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pdfBOX HIBEG
BOX HIBEG
Page Order # :
1483
BOX INSTRUCTIONS
( HIQ3345 )
IF (SP IS IN THE SUPPLEMENTAL SAMPLE), GO TO HIMCINTR - HIINTR1
( HIQ3348 ).
ELSE GO TO BOX MC1AA - (HIQ3350 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
9:00:57 AM Tuesday, May 14, 2013
Page 1 of 346
HIMCINTR
HIMCINTR
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
HIINTR1
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1484
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD HIMC
Question Text:
The next questions are about [your/(SP's)] health insurance
benefits. This card outlines the types of health insurance that I’ll be
asking you about. Please refer to this card as we talk about
[your/(SP’s)] health insurance coverage.
[EXPAIN IF NECESSARY: We ask about health insurance
coverage because it is important to understand how beneficiaries
cover the costs of their medical care, such as doctor visits,
prescribed medicines, and hospital stays.]
Int. Instr II:
9:00:57 AM Tuesday, May 14, 2013
Page 2 of 346
HIMCINTR
INPUT FIELDS / ROUTING
HIINTR1
Field1:
Cheshire Name:
( HIQ3348 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX MC1AA - (HIQ3350 )
English text: CONTINUE
Attribute
Route
Empty
BOX MC1AA - (HIQ3350 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
9:00:58 AM Tuesday, May 14, 2013
Page 3 of 346
BOX MC1AA
BOX MC1AA
9:00:58 AM Tuesday, May 14, 2013
Page Order # :
1485
Page 4 of 346
BOX MC1AA
BOX INSTRUCTIONS
( HIQ3350 )
IF (SP IS IN THE SUPPLEMENTAL SAMPLE) AND (SP HAS A LOADED
CMS MEDICARE MANAGED CARE PLAN), GO TO MC1 - LOADCORR (
HIQ3430 ).
ELSE IF (SP IS NOT IN THE SUPPLEMENTAL SAMPLE) AND (SP HAS A
MEDICARE MANAGED CARE PLAN THAT WAS "CURRENT" AT THE TIME
OF THE PREVIOUS ROUND INTERVIEW), GO TO HIMC1A - MHMOSAME (
HIQ3591 ).
ELSE GO TO HIMC1 - MHMOCOV ( HIQ3600 ).
ASSIGNMENTS
Create current round PLRO for Medicare Plan where PLAN.PLANTYPE = 1/Medicare.
PLRO KEY = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
Set plan status = current. See detailed instructions below:
PLROPLAN
Create PLRO where PLRO.PLROPLAN = 01.
PLRORND
Create PLRO where PLRO.PLRORND = current
round.
COVTIME
Set PLRO.COVTIME = 1/WholeTime.
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
51
MHMOCurrPrevRnd
Medicare Managed Care plan (Medicare Advantage plan)
"current" at time of previous round interview =
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=previous
round & COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
50
LoadedMHMO
Loaded CMS Medicare Managed Care plan (Medicare
Advantage plan) =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:00:58 AM Tuesday, May 14, 2013
Page 5 of 346
MC1
MC1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
LOADCORR
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1550
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the name of the loaded CMS Medicare Managed Care Plan
in the next-to-last sentence, PLAN.PLNAME.
Question display:
Always display "(Health Maintenance Organizations)" and
"(Preferred Provider Organizations)" in parenthesis.
Display "currently" in BOLD.
Display the name of the loaded CMS Medicare Managed Care Plan
in the next-to-last sentence, PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MA PLAN: (CMS MEDICARE MANAGED CARE PLAN NAME)
Int. Instr I:
Question Text:
9:00:59 AM Tuesday, May 14, 2013
As you may know, Medicare allows beneficiaries in certain parts of
the country to enroll in Medicare Advantage plans, such as HMOs
(Health Maintenance Organizations) and PPOs (Preferred Provider
Organizations), to receive their Medicare-covered health care.
Page 6 of 346
MC1
According to Medicare records, [you are/(SP) is] currently enrolled in
a Medicare Advantage Plan called (CMS MEDICARE MANAGED
CARE PLAN NAME). Is this information correct?
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
LOADCORR
Cheshire Name:
( HIQ3430 )
HRND.LOADCORR
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HIMC1 - (HIQ4010 )
English text: YES
No
MC2 - WHATWRNG ( HIQ3440 )
English text: NO
Attribute
Route
Don't know
MC11 - REFERMED ( HIQ3560 )
Refusal
BOX HIMC4 - (HIQ4500 )
BACKGROUND VARIABLE ASSIGNMENTS
If CMS reported that the SP was enrolled in a Medicare Managed Care plan, a current
round PLAN and PLRO will be generated at the home office and will be preloaded with
release of case. The preloaded records will include the following information:
PLAN.PLANNUM = Number of CMS loaded plan
PLAN.PLANRNDC=current round
PLAN.PLANTYPE=5/MHMO
PLAN.MHMOLRND=current round
PLRO.PLROPLAN = PLAN.PLANNUM
PLRO.PLRORND=current round
PLRO.COVANYTM=1/Yes.
The status of the loaded CMS Medicare Managed Care plan may be determined by the
9:01:00 AM Tuesday, May 14, 2013
Page 7 of 346
MC1
response to MC1, HRND.LOADCORR.
Plan details will be collected on this PLAN and PLRO records. When setting status of this
plan, set variable on PLRO where PLRO.PLROPLAN=this PLAN.PLANNUM and
PLRO.PLRORND=current round.
See detailed instructions below:
COVCURNT
If LOADCORR = 1/Yes, set
PLRO.COVCURNT=1/Yes.
if LOADCORR = DK or RF, set
PLRO.COVCURNT=2/No.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
50
LoadedMHMO
Loaded CMS Medicare Managed Care plan (Medicare
Advantage plan) =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.
DESIGN NOTES
9:01:00 AM Tuesday, May 14, 2013
Page 8 of 346
MC2
MC2
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
WHATWRNG
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1560
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the name of the loaded CMS Medicare Managed Care Plan,
PLAN.PLNAME.
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
(CMS MEDICARE MANAGED CARE PLAN NAME)
Int. Instr I:
Question Text:
How is this information incorrect?
Int. Instr II:
SELECT ONLY ONE. IF MORE THAN ONE RESPONSE IS
APPLICABLE, SELECT THE RESPONSE THAT IS CLOSEST TO
THE TOP OF THE LIST.
INPUT FIELDS / ROUTING
9:01:01 AM Tuesday, May 14, 2013
Page 9 of 346
MC2
Field1:
WHATWRNG
HRND.WHATWRNG
Cheshire Name:
Item Text display:
( HIQ3440 )
Display the name of the loaded CMS Medicare Managed
Care Plan in the response categories, PLAN.PLNAME.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TWhatwrng
1
No
No
Number Label
1 EnrolledNewPlan
FieldSize:
Min Value:
Max Value:
Mask:
Route
MC2B - YDISNROL ( HIQ3450 )
2
English text: SP DISENROLLED FROM (CMS MHMO PLAN NAME), ENROLLED IN NEW
MEDICARE ADVANTAGE PLAN
DoesNotThinkItsPlan
MC3 - PRIMPHYS ( HIQ3480 )
3
English text: SP HAS PLAN CALLED (CMS MHMO PLAN NAME), R DOESN'T THINK IT'S A
MEDICARE ADVANTAGE PLAN
Disenrolled
MC2B - YDISNROL ( HIQ3450 )
4
English text: SP NOW DISENROLLED FROM (CMS MHMO PLAN NAME), NO LONGER IN
ANY MEDICARE ADVANTAGE PLAN
EnrolledButNotThisPlan
MC4 - SAMEPLAN ( HIQ3490 )
5
English text: SP ENROLLED IN MEDICARE ADVANTAGE PLAN, BUT NEVER (CMS MHMO
PLAN NAME)
NeverEnrolled
MC11 - REFERMED ( HIQ3560 )
English text: SP NEVER COVERED BY OR ENROLLED IN (CMS MHMO PLAN NAME)
Attribute
Route
BACKGROUND VARIABLE ASSIGNMENTS
The status of the loaded CMS Medicare Managed Care plan may be set depending on
response to MC2. When setting status of this plan, set PLRO variable on PLRO where
PLRO.PLROPLAN=this PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
COVCURNT
9:01:03 AM Tuesday, May 14, 2013
If WHATWRNG=2/DoesNotThinkItsPlan, set
PLRO.COVCURNT=1/Yes.
