Name:

Item Text display:

( RXQ1130 )

PDRX.PDOPMOST
The response options for RXPD18A - PDOPMOST will be
displayed based on the responses to RXPD18.
For each question asked at RXPD18 where the response

equals "YES", display corresponding response option at

RXPD18A.

Else do not display response option.

See detailed instructions below.
If RXDP18 - PDOPTPRE = 1/Yes, display response option
1/CostOfMonthlyPremium .
If RXDP18 - PDOPTDUC = 1/Yes, display response option
2/PlansDeductible.
If RXDP18 - PDOPTFOR = 1/Yes, display response option
3/DrugsOnPlansList.
If RXDP18 - PDOPTVEN = 1/Yes, response option
4/ConvenienceOfThePharamacies.
If RXDP18 - PDOPTREC = 1/Yes, display response option
5/RecommendationOfPlan.
If RXDP18 - PDOPTGAP = 1/Yes, display response option
6/GapInCoverage.
If RXDP18 - PDOPTPAY = 1/Yes, display response option
7/WhatSPWouldPayForPMs.
If displaying response option 4 or 7, display SP's name as
part of the English Display Text.

Item Text:

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TPDopMost
1
No
No

Number Label
1 CostOfMonthlyPremium
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
RXPD18B - PDRECLIS ( RXQ1137 )

English text: THE COST OF THE PLANS MONTHLY PREMIUM
PlansDeductible
RXPD18B - PDRECLIS ( RXQ1137 )
English text: THE PLANS DEDUCTIBLE

1:13:34 PM Monday, December 24, 2012

Page 47 of 101

RXPD18A

3

DrugsOnPlansList

RXPD18B - PDRECLIS ( RXQ1137 )

4

English text: THE PLANS LIST OF MEDICINES OR FORMULARY
ConvenienceOfPharmacies
RXPD18B - PDRECLIS ( RXQ1137 )

5

English text: CONVENIENCE OF THE PHARMACIES THAT THE PLAN ALLOWS (SP) TO USE
RecommendationOfPlan
RXPD18B - PDRECLIS ( RXQ1137 )

6

English text: SOMEONES RECOMMENDATION OF THE PLAN
GapInCoverage
RXPD18B - PDRECLIS ( RXQ1137 )

7

English text: THE GAP IN COVERAGE OR DONUT HOLE
WhatSPWouldPayForPMs
RXPD18B - PDRECLIS ( RXQ1137 )
English text: THE DOLLAR AMOUNT (SP) WOULD PAY FOR PRESCRIBED MEDICINES

Attribute
Don't know

Route
RXPD18B - PDRECLIS ( RXQ1137 )

Refusal

RXPD18B - PDRECLIS ( RXQ1137 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:13:35 PM Monday, December 24, 2012

Page 48 of 101

RXPD18B

RXPD18B

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDRECLIS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

215

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

As you may know, the government has programs that help
beneficiaries pay for the costs associated with a Medicare drug plan
and the purchase of prescription drugs. The help provided is
referred to as a "low-income subsidy" or "extra help".
[Are you/Is (SP)] receiving this type of help to pay for (your/his/her)
(CURRENT YEAR) Medicare prescription drug coverage?
[EXPLAIN IF NECESSARY: Beneficiaries who qualify for these
programs receive help paying for the Medicare drug plan's monthly
premium, help paying any yearly deductible, help paying

1:13:35 PM Monday, December 24, 2012

Page 49 of 101

RXPD18B
coinsurance and copayments for prescription drugs, and have no
coverage gap.]
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

( RXQ1137 )

PDRECLIS

Cheshire Name:

PDRX.PDRECLIS

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 RX2 - (RXQ1215 )

English text: YES
No

RXPD20 - PDEXAPLY ( RXQ1140 )

English text: NO
Attribute

Route

Don't know

RXPD20 - PDEXAPLY ( RXQ1140 )

Refusal

RXPD20 - PDEXAPLY ( RXQ1140 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =

1:13:36 PM Monday, December 24, 2012

Page 50 of 101

RXPD18B
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
5

SPMale

SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.

6

SPFemale

SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.

DESIGN NOTES

1:13:36 PM Monday, December 24, 2012

Page 51 of 101

RXPD20

RXPD20

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDEXAPLY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

220

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:

Did [you/(SP)] apply to the Social Security Administration for extra
help with (CURRENT YEAR) drug coverage?

Int. Instr II:
INPUT FIELDS / ROUTING

1:13:37 PM Monday, December 24, 2012

Page 52 of 101

RXPD20

Field1:

PDEXAPLY

Cheshire Name:

( RXQ1140 )

PDRX.PDEXAPLY

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
RXPD21 - PDEXACCP ( RXQ1145 )

English text: YES
No

BOX RX2 - (RXQ1215 )

English text: NO
Attribute

Route

Don't know

BOX RX2 - (RXQ1215 )

Refusal

BOX RX2 - (RXQ1215 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:13:38 PM Monday, December 24, 2012

Page 53 of 101

RXPD21

RXPD21

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PDEXACCP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

230

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:

Was [your/(SP's)] application for extra help accepted or denied?

Int. Instr II:

INPUT FIELDS / ROUTING

1:13:38 PM Monday, December 24, 2012

Page 54 of 101

RXPD21

Field1:

PDEXACCP

Cheshire Name:

( RXQ1145 )

PDRX.PDEXACCP

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TPDExacp
1
No
No

Number Label
1 Accepted

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX RX2 - (RXQ1215 )

2

English text: ACCEPTED
Denied

BOX RX2 - (RXQ1215 )

3

English text: DENIED
StillPending

BOX RX2 - (RXQ1215 )

English text: STILL PENDING/NO DECISION YET
Attribute
Don't know

Route
BOX RX2 - (RXQ1215 )

Refusal

BOX RX2 - (RXQ1215 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:13:39 PM Monday, December 24, 2012

Page 55 of 101

BOX RX2

BOX RX2

Page Order # :

300

BOX INSTRUCTIONS
( RXQ1215 )

IF (SP HAS A "CURRENT" MEDICARE PRESCRIPTION DRUG PLAN) OR
(IF SP HAS A "CURRENT" MEDICARE MANAGED CARE PLAN THAT HAS
RX COVERAGE) OR (IF SP HAS A "CURRENT" PRIVATE PLAN THAT HAS
RX COVERAGE), GO TO RXINTRO - RXINTRO ( RXQ1220 ).
ELSE GO TO RX19 - PDNTENR ( RXQ1390 ).

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.

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.

344

MHMOCurrWithRx

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

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:13:39 PM Monday, December 24, 2012

Page 56 of 101

RXINTRO

RXINTRO

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

RXINTRO

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

310

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is the respondent, display "you now receive".
Else display "(SP) now receives".
Display the word "now" in bold.
If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE MANAGED CARE
PLAN NAME)".
Else if SP has a "current" Medicare Prescription Drug Plan, display
"(CURRENT MEDICARE PRESCRIPTION DRUG PLAN NAME)".
Else if SP has at least one "current" Private plan that has RX
coverage, display "current" Private plans that have RX coverage in
the following format "PRIVATE PLAN 1, PRIVATE PLAN 2,
PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

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

TEXT:
1:13:40 PM Monday, December 24, 2012

Page 57 of 101

RXINTRO
Context Header:
Int. Instr I:
I have a few questions regarding the prescribed drug coverage that
[you now receive/(SP) now receives] through [(CURRENT
MEDICARE MANAGED CARE PLAN NAME)/(CURRENT
MEDICARE PRESCRIPTION DRUG PLAN NAME)/(CURRENT
PRIVATE PLAN NAMES WITH RX)].

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING

Field1:

( RXQ1220 )

RXINTRO

Cheshire Name:

TEMP

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

Enumerated
TContinueEMPTY
1
No
No

Number Label
1 Continue

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX RX3 - (RXQ1222 )

English text: CONTINUE
Attribute
Empty

Route
BOX RX3 - (RXQ1222 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

1:13:41 PM Monday, December 24, 2012

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
Page 58 of 101

RXINTRO
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
342

MPDPCurrent

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

344

MHMOCurrWithRx

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

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

4

Respondent

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

DESIGN NOTES

1:13:41 PM Monday, December 24, 2012

Page 59 of 101

BOX RX3

BOX RX3

Page Order # :

313

BOX INSTRUCTIONS
( RXQ1222 )

IF (SP HAS A "CURRENT" MEDICARE PRESCRIPTION DRUG PLAN) OR
(SP HAS A "CURRENT" MEDICARE MANAGED CARE PLAN THAT HAS RX
COVERAGE), GO TO RXPD23A - PDSATSFY ( RXQ1225 ).
ELSE GO TO RX2 - PDCONFID ( RXQ1227 ).

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.

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.