Else if WHATWRNG = 1/EnrolledNewPlan,
3/Disenrolled or 5/NeverEnrolled, set
Page 10 of 346
MC2
PLRO.COVCURNT=2/No.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
50
LoadedMHMO
Loaded CMS Medicare Managed Care plan (Medicare
Advantage plan) =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.
DESIGN NOTES
9:01:03 AM Tuesday, May 14, 2013
Page 11 of 346
MC2B
MC2B
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
YDISNROL
Field 2:
YDISNROS
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
1575
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the name of the loaded CMS Medicare Managed Care Plan,
PLAN.PLNAME.
Question display:
Display the name of the loaded CMS Medicare Managed Care Plan,
PLAN.PLNAME.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MA PLAN: (CMS MEDICARE MANAGED CARE PLAN NAME)
Int. Instr I:
Question Text:
What is the most important reason [you/(SP)] stopped the (CMS
MEDICARE MANAGED CARE PLAN NAME)
coverage?
Int. Instr II:
INPUT FIELDS / ROUTING
9:01:04 AM Tuesday, May 14, 2013
Page 12 of 346
MC2B
9:01:06 AM Tuesday, May 14, 2013
Page 13 of 346
MC2B
Field1:
YDISNROL
Cheshire Name:
( HIQ3450 )
PLRO.YDISNROL
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TDisenrol
1
No
No
Number Label
1 TooExpensive
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX MC1A - (HIQ3470 )
2
English text: TOO EXPENSIVE OR COULDN'T AFFORD
DissatisfiedWithQuality
BOX MC1A - (HIQ3470 )
3
English text: SP DISSATISFIED WITH QUALITY OF CARE
ToGetRx
BOX MC1A - (HIQ3470 )
4
English text: TO GET RX COVERAGE IN ANOTHER PLAN
BenefitBesideRx
BOX MC1A - (HIQ3470 )
5
English text: TO GET BENEFIT COVERAGE OTHER THAN RX
OutOfBusiness
BOX MC1A - (HIQ3470 )
6
English text: PLAN WENT OUT OF BUSINESS/STOPPED MEDICARE COVERAGE
PlanChangedName
BOX MC1A - (HIQ3470 )
7
English text: PLAN NAME CHANGED OR PLAN WAS BOUGHT BY/MERGED WITH
ANOTHER PLAN
DrLeftPlan
BOX MC1A - (HIQ3470 )
8
English text: DOCTOR LEFT PLAN/DIED/RETIRED
CouldntGetAppt
BOX MC1A - (HIQ3470 )
9
English text: DIFFICULTIES GETTING APPTS OR SEEING PARTICULAR PROVIDERS
SpMoved
BOX MC1A - (HIQ3470 )
10
English text: SP MOVED OUT OF PLAN AREA
DidNotLikeChoice
BOX MC1A - (HIQ3470 )
11
English text: SP DIDN'T LIKE CHOICE OF DOCTORS
WantedChoice
BOX MC1A - (HIQ3470 )
91
English text: SP WANTED CHOICE OF DOCTORS
Other
MC2B - YDISNROS ( HIQ3460 )
English text: OTHER
Attribute
Route
9:01:09 AM Tuesday, May 14, 2013
Page 14 of 346
MC2B
Don't know
BOX MC1A - (HIQ3470 )
Refusal
BOX MC1A - (HIQ3470 )
Field2:
( HIQ3460 )
YDISNROS
Cheshire Name:
PLRO.YDISNROS
Item Text display:
Display "(SPECIFY)" in same blue font used for interviewer
instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
30
Route
BOX MC1A - (HIQ3470 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
50
LoadedMHMO
Loaded CMS Medicare Managed Care plan (Medicare
Advantage plan) =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.
DESIGN NOTES
9:01:10 AM Tuesday, May 14, 2013
Page 15 of 346
MC2B
9:01:10 AM Tuesday, May 14, 2013
Page 16 of 346
BOX MC1A
BOX MC1A
Page Order # :
1580
BOX INSTRUCTIONS
( HIQ3470 )
IF MC2 - WHATWRNG = 1/EnrolledNewPlan, GO TO MC5
PLAN_MHMOMCA ( HIQ3500 ).
ELSE GO TO HIMC16 - MHMOMORE ( HIQ4450 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
9:01:10 AM Tuesday, May 14, 2013
Page 17 of 346
MC3
MC3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PRIMPHYS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1590
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
In many Medicare Advantage Plans, such as HMOs or PPOs, the
health plan gives the patient a list of doctors from which he chooses
a primary care physician. This primary care physician provides the
patient’s usual medical care and can refer the patient to specialists,
if necessary. (Do you/Does SP) have a primary care physician?
Int. Instr II:
INPUT FIELDS / ROUTING
9:01:10 AM Tuesday, May 14, 2013
Page 18 of 346
MC3
Field1:
PRIMPHYS
Cheshire Name:
( HIQ3480 )
HRND.PRIMPHYS
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HIMC1 - (HIQ4010 )
English text: YES
No
BOX HIMC1 - (HIQ4010 )
English text: NO
Attribute
Route
Don't know
BOX HIMC1 - (HIQ4010 )
Refusal
BOX HIMC1 - (HIQ4010 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
9:01:11 AM Tuesday, May 14, 2013
Page 19 of 346
MC4
MC4
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
SAMEPLAN
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1600
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the name of the loaded CMS Medicare Managed Care Plan,
PLAN.PLNAME.
Question display:
Display the name of the loaded CMS Medicare Managed Care Plan,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MA PLAN: (CMS MEDICARE MANAGED CARE PLAN NAME)
Int. Instr I:
Question Text:
Is it possible that [your/(SP’s)] current insurance plan is just another
name for (CMS MEDICARE MANAGED CARE PLAN NAME), or are
they not the same plans?
Int. Instr II:
INPUT FIELDS / ROUTING
9:01:12 AM Tuesday, May 14, 2013
Page 20 of 346
MC4
Field1:
( HIQ3490 )
SAMEPLAN
Cheshire Name:
HRND.SAMEPLAN
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TSamePlan
1
No
No
Number Label
1 Same
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HIMC1 - (HIQ4010 )
English text: SAME PLANS
NotSame
MC5 - PLAN_MHMOMCA ( HIQ3500 )
English text: NOT THE SAME PLANS
Attribute
Route
Don't know
MC5 - PLAN_MHMOMCA ( HIQ3500 )
Refusal
MC5 - PLAN_MHMOMCA ( HIQ3500 )
BACKGROUND VARIABLE ASSIGNMENTS
The status of the loaded CMS Medicare Managed Care plan may be set depending on
response to MC4. When setting status of this plan, set PLRO variable on PLRO where
PLRO.PLROPLAN=this PLAN.PLANNUM and PLRO.PLRORND=current round. See
detailed instructions below:
COVCURNT
If MC4 - SAMEPLAN=1/Yes, set
PLRO.COVCURNT=1/Yes.
Else set PLRO.COVCURNT=2/No.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
9:01:13 AM Tuesday, May 14, 2013
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 21 of 346
MC4
50
LoadedMHMO
Loaded CMS Medicare Managed Care plan (Medicare
Advantage plan) =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.
DESIGN NOTES
9:01:13 AM Tuesday, May 14, 2013
Page 22 of 346
MC5
MC5
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PLAN_MHMOMCA
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Name:
Plan Roster
Roster Type:
Single Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
1610
Display as ' Add a Plan '
Display as ' Edit a Plan '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all health insurance plans from the Plan Roster except for
the loaded CMS Medicare Managed Care Plan.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare plan
Medicaid
Tricare
Public Plans
Private Plans
Medicare Prescription Drug Plans
Roster/Grid display:
COL #
1
9:01:14 AM Tuesday, May 14, 2013
HEADER
Plan Name
INSTRUCTIONS
Display PLAN.PLNAME.
Page 23 of 346
MC5
2
Plan Type
Display PLAN.PLANTYPE:
1/Medicare, display "MCAR"
2/Medicaid, display "MCAD"
3/PublicPlan, display "PUBL"
4/PrivatePlan, display "PRIV"
5/MHMO, display "MHMO"
6/Tricare, display "TRIC"
7/MPDP, display "MPDP"
3
Plan Status
Display CURRENT ROUND PLAN
STATUS.
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What is the name of the Medicare Advantage Plan that provides
[your/(SP’s)] health care?
Int. Instr II:
SELECT OR ADD ONLY ONE MEDICARE ADVANTAGE PLAN AT
THIS ROSTER.
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
PLAN_MHMOMCA
( HIQ3500 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TPlanPick8
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
8
Route
BOX HIMC1 - (HIQ4010 )
BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
9:01:14 AM Tuesday, May 14, 2013
Page 24 of 346
MC5
PLAN.PLANNUM = Number of plan selected at MC5.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at MC5.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
The plan selected at MC5 is the SP's current Medicare Managed Care plan for the present
round. To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
PLROPLAN
PLRO.PLROPLAN=PLAN.PLANNUM of PLAN
selected.
PLRORND
PLRO.PLRORND=current round.
COVANYTM
Set PLRO.COVANYTM=1/Yes for plan selected at
MC5.
COVCURNT
Set PLRO.COVCURNT=1/Yes for plan selected at
MC5.
PLANTYPE
If PLAN added to roster, set
PLAN.PLANTYPE=5/MHMO.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
95
PlanIsCurrent
If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
53
PlanTypes
Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Advantage: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.
9:01:14 AM Tuesday, May 14, 2013
Page 25 of 346
MC5
50
LoadedMHMO
Loaded CMS Medicare Managed Care plan (Medicare
Advantage plan) =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.
DESIGN NOTES
9:01:14 AM Tuesday, May 14, 2013
Page 26 of 346
MC11
MC11
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
REFERMED
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1670
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Do you refer to [your/(SP’s)] Medicare coverage by any name
besides Medicare?
Int. Instr II:
INPUT FIELDS / ROUTING
9:01:15 AM Tuesday, May 14, 2013
Page 27 of 346
MC11
Field1:
REFERMED
Cheshire Name:
( HIQ3560 )
HRND.REFERMED
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRefermed
1
No
No
Number Label
1 MedicareOnly
2
English text: MEDICARE ONLY
OtherName
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HIMC4 - (HIQ4500 )
MC12 - PLAN_MHMOMCB ( HIQ3570 )
English text: OTHER NAME
Attribute
Route
Don't know
BOX HIMC4 - (HIQ4500 )
Refusal
BOX HIMC4 - (HIQ4500 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
9:01:16 AM Tuesday, May 14, 2013
Page 28 of 346
MC12
MC12
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PLAN_MHMOMCB
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Plan Roster
Roster Type:
Single Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
1680
Display as ' Add a Plan '
Display as ' Edit a Plan '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all health insurance plans from the Plan Roster except for
the loaded CMS Medicare Managed Care Plan.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare plan
Medicaid
Tricare
Public Plans
Private Plans
Medicare Prescription Drug Plans
Roster/Grid display:
COL #
1
9:01:16 AM Tuesday, May 14, 2013
HEADER
Plan Name
INSTRUCTIONS
Display PLAN.PLNAME.
Page 29 of 346
MC12
2
Plan Type
Display PLAN.PLANTYPE:
1/Medicare, display "MCAR"
2/Medicaid, display "MCAD"
3/PublicPlan, display "PUBL"
4/PrivatePlan, display "PRIV"
5/MHMO, display "MHMO"
6/Tricare, display "TRIC"
7/MPDP, display "MPDP"
3
Plan Status
Display CURRENT ROUND PLAN
STATUS.
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What do you call [your/(SP’s)] coverage?
Int. Instr II:
SELECT OR ADD ONLY ONE MEDICARE ADVANTAGE PLAN AT
THIS ROSTER.
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
PLAN_MHMOMCB
( HIQ3570 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TPlanPick8
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
8
Route
BOX HIMC1 - (HIQ4010 )
BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at MC12.
9:01:17 AM Tuesday, May 14, 2013
Page 30 of 346
MC12
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at MC12.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
The plan selected at MC12 is the SP's current Medicare Managed Care plan for the present
round. To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
PLROPLAN
PLRO.PLROPLAN=PLAN.PLANNUM of PLAN
selected.
PLRORND
PLRO.PLRORND=current round.
COVANYTM
Set PLRO.COVANYTM=1/Yes for plan selected at
MC12.
COVCURNT
Set PLRO.COVCURNT=1/Yes for plan selected at
MC12.
PLANTYPE
If PLAN added to roster, set
PLAN.PLANTYPE=5/MHMO.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
95
PlanIsCurrent
If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
53
PlanTypes
Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Advantage: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.
9:01:17 AM Tuesday, May 14, 2013
Page 31 of 346
MC12
50
LoadedMHMO
Loaded CMS Medicare Managed Care plan (Medicare
Advantage plan) =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.
DESIGN NOTES
9:01:17 AM Tuesday, May 14, 2013
Page 32 of 346
HIMC1A
HIMC1A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MHMOSAME
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1700
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display Medicare Managed Care plan that was current at the time of
the previous round interview, PLAN.PLNAME.
Question display:
Display Medicare Managed Care plan that was current at the time of
the previous round interview, PLAN.PLNAME.
If SP is deceased or institutionalized, display "Was (SP) covered
by...".
Else display "[Are you/Is (SP)] now covered...".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MA PLAN: (MEDICARE MANAGED CARE PLAN NAME)
Int. Instr I:
Question Text:
At the time of the last interview [you were/(SP) was] covered by
(MEDICARE MANAGED CARE PLAN NAME).
[[Are you/Is (SP)] now covered by (MEDICARE MANAGED CARE
PLAN NAME)?] [Was (SP) covered by (MEDICARE MANAGED
9:01:18 AM Tuesday, May 14, 2013
Page 33 of 346
HIMC1A
CARE PLAN NAME) on (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)?]
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
MHMOSAME
Cheshire Name:
( HIQ3591 )
HRND.MHMOSAME
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HIMC1 - (HIQ4010 )
English text: YES
No
HIMC1B1 - YDISNROL ( HIQ3593 )
English text: NO
Attribute
Route
Don't know
HIMC1C - MHMOOTHR ( HIQ3596 )
Refusal
BOX HIMC4 - (HIQ4500 )
BACKGROUND VARIABLE ASSIGNMENTS
The Medicare Managed Care plan being asked about at HIMC1A was SP's current
Medicare Managed Care plan at the time of the previous round interview. This also means
that the SP was covered by this Medicare Managed Care plan for some time during the
current round.
To set current round status of this plan, create a current round PLRO where
PLRO.PLROPLAN = this PLAN.PLANNUM.
PLRO KEY = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
Based on response to HIMC1A, HRND.MHMOSAME, set the status of this plan on the
current round PLRO.
See detailed instructions below:
9:01:19 AM Tuesday, May 14, 2013
Page 34 of 346
HIMC1A
PLROPLAN
PLRO.PLROPLAN = PLAN.PLANNUM of MHMO
current at time of previous round.
PLRORND
PLRO.PLRORND = current round.
COVANYTM
Set PLRO.COVANYTM = 1/Yes.
COVCURNT
If HIMC1A - MHMOSAME = 1/Yes, set
PLRO.COVCURNT=1/Yes.