344

MHMOCurrWithRx

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

DESIGN NOTES

1:13:41 PM Monday, December 24, 2012

Page 60 of 101

RXPD23A

RXPD23A

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PDSATSFY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

317

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has a "current" Medicare Managed Care Plan that has RX
coverage, display "(CURRENT MEDICARE MANAGED CARE
PLAN)".
Else display the name of the "current" Medicare Prescription Drug
plan, PLAN.PLNAME.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:

SHOW CARD RX3

Question Text:

At the time that [you/(SP)] decided to have (CURRENT YEAR) drug
coverage through ([CURRENT MEDICARE MANAGED CARE
PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)],
how satisfied were you with the information that you had to make
that decision?

Int. Instr II:
1:13:42 PM Monday, December 24, 2012

Page 61 of 101

RXPD23A
INPUT FIELDS / ROUTING
( RXQ1225 )

PDSATSFY

Field1:
Cheshire Name:

PDRX.PDSATSFY

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

Enumerated
TSatsfya

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 VerySatisfied

Route
RX2 - PDCONFID ( RXQ1227 )

2

English text: VERY SATISFIED
Satisfied

RX2 - PDCONFID ( RXQ1227 )

3

English text: SATISFIED
Dissatisfied

RX2 - PDCONFID ( RXQ1227 )

4

English text: DISSATISFIED
VeryDissatisfied

RX2 - PDCONFID ( RXQ1227 )

English text: VERY DISSATISFIED
Attribute

Route

Don't know

RX2 - PDCONFID ( RXQ1227 )

Refusal

RX2 - PDCONFID ( RXQ1227 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

1:13:43 PM Monday, December 24, 2012

Deleted plans that are not valid for displays or checks =

Page 62 of 101

RXPD23A
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

1:13:43 PM Monday, December 24, 2012

Page 63 of 101

RX2

RX2

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PDCONFID

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

320

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is the respondent, display "you now have".
Else display "(SP) now has".
Display the word "now" in bold.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:

SHOW CARD RX4

Question Text:

How confident are you that [you now have/(SP) now has] the drug
coverage that best meets (your/his/her) needs? Would you say you
are…

Int. Instr II:
INPUT FIELDS / ROUTING
1:13:44 PM Monday, December 24, 2012

Page 64 of 101

RX2

Field1:

PDCONFID

Cheshire Name:
Item Text display:

( RXQ1227 )

PDRX.PDCONFID
Note to programmer: The English response text should be
displayed as Upper and Lower case as specified.

Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
Tconfidence
1
No
No

Number Label
1 ExConfident

FieldSize:
Min Value:
Max Value:
Mask:

Route
RX3 - RXUSEPLN ( RXQ1230 )

2

English text: Extremely confident,
VeryConfident

RX3 - RXUSEPLN ( RXQ1230 )

3

English text: Very confident,
ModConfident

RX3 - RXUSEPLN ( RXQ1230 )

4

English text: Moderately confident,
SlConfident

RX3 - RXUSEPLN ( RXQ1230 )

5

English text: Slightly confident, or
NotConfident

RX3 - RXUSEPLN ( RXQ1230 )

English text: Not confident?
Attribute
Don't know

Route
RX3 - RXUSEPLN ( RXQ1230 )

Refusal

RX3 - RXUSEPLN ( RXQ1230 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

1:13:45 PM Monday, December 24, 2012

Page 65 of 101

RX2
4

Respondent

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

DESIGN NOTES

1:13:45 PM Monday, December 24, 2012

Page 66 of 101

RX3

RX3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

RXUSEPLN

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

330

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE MANAGED CARE
PLAN) drug".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else if SP has at least one "current" Private plan that has RX
coverage, display "current" Private plans that have RX coverage in
the following format "PRIVATE PLAN 1, PRIVATE PLAN 2,
PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:

1:13:46 PM Monday, December 24, 2012

Page 67 of 101

RX3
[Have you/Has (SP)] used (your/his/her) [(CURRENT MEDICARE
MANAGED CARE PLAN) drug/(CURRENT MEDICARE
PRESCRIPTION DRUG PLAN NAME)/(CURRENT PRIVATE PLAN
NAMES WITH RX)] coverage when purchasing medicines since
January 1 of this year?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING
RXUSEPLN

Field1:
Cheshire Name:

( RXQ1230 )

PDRX.RXUSEPLN

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
RX4 - RXCOSTLY ( RXQ1235 )

English text: YES
No

RX18 - PDNOUSE ( RXQ1360 )

English text: NO
Attribute
Don't know

Route
RX18 - PDNOUSE ( RXQ1360 )