Else set PLRO.COVCURNT = 2/No.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
51
MHMOCurrPrevRnd
Medicare Managed Care plan (Medicare Advantage plan)
"current" at time of previous round interview =
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=previous
round & COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:01:19 AM Tuesday, May 14, 2013
Page 35 of 346
HIMC1B1
HIMC1B1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
YDISNROL
Field 2:
YDISNROS
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
1703
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name of Medicare Managed Care plan that was current at
the time of the previous round interview, PLAN.PLNAME.
Question display:
Display name of Medicare Managed Care plan that was current at
the time of the previous round interview, PLAN.PLNAME.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MA PLAN: (MEDICARE MANAGED CARE PLAN NAME)
Int. Instr I:
Question Text:
What is the most important reason [you/(SP)] stopped the
(MEDICARE MANAGED CARE PLAN NAME) coverage?
Int. Instr II:
INPUT FIELDS / ROUTING
9:01:20 AM Tuesday, May 14, 2013
Page 36 of 346
HIMC1B1
9:01:22 AM Tuesday, May 14, 2013
Page 37 of 346
HIMC1B1
Field1:
YDISNROL
Cheshire Name:
( HIQ3593 )
PLRO.YDISNROL
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TDisenrol
1
No
No
Number Label
1 TooExpensive
FieldSize:
Min Value:
Max Value:
Mask:
Route
HIMC1C - MHMOOTHR ( HIQ3596 )
2
English text: TOO EXPENSIVE OR COULDN'T AFFORD
DissatisfiedWithQuality
HIMC1C - MHMOOTHR ( HIQ3596 )
3
English text: SP DISSATISFIED WITH QUALITY OF CARE
ToGetRx
HIMC1C - MHMOOTHR ( HIQ3596 )
4
English text: TO GET RX COVERAGE IN ANOTHER PLAN
BenefitBesideRx
HIMC1C - MHMOOTHR ( HIQ3596 )
5
English text: TO GET BENEFIT COVERAGE OTHER THAN RX
OutOfBusiness
HIMC1C - MHMOOTHR ( HIQ3596 )
6
English text: PLAN WENT OUT OF BUSINESS/STOPPED MEDICARE COVERAGE
PlanChangedName
HIMC1C - MHMOOTHR ( HIQ3596 )
7
English text: PLAN NAME CHANGED OR PLAN WAS BOUGHT BY/MERGED WITH
ANOTHER PLAN
DrLeftPlan
HIMC1C - MHMOOTHR ( HIQ3596 )
8
English text: DOCTOR LEFT PLAN/DIED/RETIRED
CouldntGetAppt
HIMC1C - MHMOOTHR ( HIQ3596 )
9
English text: DIFFICULTIES GETTING APPTS OR SEEING PARTICULAR PROVIDERS
SpMoved
HIMC1C - MHMOOTHR ( HIQ3596 )
10
English text: SP MOVED OUT OF PLAN AREA
DidNotLikeChoice
HIMC1C - MHMOOTHR ( HIQ3596 )
11
English text: SP DIDN'T LIKE CHOICE OF DOCTORS
WantedChoice
HIMC1C - MHMOOTHR ( HIQ3596 )
91
English text: SP WANTED CHOICE OF DOCTORS
Other
HIMC1B1 - YDISNROS ( HIQ3594 )
English text: OTHER
Attribute
Route
9:01:25 AM Tuesday, May 14, 2013
Page 38 of 346
HIMC1B1
Don't know
HIMC1C - MHMOOTHR ( HIQ3596 )
Refusal
HIMC1C - MHMOOTHR ( HIQ3596 )
Field2:
( HIQ3594 )
YDISNROS
Cheshire Name:
PLRO.YDISNROS
Item Text display:
Display "(SPECIFY)" in same blue font used for interviewer
instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
30
Route
HIMC1C - MHMOOTHR ( HIQ3596 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
51
MHMOCurrPrevRnd
Medicare Managed Care plan (Medicare Advantage plan)
"current" at time of previous round interview =
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=previous
round & COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
9:01:26 AM Tuesday, May 14, 2013
Page 39 of 346
HIMC1B1
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:01:26 AM Tuesday, May 14, 2013
Page 40 of 346
HIMC1C
HIMC1C
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MHMOOTHR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1704
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name of Medicare Managed Care Plan that was current at
the time of the previous round interview, PLAN.PLNAME.
Question display:
If SP is deceased or institutionalized, display "was (SP)".
Else display "[have you/has (SP)] been".
Display name of Medicare Managed Care Plan that was current at
the time of the previous round interview, PLAN.PLNAME.
Multi Field display:
Display name of Medicare Managed Care Plan that was current at
the time of the previous round interview, PLAN.PLNAME.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MA PLAN: (MEDICARE MANAGED CARE PLAN NAME)
Int. Instr I:
SHOW CARD HIMC1
Question Text:
[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/INSTITUTIONALIZATION)], [have you/has (SP)
been/was (SP)] covered by any other Medicare Advantage Plans
besides (MEDICARE MANAGED CARE PLAN)?
9:01:27 AM Tuesday, May 14, 2013
Page 41 of 346
HIMC1C
Int. Instr II:
INPUT FIELDS / ROUTING
MHMOOTHR
Field1:
Cheshire Name:
( HIQ3596 )
HRND.MHMOOTHR
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HIMC3 - MHMOCURR ( HIQ3970 )
English text: YES
No
BOX HIMC4 - (HIQ4500 )
English text: NO
Attribute
Route
Don't know
BOX HIMC4 - (HIQ4500 )
Refusal
BOX HIMC4 - (HIQ4500 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
9:01:28 AM Tuesday, May 14, 2013
Page 42 of 346
HIMC1C
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
51
MHMOCurrPrevRnd
Medicare Managed Care plan (Medicare Advantage plan)
"current" at time of previous round interview =
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=previous
round & COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:01:28 AM Tuesday, May 14, 2013
Page 43 of 346
HIMC1
HIMC1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MHMOCOV
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1710
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(may)" and "(Health Maintenance Organizations)"
and "(Preferred Provider Organizations)" in parenthesis.
Note to programmer: Currently all states have at least one
Medicare Managed Care plan, however, this can change.
Therefore, we are leaving in this display fill:
If there are no Medicare Managed Care Plans in SP's state, display
"any".
Else display "(one of these/any)". Always display in parenthesis.
If there are Medicare Managed Care Plans in SP’s state, display
"Please look at this card.".
Else do not display.
If there are Medicare Managed Care Plans in SP’s state, display
"SHOW CARD HIMC1" interviewer instruction. Do not display in
parenthesis. Parenthesis indicate that this is a display fill.
Else do not display.
If SP is deceased or institutionalized, display "had (SP)".
Else if SP is the respondent, display "have you".
Else display "has (SP)".
Multi Field display:
Roster/Grid Instructions:
9:01:29 AM Tuesday, May 14, 2013
Page 44 of 346
HIMC1
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
(SHOW CARD HIMC1)
Question Text:
As you (may) know, Medicare allows beneficiaries in certain parts of
the country to enroll in Medicare Advantage plans, such as HMOs
(Health Maintenance Organizations) and PPOs (Preferred Provider
Organizations), to receive their Medicare-covered health care.
(Please look at this card.) At any time [since (REFERENCE
DATE)/between (REFERENCE DATE) and (DATE OF DEATH/DATE
OF INSTITUTIONALIZATION),] [have you/has (SP)/had (SP)] been
enrolled in or covered by [any/(one of these/any)] Medicare
Advantage plans?
Int. Instr II:
INPUT FIELDS / ROUTING
9:01:30 AM Tuesday, May 14, 2013
Page 45 of 346
HIMC1
Field1:
( HIQ3600 )
MHMOCOV
Cheshire Name:
HRND.MHMOCOV
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HIMC3 - MHMOCURR ( HIQ3970 )
English text: YES
No
BOX HIMC4 - (HIQ4500 )
English text: NO
Attribute
Route
Don't know
BOX HIMC4 - (HIQ4500 )
Refusal
BOX HIMC4 - (HIQ4500 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
340
AllStateWithMHMO
If there are Medicare Managed Care plans (Medicare
Advantage plans) in SP's state =
All States have at least one Medicare Advantage Plan.