Refusal

RX18 - PDNOUSE ( RXQ1360 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
1:13:47 PM Monday, December 24, 2012

Page 68 of 101

RX3
52

DeletedPlans

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

342

MPDPCurrent

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

344

MHMOCurrWithRx

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

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:13:47 PM Monday, December 24, 2012

Page 69 of 101

RX4

RX4

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

RXCOSTLY

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

340

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE MANAGED CARE
PLAN) drug".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else if SP has at least one "current" Private plan that has RX
coverage, display "current" Private plans that have RX coverage in
the following format "PRIVATE PLAN 1, PRIVATE PLAN 2,
PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:

1:13:48 PM Monday, December 24, 2012

Page 70 of 101

RX4
Compared to last year, is the cost of the monthly premium for
[your/(SP's)] [(CURRENT MEDICARE MANAGED CARE PLAN)
drug/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN
NAME)/(CURRENT PRIVATE PLAN NAMES WITH RX)] coverage
more, less, or the same?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING
RXCOSTLY

Field1:
Cheshire Name:

( RXQ1235 )

PDRX.RXCOSTLY

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TMonthlyPremium
1
No
No

Number Label
1 MoreThanLastYear

FieldSize:
Min Value:
Max Value:
Mask:

Route
RX5 - RXAMNTLY ( RXQ1240 )

2

English text: MORE THAN LAST YEAR
LessThanLastYear

RX5 - RXAMNTLY ( RXQ1240 )

3

English text: LESS THAN LAST YEAR
SameAsLastYear

RX5 - RXAMNTLY ( RXQ1240 )

4

English text: THE SAME AS LAST YEAR
NoDrugCovLastYear

RX5 - RXAMNTLY ( RXQ1240 )

English text: NO DRUG COVERAGE PREMIUM LAST YEAR
Attribute

Route

Don't know

RX5 - RXAMNTLY ( RXQ1240 )

Refusal

RX5 - RXAMNTLY ( RXQ1240 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

1:13:49 PM Monday, December 24, 2012

Page 71 of 101

RX4
HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

1:13:49 PM Monday, December 24, 2012

Page 72 of 101

RX5

RX5

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

RXAMNTLY

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

350

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is respondent, display "you pay".
Else display "(SP) pays".
If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE MANAGED CARE
PLAN) drug".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else if SP has at least one "current" Private plan that has RX
coverage, display "current" Private plans that have RX coverage in
the following format "PRIVATE PLAN 1, PRIVATE PLAN 2,
PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

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

TEXT:

1:13:50 PM Monday, December 24, 2012

Page 73 of 101

RX5
Context Header:
Int. Instr I:
Are the amounts that [you pay/(SP) pays] for medicines at the
pharmacy using (your/his/her) [(CURRENT MEDICARE MANAGED
CARE PLAN) drug/(CURRENT MEDICARE PRESCRIPTION DRUG
PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)] coverage
more, less, or the same compared to what (you/he/she) paid last
year?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING

Field1:

RXAMNTLY

Cheshire Name:

( RXQ1240 )

PDRX.RXAMNTLY

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TRXPayment
1
No
No

Number Label
1 MoreThanLastYear

FieldSize:
Min Value:
Max Value:
Mask:

Route
RX7 - PDNOCVG ( RXQ1250 )

2

English text: MORE THAN LAST YEAR
LessThanLastYear

RX7 - PDNOCVG ( RXQ1250 )

3

English text: LESS THAN LAST YEAR
SameAsLastYear

RX7 - PDNOCVG ( RXQ1250 )

4

English text: THE SAME AS LAST YEAR
NoRXCostLastYear

RX7 - PDNOCVG ( RXQ1250 )

English text: NO COST FOR RX LAST YEAR
Attribute

Route

Don't know

RX7 - PDNOCVG ( RXQ1250 )

Refusal

RX7 - PDNOCVG ( RXQ1250 )

BACKGROUND VARIABLE ASSIGNMENTS

1:13:51 PM Monday, December 24, 2012

Page 74 of 101

RX5

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.

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.