DESIGN NOTES
9:01:31 AM Tuesday, May 14, 2013
Page 46 of 346
HIMC3
HIMC3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MHMOCURR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1890
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If (SP is alive and not institutionalized), display "currently".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Are you/Is (SP)/Was (SP)] (currently) covered by or enrolled in a
Medicare Advantage Plan [on (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]?
Int. Instr II:
INPUT FIELDS / ROUTING
9:01:32 AM Tuesday, May 14, 2013
Page 47 of 346
HIMC3
Field1:
MHMOCURR
Cheshire Name:
( HIQ3970 )
HRND.MHMOCURR
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HIMC5 - PLAN_MHMO ( HIQ4000 )
English text: YES
No
BOX HIMC2 - (HIQ4440 )
English text: NO
Attribute
Route
Don't know
BOX HIMC2 - (HIQ4440 )
Refusal
BOX HIMC2 - (HIQ4440 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
9:01:33 AM Tuesday, May 14, 2013
Page 48 of 346
HIMC3
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
HIMC3 is also called from ST, NS, CPS when a Medicare Managed Care
Plan is added at the Source of Payment roster and SP has not already
reported a current Medicare Managed Care Plan.
9:01:33 AM Tuesday, May 14, 2013
Page 49 of 346
HIMC5
HIMC5
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PLAN_MHMO
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Name:
Plan Roster
Roster Type:
Single Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
1920
Display as ' Add a Plan '
Display as ' Edit a Plan '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "[What is the name…"] in brackets.
If SP is deceased, display "on (DATE OF DEATH)".
Else if SP is institutionalized, display "on (DATE OF
INSTITUTIONALIZATION)" .
Else do not display.
If SP is deceased or institutionalized, display "covered".
Else display "covers".
Multi Field display:
Roster/Grid Instructions:
Display all health insurance plans from the Plan Roster.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare plan
Medicare Managed Care plan if "current" at the time of the previous
round interview
Medicaid
Tricare
Public Plans
Private Plans
Medicare Prescription Drug Plans
Roster/Grid display:
COL #
1
9:01:34 AM Tuesday, May 14, 2013
HEADER
Plan Name
INSTRUCTIONS
Display PLAN.PLNAME.
Page 50 of 346
HIMC5
2
Plan Type
Display PLAN.PLANTYPE:
1/Medicare, display "MCAR"
2/Medicaid, display "MCAD"
3/PublicPlan, display "PUBL"
4/PrivatePlan, display "PRIV"
5/MHMO, display "MHMO"
6/Tricare, display "TRIC"
7/MPDP, display "MPDP"
3
Plan Status
Display CURRENT ROUND PLAN
STATUS.
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[What is the name of the Medicare Advantage Plan that (currently
covers/covered) [you/(SP)] [on (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]?]
Int. Instr II:
SELECT OR ADD ONLY ONE MEDICARE ADVANTAGE PLAN AT
THIS ROSTER.
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
PLAN_MHMO
( HIQ4000 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TPlanPick32
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
32
Route
BOX HIMC1 - (HIQ4010 )
BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
9:01:34 AM Tuesday, May 14, 2013
Page 51 of 346
HIMC5
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at HIMC5.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HIMC5.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
The plan selected at HIMC5 is the SP's current Medicare Managed Care plan for the
present round. To set status of PLAN, create current round PLRO where
PLRO.PLROPLAN=this PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
COVANYTM
Set PLRO.COVANYTM=1/Yes for plan selected at
HIMC5.
COVCURNT
Set PLRO.COVCURNT=1/Yes for plan selected at
HIMC5.
PLANTYPE
If PLAN added to roster, set
PLAN.PLANTYPE=5/MHMO.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
95
PlanIsCurrent
If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
50
LoadedMHMO
Loaded CMS Medicare Managed Care plan (Medicare
Advantage plan) =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.
65
MHMOCurrent
SP has a current Medicare Managed Care plan
(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.
9:01:34 AM Tuesday, May 14, 2013
Page 52 of 346
HIMC5
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
53
PlanTypes
Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Advantage: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.
51
MHMOCurrPrevRnd
Medicare Managed Care plan (Medicare Advantage plan)
"current" at time of previous round interview =
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=previous
round & COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
HIMC5 is called from ST, NS, CPS when a Medicare Managed Care Plan is
added at the Source of Payment roster and SP has already reported a
current Medicare Managed Care plan but has now reported a change
regarding which Medicare Managed Care plan is current.
9:01:34 AM Tuesday, May 14, 2013
Page 53 of 346
BOX HIMC1
BOX HIMC1
Page Order # :
1930
BOX INSTRUCTIONS
( HIQ4010 )
THIS PLAN IS THE SP'S CURRENT MEDICARE MANAGED CARE PLAN .
IF (THIS MEDICARE MANAGED CARE PLAN IS NEW OR HAS BEEN
"RESTARTED") OR THIS IS A FALL ROUND GO TO HIMC6A - MHMORXTM
( HIQ4020 ).
ELSE GO TO BOX HIMC1CC1 - (HIQ4030 ).
ASSIGNMENTS
The PLAN directed to BOX HIMC1 is the SP's current Medicare Managed Care plan this
round.
If current Medicare Managed Care plan was
"current" at time of previous round interview and this
is not a fall round, current round PLRO.MHMORX =
previous round PLRO.MHMORX for plan where
PLRO.PLROPLAN = PLAN.PLANNUM of current
Medicare Managed Care plan.
MHMORX
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.
61
ThisPlanNew
This Plan is new =
PLAN.PLANRNDC = current round and
PLAN.PLANSUMM ^= 1/Yes.
Exclude Deleted Plans. See T.N. 52.
74
ThisMHMORestarted
This Medicare Managed Care plan (Medicare Advantage
plan) has been restarted =
For this PLAN, there is not a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes ).
Exclude Deleted Plans. See T.N. 52.
51
MHMOCurrPrevRnd
Medicare Managed Care plan (Medicare Advantage plan)
"current" at time of previous round interview =
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=previous
round & COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
DESIGN NOTES
If Supplemental Case and PLAN currently being asked about is the
loaded CMS plan, this plan is considered "NEW" (PLAN.PLANRNDC=52)
and should route to HIMC6.
9:01:34 AM Tuesday, May 14, 2013
Page 54 of 346
HIMC6A
HIMC6A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MHMORXTM
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
1940
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
Question display:
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
If respondent is the SP, display "you personally have".
Else if SP is deceased or institutionalized, display "(SP) personally
had".
Else display "(SP) personally has".
Display "you" or "(SP)' in "(you personally have/(SP) personally
has/(SP) personally had)" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MA PLAN: (CURRENT MEDICARE MANAGED CARE PLAN NAME)
Int. Instr I:
Question Text:
9:01:35 AM Tuesday, May 14, 2013
[Do you/Does (SP)/Did (SP)] have prescribed medicine coverage
Page 55 of 346
HIMC6A
through (CURRENT MEDICARE MANAGED CARE PLAN)?
[PROBE: I am asking about the type of insurance coverage that [you
personally have/(SP) personally has/(SP) personally had], not what
the plan offers everyone.]
Int. Instr II:
INPUT FIELDS / ROUTING
MHMORXTM
Field1:
Cheshire Name:
( HIQ4020 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HIMC1CC1 - (HIQ4030 )
English text: YES
No
BOX HIMC1CC1 - (HIQ4030 )
English text: NO
Attribute
Don't know
Route
BOX HIMC1CC1 - (HIQ4030 )
Refusal
BOX HIMC1CC1 - (HIQ4030 )
BACKGROUND VARIABLE ASSIGNMENTS
MHMORX
PLRO.MHMORX = HIMC6A-MHMORXTM
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9:01:36 AM Tuesday, May 14, 2013
Page 56 of 346
HIMC6A
DESIGN NOTES
9:01:36 AM Tuesday, May 14, 2013
Page 57 of 346
BOX HIMC1CC1
BOX HIMC1CC1
Page Order # :
1950
BOX INSTRUCTIONS
( HIQ4030 )
IF (THIS MEDICARE MANAGED CARE PLAN IS NEW OR HAS BEEN
"RESTARTED"), GO TO HIMC7 - MHMODENT ( HIQ4280 ).
ELSE GO TO BOX HIMC2 - (HIQ4440 ).
ASSIGNMENTS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
61
ThisPlanNew
This Plan is new =
PLAN.PLANRNDC = current round and
PLAN.PLANSUMM ^= 1/Yes.
Exclude Deleted Plans. See T.N. 52.
74
ThisMHMORestarted
This Medicare Managed Care plan (Medicare Advantage
plan) has been restarted =
For this PLAN, there is not a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes ).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:01:36 AM Tuesday, May 14, 2013
Page 58 of 346
HIMC7
HIMC7
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MHMODENT
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2100
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
Question display:
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MA PLAN: (CURRENT MEDICARE MANAGED CARE PLAN NAME)
Int. Instr I:
Question Text:
[Do you/Does (SP)/Did (SP)] have dental coverage through
(CURRENT MEDICARE MANAGED CARE PLAN NAME)?
Int. Instr II:
INPUT FIELDS / ROUTING
9:01:37 AM Tuesday, May 14, 2013
Page 59 of 346
HIMC7
Field1:
MHMODENT
Cheshire Name:
( HIQ4280 )
PLRO.MHMODENT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HIMC8 - MHMOEYE ( HIQ4290 )
English text: YES
No
HIMC8 - MHMOEYE ( HIQ4290 )
English text: NO
Attribute
Route
Don't know
HIMC8 - MHMOEYE ( HIQ4290 )
Refusal
HIMC8 - MHMOEYE ( HIQ4290 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
9:01:38 AM Tuesday, May 14, 2013
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
Page 60 of 346
HIMC7
65
MHMOCurrent
SP has a current Medicare Managed Care plan
(Medicare Advantage plan) =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:01:38 AM Tuesday, May 14, 2013
Page 61 of 346
HIMC8
HIMC8
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MHMOEYE
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2110
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
Question display:
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MA PLAN: (CURRENT MEDICARE MANAGED CARE PLAN NAME)
Int. Instr I:
Question Text:
[Do you/Does (SP)/Did (SP)] have optical coverage through
(CURRENT MEDICARE MANAGED CARE PLAN NAME), that is, for
eyeglasses or contact lenses?
Int. Instr II:
INPUT FIELDS / ROUTING
9:01:39 AM Tuesday, May 14, 2013
Page 62 of 346
HIMC8
Field1:
( HIQ4290 )
MHMOEYE
Cheshire Name:
PLRO.MHMOEYE
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HIMC10 - MHMONH ( HIQ4310 )
English text: YES
No
HIMC10 - MHMONH ( HIQ4310 )
English text: NO
Attribute
Route
Don't know
HIMC10 - MHMONH ( HIQ4310 )
Refusal
HIMC10 - MHMONH ( HIQ4310 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
9:01:40 AM Tuesday, May 14, 2013
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
Page 63 of 346
HIMC8
65
MHMOCurrent
SP has a current Medicare Managed Care plan
(Medicare Advantage plan) =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:01:40 AM Tuesday, May 14, 2013
Page 64 of 346
HIMC10
HIMC10
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MHMONH
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2130
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
Question display:
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MA PLAN: (CURRENT MEDICARE MANAGED CARE PLAN NAME)
Int. Instr I:
Question Text:
[Does your/Does (SP’s)/Did (SP’s)] (CURRENT MEDICARE
MANAGED CARE PLAN NAME) coverage include nursing home
care over and beyond what Medicare normally covers?
[EXPLAIN IF NECESSARY: Under regular fee-for-service, Medicare
pays for limited skilled nursing facility (SNF) care during a benefit
period. In 2013, the first 20 days are paid in full and the next 80
days require a copayment of up to $148.00 per day.]
9:01:41 AM Tuesday, May 14, 2013
Page 65 of 346
HIMC10
Int. Instr II:
INPUT FIELDS / ROUTING
( HIQ4310 )
MHMONH
Field1:
Cheshire Name:
PLRO.MHMONH
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HIMC11 - MHMOPAY ( HIQ4320 )
English text: YES
No
HIMC11 - MHMOPAY ( HIQ4320 )
English text: NO
Attribute
Route
Don't know
HIMC11 - MHMOPAY ( HIQ4320 )
Refusal
HIMC11 - MHMOPAY ( HIQ4320 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
9:01:42 AM Tuesday, May 14, 2013
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
Page 66 of 346
HIMC10
65
MHMOCurrent
SP has a current Medicare Managed Care plan
(Medicare Advantage plan) =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:01:42 AM Tuesday, May 14, 2013
Page 67 of 346
HIMC11
HIMC11
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MHMOPAY
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2140
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
Question display:
If SP is deceased or institutionalized, display "was".
Else display "is".
If SP is deceased or institutionalized, display "have paid".
Else display "pay".
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MA PLAN: (CURRENT MEDICARE MANAGED CARE PLAN NAME)
Int. Instr I:
Question Text:
9:01:43 AM Tuesday, May 14, 2013
Besides the cost of [your/(SP’s)] Medicare Part B premium, (is/was)
there an additional cost for [your/(SP’s)] (CURRENT MEDICARE
MANAGED CARE PLAN NAME) coverage? Please do not include
Page 68 of 346
HIMC11
any amount that [you/(SP)] may (pay/have paid) as a co-payment for
an office visit or a prescribed medicine.
[EXPLAIN IF NECESSARY: Some managed care plans may charge
a monthly premium to cover the cost of the deductibles and
coinsurance for Medicare-covered services or because they provide
services that are not covered by Medicare such as prescribed
medicines, routine exams, and dental, eye, or hearing. Plans that
have premiums typically charge from $50 to $75 per month.]
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
MHMOPAY
Cheshire Name:
( HIQ4320 )
PLRO.MHMOPAY
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HIMC12 - MHMOAMT ( HIQ4330 )
English text: YES
No
BOX HIMC2 - (HIQ4440 )
English text: NO
Attribute
Route
Don't know
BOX HIMC2 - (HIQ4440 )
Refusal
BOX HIMC2 - (HIQ4440 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
9:01:44 AM Tuesday, May 14, 2013
Page 69 of 346
HIMC11
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
65
MHMOCurrent
SP has a current Medicare Managed Care plan
(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.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
9:01:44 AM Tuesday, May 14, 2013
Page 70 of 346
HIMC12
HIMC12
Page Order # :
Design Screen Type:
Quantity Unit Hybrid
Fields:
Field 1:
MHMOAMT
Field 2:
MHMOUNIT
Field 3:
MHMOUNOS
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
2150
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
Question display:
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
If SP is deceased or institutionalized, display "was",
Else display "is".
If SP is deceased or institutionalized, display "(SP) paid".
Else if SP is respondent, "you pay".
Else display "(SP) pays".
If SP is deceased or institutionalized, display "have been".
Else display "be".
Always display "[Please do not include any copayments...]" in
brackets.
Display "additional" in BOLD.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
9:01:46 AM Tuesday, May 14, 2013
Page 71 of 346
HIMC12
Report display:
TEXT:
MA PLAN: (CURRENT MEDICARE MANAGED CARE PLAN NAME)
Context Header:
Int. Instr I:
Not including the cost of [your/(SP’s)] Medicare Part B premium,
what (is/was) the additional amount that [you pay/(SP) pays/(SP)
paid] for (your/his/her) (CURRENT MEDICARE MANAGED CARE
PLAN NAME) coverage? [Please do not include any copayments or
any amount that may (be/have been) paid for anyone other than
[you/(SP)].]