344

MHMOCurrWithRx

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

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

4

Respondent

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

DESIGN NOTES

1:13:51 PM Monday, December 24, 2012

Page 75 of 101

RX7

RX7

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDNOCVG

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

370

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is respondent, display "you regularly take".
Else display "(SP) regularly takes".
If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE MANAGED CARE
PLAN) drug".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else if SP has at least one "current" Private plan that has RX
coverage, display "current" Private plans that have RX coverage in
the following format "PRIVATE PLAN 1, PRIVATE PLAN 2,
PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

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

TEXT:

1:13:52 PM Monday, December 24, 2012

Page 76 of 101

RX7
Context Header:
Int. Instr I:
Are there any prescribed medicines that [you regularly take/(SP)
regularly takes] that are not covered by (your/his/her) (CURRENT
YEAR) [(CURRENT MEDICARE MANAGED CARE PLAN)
drug/(CURRENT MEDICARE PRESCRIPTION DRUG
PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)] coverage?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING

Field1:

PDNOCVG

Cheshire Name:

( RXQ1250 )

PDRX.PDNOCVG

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
RX8 - RXCHGMED ( RXQ1255 )

English text: YES
No

RX8 - RXCHGMED ( RXQ1255 )

English text: NO
Attribute

Route

Don't know

RX8 - RXCHGMED ( RXQ1255 )

Refusal

RX8 - RXCHGMED ( RXQ1255 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
1:13:53 PM Monday, December 24, 2012

Page 77 of 101

RX7

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.

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.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare

Advantage plan) with RX coverage=

There is a PLAN where PLANTYPE=5/MHMO & PLRO

where (PLROPLAN=PLANNUM & PLRORND=current

round & COVCURNT=1/Yes & MHMORX=1/Yes)).

Exclude Deleted Plans. See T.N. 52.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =

There is a PLAN where PLANTYPE=4/PrivatePlan &

PLRO where (PLROPLAN=PLAN.PLANNUM &

PLRORND=current round & (COVTIME=1/WholeTime or

COVNOW=1/Yes) & PRVRXCOV=1/Yes)).

Exclude Deleted Plans. See T.N. 52.

4

Respondent

On MRES where MRES.MRESRND = current round:

A Proxy interview (respondent is a proxy) =

MRES.SPPROXY=2/Proxy.

MRES.RROSTNUM=ROST.ROSTNUM of respondent.

An SP interview (respondent is the SP) =

MRES.SPPROXY=1/SP.

MRES.RROSTNUM='01'.

5

SPMale

SP is male =

ROST.ROSTSEX=1/Male on ROST where

ROST.ROSTNUM='01'.

6

SPFemale

SP is female =

ROST.ROSTSEX=2/Female on ROST where

ROST.ROSTNUM='01'.

DESIGN NOTES

1:13:53 PM Monday, December 24, 2012

Page 78 of 101

RX8

RX8

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

RXCHGMED

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:

If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE MANAGED CARE
PLAN) drug".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else if SP has at least one "current" Private plan that has RX
coverage, display "current" Private plans that have RX coverage in
the following format "PRIVATE PLAN 1, PRIVATE PLAN 2,
PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:

1:13:54 PM Monday, December 24, 2012

Page 79 of 101

RX8
[Have you/Has (SP)] had to change any of (your/his/her) prescribed
medicines from a brand name to a generic medicine because of
(your/his/her) (CURRENT YEAR) [(CURRENT MEDICARE
MANAGED CARE PLAN) drug/(CURRENT MEDICARE
PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE PLAN
NAMES WITH RX)] coverage?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING
RXCHGMED

Field1:
Cheshire Name:

( RXQ1255 )

PDRX.RXCHGMED

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
RX9 - RXSWTCH ( RXQ1260 )

English text: YES
No

RX9 - RXSWTCH ( RXQ1260 )

English text: NO
Attribute
Don't know

Route
RX9 - RXSWTCH ( RXQ1260 )

Refusal

RX9 - RXSWTCH ( RXQ1260 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

1:13:55 PM Monday, December 24, 2012

Page 80 of 101

RX8
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.

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.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare

Advantage plan) with RX coverage=

There is a PLAN where PLANTYPE=5/MHMO & PLRO

where (PLROPLAN=PLANNUM & PLRORND=current

round & COVCURNT=1/Yes & MHMORX=1/Yes)).

Exclude Deleted Plans. See T.N. 52.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =

There is a PLAN where PLANTYPE=4/PrivatePlan &

PLRO where (PLROPLAN=PLAN.PLANNUM &

PLRORND=current round & (COVTIME=1/WholeTime or

COVNOW=1/Yes) & PRVRXCOV=1/Yes)).

Exclude Deleted Plans. See T.N. 52.

4

Respondent

On MRES where MRES.MRESRND = current round:

A Proxy interview (respondent is a proxy) =

MRES.SPPROXY=2/Proxy.

MRES.RROSTNUM=ROST.ROSTNUM of respondent.

An SP interview (respondent is the SP) =

MRES.SPPROXY=1/SP.

MRES.RROSTNUM='01'.

5

SPMale

SP is male =

ROST.ROSTSEX=1/Male on ROST where

ROST.ROSTNUM='01'.

5

SPMale

SP is male =

ROST.ROSTSEX=1/Male on ROST where

ROST.ROSTNUM='01'.

DESIGN NOTES

1:13:55 PM Monday, December 24, 2012

Page 81 of 101

RX9

RX9

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

RXSWTCH

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

390

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE MANAGED CARE
PLAN) drug".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else if SP has at least one "current" Private plan that has RX
coverage, display "current" Private plans that have RX coverage in
the following format "PRIVATE PLAN 1, PRIVATE PLAN 2,
PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:

1:13:56 PM Monday, December 24, 2012

Page 82 of 101

RX9
[Have you/Has (SP)] had to switch to a different medication because
a drug (you/he/she) needed was not available through (your/his/her)
(CURRENT YEAR) [(CURRENT MEDICARE MANAGED CARE
PLAN) drug/(CURRENT MEDICARE PRESCRIPTION DRUG
PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)] coverage?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING
RXSWTCH

Field1:
Cheshire Name:

( RXQ1260 )

PDRX.RXSWTCH

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
RX16 - RXPARTIC ( RXQ1350 )

English text: YES
No

RX16 - RXPARTIC ( RXQ1350 )

English text: NO
Attribute
Don't know

Route
RX16 - RXPARTIC ( RXQ1350 )

Refusal

RX16 - RXPARTIC ( RXQ1350 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
1:13:57 PM Monday, December 24, 2012

Page 83 of 101

RX9
52

DeletedPlans

Deleted plans that are not valid for displays or checks =

Any PLAN where (PLAN.PLANDFLG=1/Yes or

PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or

PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =

There is a PLAN where PLAN.PLANTYPE=7/MPDP &

PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &

PLRO.PLRORND=current round &

PLRO.COVCURNT=1/Yes).

Exclude Deleted Plans. See T.N. 52.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare

Advantage plan) with RX coverage=

There is a PLAN where PLANTYPE=5/MHMO & PLRO

where (PLROPLAN=PLANNUM & PLRORND=current

round & COVCURNT=1/Yes & MHMORX=1/Yes)).

Exclude Deleted Plans. See T.N. 52.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =

There is a PLAN where PLANTYPE=4/PrivatePlan &

PLRO where (PLROPLAN=PLAN.PLANNUM &

PLRORND=current round & (COVTIME=1/WholeTime or

COVNOW=1/Yes) & PRVRXCOV=1/Yes)).

Exclude Deleted Plans. See T.N. 52.

4

Respondent

On MRES where MRES.MRESRND = current round:

A Proxy interview (respondent is a proxy) =

MRES.SPPROXY=2/Proxy.

MRES.RROSTNUM=ROST.ROSTNUM of respondent.

An SP interview (respondent is the SP) =

MRES.SPPROXY=1/SP.

MRES.RROSTNUM='01'.

5

SPMale

SP is male =

ROST.ROSTSEX=1/Male on ROST where

ROST.ROSTNUM='01'.

6

SPFemale

SP is female =

ROST.ROSTSEX=2/Female on ROST where

ROST.ROSTNUM='01'.

DESIGN NOTES

1:13:57 PM Monday, December 24, 2012

Page 84 of 101

RX16

RX16

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

RXPARTIC

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:

If SP is the respondent, display "you generally prefer".
Else display "(SP) generally prefers".
If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE MANAGED CARE
PLAN)".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else if SP has at least one "current" Private plan that has RX
coverage, display"current" Private plans that have RX coverage in
the following format "PRIVATE PLAN 1, PRIVATE PLAN 2,
PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

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

TEXT:

1:13:57 PM Monday, December 24, 2012

Page 85 of 101

RX16
Context Header:
Int. Instr I:
Does the [(CURRENT MEDICARE MANAGED CARE
PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG
PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)] drug plan
network include the pharmacy that [you generally prefer/(SP)
generally prefers] to use?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING

Field1:

RXPARTIC

Cheshire Name:

( RXQ1350 )

PDRX.RXPARTIC

Item Text display:
Item Text:
Label:

Label Position:

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

Enumerated
TRXPartIC
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
RX17 - PDRXRATE ( RXQ1355 )

2

English text: YES
No

3

English text: NO
OnlyUsesNetMailOrder

RX17 - PDRXRATE ( RXQ1355 )

DO NOT DISPLAY. DATA EDITING ONLY.
English text: ONLY USES NETWORK MAIL ORDER PHARMACY
Attribute
Don't know

Route
RX17 - PDRXRATE ( RXQ1355 )

Refusal

RX17 - PDRXRATE ( RXQ1355 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
1:13:59 PM Monday, December 24, 2012

Page 86 of 101

RX16

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.