Question Text:
[PROBE IF NECESSARY: Is that per year, per month, per week, or
what?]
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
MHMOAMT
Cheshire Name:
( HIQ4330 )
PLRO.MHMOAMT
Item Text display:
Item Text:
Label:
Label Position:
AMOUNT:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Real
TMippamt
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
HIMC12A - MHMOCOST ( HIQ4360 )
Refusal
HIMC12A - MHMOCOST ( HIQ4360 )
9:01:48 AM Tuesday, May 14, 2013
FieldSize:
Min Value:
Max Value:
Mask:
0.01
99999.99
Dollars
Route
HIMC12 - MHMOUNIT ( HIQ4340 )
Page 72 of 346
HIMC12
Field2:
MHMOUNIT
Cheshire Name:
( HIQ4340 )
PLRO.MHMOUNIT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TMippunit
1
No
No
Number Label
1 PerYear
FieldSize:
Min Value:
Max Value:
Mask:
Route
HIMC12A - MHMOCOST ( HIQ4360 )
2
English text: PER YEAR
Quarterly
3
English text: QUARTERLY/EVERY 3 MONTHS
Bimonthly
HIMC12A - MHMOCOST ( HIQ4360 )
4
English text: BIMONTHLY/EVERY 2 MONTHS
PerMonth
HIMC12A - MHMOCOST ( HIQ4360 )
5
English text: PER MONTH
PerWeek
HIMC12A - MHMOCOST ( HIQ4360 )
6
English text: PER WEEK
SemiAnnually
HIMC12A - MHMOCOST ( HIQ4360 )
7
English text: SEMI-ANNUALLY/2 TIMES PER YEAR
SemiMonthly
HIMC12A - MHMOCOST ( HIQ4360 )
91
English text: SEMI-MONTHLY/2 TIMES PER MONTH
Other
HIMC12 - MHMOUNOS ( HIQ4350 )
HIMC12A - MHMOCOST ( HIQ4360 )
English text: OTHER
Attribute
Route
Don't know
HIMC12A - MHMOCOST ( HIQ4360 )
Refusal
HIMC12A - MHMOCOST ( HIQ4360 )
9:01:51 AM Tuesday, May 14, 2013
Page 73 of 346
HIMC12
Field3:
MHMOUNOS
Cheshire Name:
( HIQ4350 )
PLRO.MHMOUNOS
Item Text display:
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
30
Route
HIMC12A - MHMOCOST ( HIQ4360 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1:
If MHMOAMT ^= DK and MHMOAMT ^= RF, then:
If MHMOUNIT = 1/PerYear, then MHMOAMT = $50.00 - 10,000.00.
Else If MHMOUNIT = 2/Quarterly, then MHMOAMT = $15.00 -
2500.00.
Else If MHMOUNIT = 3/Bimonthly, then MHMOAMT = $10.00 -
1650.00.
Else If MHMOUNIT = 4/PerMonth, then MHMOAMT = $5.00 -
850.00.
Else If MHMOUNIT = 5/PerWeek, then MHMOAMT = $5.00 - 200.00.
Else If MHMOUNIT = 6/Semiannually, then MHMOAMT = $25.00 -
5,000.00.
Else If MHMOUNIT = 7/Semimonthly, then MHMOAMT = $2.00 -
425.00.
Else If MHMOUNIT = 91/Other, then MHMOAMT = $5.00 - 15,000.00.
If not true, display message "THE AMOUNT ENTERED SEEMS
UNLIKELY. PLEASE VERIFY.".
HARD EDIT CHECKS
TECHNICAL NOTES
66
SpouseInHH
9:01:51 AM Tuesday, May 14, 2013
SP has spouse living in the household =
There is a ROST where ROST.ROSTREL=2/Spouse and
ENUM where (ENUM.ENUMROST= ROST.ROSTNUM
and ENUM.ENUMRND=current round and
ENUM.NOTHHRSN = empty).
Page 74 of 346
HIMC12
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
65
MHMOCurrent
SP has a current Medicare Managed Care plan
(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.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
9:01:51 AM Tuesday, May 14, 2013
Page 75 of 346
HIMC12A
HIMC12A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MHMOCOST
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2160
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
Question display:
If SP is deceased or institutionalized, display "Did".
Else display "Does".
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MA PLAN: (CURRENT MEDICARE MANAGED CARE PLAN NAME)
Int. Instr I:
Question Text:
(Does/Did) anyone else, such as an employer, a union or
professional organization pay all or some portion of the additional
cost for [your/(SP’s)] (CURRENT MEDICARE MANAGED CARE
PLAN NAME) coverage?
Int. Instr II:
9:01:52 AM Tuesday, May 14, 2013
Page 76 of 346
HIMC12A
INPUT FIELDS / ROUTING
MHMOCOST
Field1:
Cheshire Name:
( HIQ4360 )
PLRO.MHMOCOST
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HIMC12B - MHMOWHO ( HIQ4370 )
English text: YES
No
BOX HIMC2 - (HIQ4440 )
English text: NO
Attribute
Don't know
Route
BOX HIMC2 - (HIQ4440 )
Refusal
BOX HIMC2 - (HIQ4440 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
9:01:54 AM Tuesday, May 14, 2013
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
Page 77 of 346
HIMC12A
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.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
9:01:54 AM Tuesday, May 14, 2013
Page 78 of 346
HIMC12B
HIMC12B
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MHMOWHO
Field 2:
MHMOWHOS
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
2170
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
Question display:
If SP is deceased or institutionalized, display "paid".
Else display "pays".
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MA PLAN: (CURRENT MEDICARE MANAGED CARE PLAN NAME)
Int. Instr I:
Question Text:
9:01:55 AM Tuesday, May 14, 2013
Who else (pays/paid) all or some portion of the additional cost for
[your/(SP’s)] (CURRENT MEDICARE MANAGED CARE PLAN
NAME) coverage?
Page 79 of 346
HIMC12B
Int. Instr II:
INPUT FIELDS / ROUTING
9:01:57 AM Tuesday, May 14, 2013
Page 80 of 346
HIMC12B
Field1:
MHMOWHO
Cheshire Name:
Item Text display:
( HIQ4370 )
PLRO.MHMOWHO
[(SP's)/(MIP's)]: Display (SP's), SP's name, in response
text for "1/CurrentEmployer", "2/FormerEmployer", and
"3/Union".
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TMhmowho
1
No
No
Number Label
1 CurrentEmployer
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HIMC2 - (HIQ4440 )
2
English text: [(SP's)/(MIP's)] CURRENT EMPLOYER
FormerEmployer
BOX HIMC2 - (HIQ4440 )
3
English text: (SP's/MIP's) FORMER EMPLOYER
Union
BOX HIMC2 - (HIQ4440 )
4
English text: (SP's/MIP's) UNION
SpousesCurrentEmployer
5
English text: SPOUSE'S CURRENT EMPLOYER
SpousesFormerEmployer
BOX HIMC2 - (HIQ4440 )
6
English text: SPOUSE'S FORMER EMPLOYER
ProfessionalOrg
BOX HIMC2 - (HIQ4440 )
7
English text: PROFESSIONAL/FRATERNAL ORGANIZATION
Medicaid
BOX HIMC2 - (HIQ4440 )
91
BOX HIMC2 - (HIQ4440 )
English text: MEDICAID/MEDICAL ASSISTANCE
Other
HIMC12B - MHMOWHOS ( HIQ4380 )
English text: OTHER
Attribute
Don't know
Route
BOX HIMC2 - (HIQ4440 )
Refusal
BOX HIMC2 - (HIQ4440 )
9:02:00 AM Tuesday, May 14, 2013
Page 81 of 346
HIMC12B
Field2:
MHMOWHOS
Cheshire Name:
( HIQ4380 )
PLRO.MHMOWHOS
Item Text display:
Display "(SPECIFY)" in same blue font used for interviewer
instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
30
Route
BOX HIMC2 - (HIQ4440 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
65
MHMOCurrent
SP has a current Medicare Managed Care plan
(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.