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.

344

MHMOCurrWithRx

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

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:13:59 PM Monday, December 24, 2012

Page 87 of 101

RX17

RX17

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PDRXRATE

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:

If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE MANAGED CARE
PLAN)".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else if SP has at least one "current" Private plan that has RX
coverage, display "current" Private plans that have RX coverage in
the following format "PRIVATE PLAN 1, PRIVATE PLAN 2,
PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:

1:13:59 PM Monday, December 24, 2012

SHOW CARD RX3

Page 88 of 101

RX17
Overall, how satisfied are you with [your/(SP's)] drug plan through
[(CURRENT MEDICARE MANAGED CARE PLAN)/(CURRENT
MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE
PLAN NAMES WITH RX)]?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING

Field1:

PDRXRATE

Cheshire Name:

( RXQ1355 )

PDRX.PDRXRATE

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TSatsfya
1
No
No

Number Label
1 VerySatisfied

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX RXEND - (RXQ1455 )

2

English text: VERY SATISFIED
Satisfied

BOX RXEND - (RXQ1455 )

3

English text: SATISFIED
Dissatisfied

BOX RXEND - (RXQ1455 )

4

English text: DISSATISFIED
VeryDissatisfied

BOX RXEND - (RXQ1455 )

English text: VERY DISSATISFIED
Attribute

Route

Don't know

BOX RXEND - (RXQ1455 )

Refusal

BOX RXEND - (RXQ1455 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

1:14:01 PM Monday, December 24, 2012

Page 89 of 101

RX17
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.

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.

344

MHMOCurrWithRx

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

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:14:01 PM Monday, December 24, 2012

Page 90 of 101

RX18

RX18

Page Order # :

Design Screen Type:

Code All

Fields:

Field 1:

PDNOUSE

Field 2:

PDNOOTHOS

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:

490

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE MANAGED CARE
PLAN)".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else if SP has at least one "current" Private plan that has RX
coverage, display "current" Private plans that have RX coverage in
the following format "PRIVATE PLAN 1, PRIVATE PLAN 2,
PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

Vertical Alignment

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

TEXT:
Context Header:

1:14:01 PM Monday, December 24, 2012

Page 91 of 101

RX18
Int. Instr I:
Question Text:

Why [haven't you/hasn't (SP)] used (your/his/her) [(CURRENT
MEDICARE MANAGED CARE PLAN)/(CURRENT MEDICARE
PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE PLAN
NAMES WITH RX)] coverage in (CURRENT YEAR)?

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

1:14:03 PM Monday, December 24, 2012

Page 92 of 101

RX18

Field1:

PDNOUSE

Cheshire Name:

( RXQ1360 )

NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=PDRX.PDNOPCHS
2=PDRX.PDNOCARD
3=PDRX.PDNOMEDC
4=PDRX.PDNOEXPS
5=PDRX.PDNOCOVD
91=PDRX.PDNOOTHR

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TPDNOUSE
6
No
No

Number Label
1 HaveNotPurchasedMedicine

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX RXEND - (RXQ1455 )

2

English text: HAVE NOT PURCHASED MEDICINE
DontHaveCard
BOX RXEND - (RXQ1455 )

3

English text: DON'T HAVE CARD OR OTHER ENROLLMENT VERIFICATION/NOT ABLE
DUE TO PLAN PROBLEM
PharmacyWouldntGiveMedicine
BOX RXEND - (RXQ1455 )

4

English text: PHARMACY WOULDN'T GIVE MEDICINE
CostOfRxTooHigh
BOX RXEND - (RXQ1455 )

5

English text: COST OF RX TOO HIGH/EXPENSIVE
DrugsNeededNotCovered
BOX RXEND - (RXQ1455 )

91

English text: DRUG(S) NEEDED NOT COVERED BY PLAN
Other
RX18 - PDNOOTHOS ( RXQ1388 )
English text: OTHER

Attribute

Route

Don't know

BOX RXEND - (RXQ1455 )

Refusal

BOX RXEND - (RXQ1455 )

1:14:05 PM Monday, December 24, 2012

Page 93 of 101

RX18

Field2:

PDNOOTHOS

Cheshire Name:

( RXQ1388 )

PDRX.PDNOOS

Item Text display:

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

instructions.

Item Text:

OTHER (SPECIFY)

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String

TOthrspec

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]

30

Route
BOX RXEND - (RXQ1455 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

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

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.

344

MHMOCurrWithRx

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

1:14:05 PM Monday, December 24, 2012

Page 94 of 101

RX18
354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

1:14:05 PM Monday, December 24, 2012

Page 95 of 101

RX19

RX19

Page Order # :

Design Screen Type:

Code All

Fields:

Field 1:

PDNTENR

Field 2:

PDNTOTHOS

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:

500

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

You said that [you are/(SP) is] not enrolled in a Medicare

Prescription Drug plan. What is the reason (you are/he is/she is) not
enrolled in such a plan?

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

1:14:06 PM Monday, December 24, 2012

Page 96 of 101

RX19

1:14:08 PM Monday, December 24, 2012

Page 97 of 101

RX19

Field1:

PDNTENR

Cheshire Name:

( RXQ1390 )

NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=PDRX.PDNTRXCV
2=PDRX.PDNTPRES
3=PDRX.PDNTCOVR
4=PDRX.PDNTENRL
5=PDRX.PDNTPLAN
6=PDRX.PDNTEXPS
7=PDRX.PDNTCONF
8=PDRX.PDNTMANY
9=PDRX.PDNTBEFT
10=PDRX.PDNTPDP
11=PDRX.PDNTINTL
91=PDRX.PDNTOTHR

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TPDNTENR
12
No
No

Number Label
1 HaveRxCoverageThroughNonPdp

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX RXEND - (RXQ1455 )

2

English text: HAVE RX COVERAGE THROUGH A NON-PDP PLAN/SOURCE
DontTakeEnoughPrescriptions
BOX RXEND - (RXQ1455 )

3

English text: DON'T TAKE ENOUGH PRESCRIPTIONS TO NEED IT
PlansDontCoverPrescriptions
BOX RXEND - (RXQ1455 )

4

English text: PLANS DON'T COVER PRESCRIPTIONS SP TAKES
DontKnowHowToEnroll
BOX RXEND - (RXQ1455 )

5

English text: DON'T KNOW HOW TO ENROLL
DontKnowEnoughAboutPlans
BOX RXEND - (RXQ1455 )

6

English text: DON'T KNOW ENOUGH ABOUT PLANS
TooExpensive
BOX RXEND - (RXQ1455 )

7

English text: TOO EXPENSIVE OR CAN'T AFFORD
TooConfusing
BOX RXEND - (RXQ1455 )

8

English text: TOO CONFUSING OR TOO COMPLICATED
TooManyPlansToChooseFrom
BOX RXEND - (RXQ1455 )
English text: TOO MANY PLANS TO CHOOSE FROM OR CAN'T DECIDE ON ONE PLAN

1:14:10 PM Monday, December 24, 2012

Page 98 of 101

RX19

9

WontBenefitOrSaveMoney

BOX RXEND - (RXQ1455 )

10

English text: WON'T BENEFIT OR WON'T SAVE MONEY
HadAPdpDidntLike
BOX RXEND - (RXQ1455 )

11

English text: HAD A PDP, DIDN'T LIKE IT OR WASN'T USEFUL
SpBuysMedicineOutsideUS
BOX RXEND - (RXQ1455 )

91

English text: SP BUYS MEDICINE OUTSIDE OF THE U.S.
OtherReason
RX19 - PDNTOTHOS ( RXQ1395 )
English text: OTHER REASON

Attribute

Route

Don't know

BOX RXEND - (RXQ1455 )

Refusal

BOX RXEND - (RXQ1455 )

Field2:
Cheshire Name:

PDNTOTHOS

( RXQ1395 )

PDRX.PDNTOS

Item Text display:

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

Item Text:

OTHER REASON (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 RXEND - (RXQ1455 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

1:14:12 PM Monday, December 24, 2012

Page 99 of 101

RX19

DESIGN NOTES

1:14:12 PM Monday, December 24, 2012

Page 100 of 101

BOX RXEND

BOX RXEND

Page Order # :

510

BOX INSTRUCTIONS
( RXQ1455 )

GO TO NEXT SECTION .

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

1:14:12 PM Monday, December 24, 2012

Page 101 of 101