9:02:01 AM Tuesday, May 14, 2013
Page 82 of 346
HIMC12B
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
9:02:01 AM Tuesday, May 14, 2013
Page 83 of 346
BOX HIMC2
BOX HIMC2
Page Order # :
2220
BOX INSTRUCTIONS
( HIQ4440 )
IF ADMINISTERING ST, GO TO BOX ST69A - (STQ2825 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS69A - (NSQ2825 ).
ELSE IF ADMINISTERING CPS, GO TO BOX CPS29A - (CPS1710 ).
ELSE IF HIMC1A - MHMOSAME = 1/Yes, GO TO BOX HIMC4 - (HIQ4500 ).
ELSE IF HIMC3 - MHMOCURR = 2/No, DK OR RF, GO TO HIMC17 PLAN_MHMOOTHER ( HIQ4460 ).
ELSE GO TO HIMC16 - MHMOMORE ( HIQ4450 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
If administering ST, NS, CPS, you have completed the Medicare
Managed Care Plan detail questions for the Medicare Managed Care plan
added at the Source of Payment roster. Return to the section being
administered as specified above.
9:02:01 AM Tuesday, May 14, 2013
Page 84 of 346
HIMC16
HIMC16
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MHMOMORE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2230
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP has a "current" Medicare Managed Care plan, then
If SP has a loaded CMS Medicare Managed Care plan that is not
"current", display "(CURRENT MEDICARE MANAGED CARE PLAN
NAME) and (CMS MEDICARE MANAGED CARE PLAN NAME)".
Else if SP had a Medicare Managed Care plan that was "current"
at the time of the previous round interview and is not "current" in the
present round, display "(CURRENT MEDICARE MANAGED CARE
PLAN) and (MEDICARE MANAGED CARE PLAN CURRENT AT
THE TIME OF PREVIOUS ROUND INTERVIEW)".
Else display "(CURRENT MEDICARE MANAGED CARE PLAN)".
Else then
If SP had a loaded CMS MEDICARE MANAGED CARE PLAN,
display "(CMS MEDICARE MANAGED CARE PLAN)".
Else display "(MEDICARE MANAGED CARE PLAN CURRENT
AT THE TIME OF PREVIOUS ROUND INTERVIEW)".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
9:02:02 AM Tuesday, May 14, 2013
Page 85 of 346
HIMC16
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
SHOW CARD HIMC1
Question Text:
[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/ DATE OF INSTITUTIONALIZATION)], [have
you/has (SP)/had (SP)] been covered by any other Medicare
Advantage Plans besides (MEDICARE MANAGED CARE PLAN and
MEDICARE MANAGED CARE PLAN)?
Int. Instr II:
INPUT FIELDS / ROUTING
MHMOMORE
Field1:
Cheshire Name:
( HIQ4450 )
HRND.MHMOMORE
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HIMC17 - PLAN_MHMOOTHER ( HIQ4460 )
English text: YES
No
BOX HIMC4 - (HIQ4500 )
English text: NO
Attribute
Don't know
Route
BOX HIMC4 - (HIQ4500 )
Refusal
BOX HIMC4 - (HIQ4500 )
BACKGROUND VARIABLE ASSIGNMENTS
9:02:03 AM Tuesday, May 14, 2013
Page 86 of 346
HIMC16
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
65
MHMOCurrent
SP has a current Medicare Managed Care plan
(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.
50
LoadedMHMO
Loaded CMS Medicare Managed Care plan (Medicare
Advantage plan) =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.
51
MHMOCurrPrevRnd
Medicare Managed Care plan (Medicare Advantage plan)
"current" at time of previous round interview =
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=previous
round & COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:02:03 AM Tuesday, May 14, 2013
Page 87 of 346
HIMC17
HIMC17
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PLAN_MHMOOTHER
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Name:
Plan Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
Yes
Grid Functions:
Add Line
Delete Line
No
No
2240
Display as ' Add a Plan '
Display as ' Edit a Plan '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP has a "current" Medicare Managed Care plan, then
If SP had a loaded CMS Medicare Managed Care plan that is not
"current", display "Besides (CURRENT MEDICARE MANAGED
CARE PLAN) and (CMS MEDICARE MANAGED CARE PLAN),
what other".
Else if SP had an Medicare Managed Care plan that was "current"
at the time of the previous round interview and is not "current" in the
present round, display "Besides (CURRENT MEDICARE
MANAGED CARE PLAN) and (MEDICARE MANAGED CARE
PLAN CURRENT AT THE TIME OF PREVIOUS ROUND
INTERVIEW), what other".
Else display "Besides (CURRENT MEDICARE MANAGED CARE
PLAN), what other".
Else if SP had a loaded CMS MEDICARE MANAGED CARE PLAN,
display "Besides (CMS MEDICARE MANAGED CARE PLAN),
what".
Else if SP had a Medicare Managed Care plan "current " at the time
of the prevoius round interview, display "Besides (MEDICARE
MANAGED CARE PLAN NAME CURRENT AT THE TIME OF
PREVIOUS ROUND INTERVIEW), what other".
Else display "What".
Multi Field display:
9:02:03 AM Tuesday, May 14, 2013
Page 88 of 346
HIMC17
Roster/Grid Instructions:
Display all health insurance plans from the Plan Roster.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare plan
Medicare Managed Care plan if "current" at the time of the previous
round interview
Medicare Managed Care plan if reported "current" in the current
round.
Medicaid
Tricare
Public Plans
Private Plans
Medicare Prescription Drug Plans
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Plan Name
Display PLAN.PLNAME.
2
Plan Type
Display PLAN.PLANTYPE:
1/Medicare, display "MCAR"
2/Medicaid, display "MCAD"
3/PublicPlan, display "PUBL"
4/PrivatePlan, display "PRIV"
5/MHMO, display "MHMO"
6/Tricare, display "TRIC"
7/MPDP, display "MPDP"
3
Plan Status
Display CURRENT ROUND PLAN
STATUS.
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
[Besides (MEDICARE MANAGED CARE PLAN and MEDICARE
MANAGED CARE PLAN), what other/What] Medicare Advantage
Plans provided [your/(SP’s)] health care since (REFERENCE
DATE)?
Int. Instr II:
SELECT OR ADD MEDICARE ADVANTAGE PLAN NAMES AT
THIS ROSTER.
INPUT FIELDS / ROUTING
9:02:04 AM Tuesday, May 14, 2013
Page 89 of 346
HIMC17
Field1:
Cheshire Name:
PLAN_MHMOOTHER
( HIQ4460 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TPlanPick30
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX HIMC4 - (HIQ4500 )
BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at HIMC17.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HIMC17.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
Plans selected at HIMC17 are Medicare Managed Care plans that the SP was enrolled in
for some time in the current round but are not the SP's current Medicare Managed Care
plan.
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
COVANYTM
Set PLRO.COVANYTM = 1/Yes for all plan selected
at HIMC17.
COVCURNT
Set PLRO.COVCURNT = 2/No for all plan selected
at HIMC17.
9:02:04 AM Tuesday, May 14, 2013
Page 90 of 346
HIMC17
If PLAN added to roster, set
PLAN.PLANTYPE=5/MHMO.
PLANTYPE
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
51
MHMOCurrPrevRnd
Medicare Managed Care plan (Medicare Advantage plan)
"current" at time of previous round interview =
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=previous
round & COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
95
PlanIsCurrent
If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
53
PlanTypes
Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Advantage: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.
65
MHMOCurrent
SP has a current Medicare Managed Care plan
(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.
50
LoadedMHMO
Loaded CMS Medicare Managed Care plan (Medicare
Advantage plan) =
There is a PLAN where PLAN.PLANTYPE=5/MHMO and
PLAN.MHMOLRND = current round.
Plan name = PLAN.PLNAME.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:02:04 AM Tuesday, May 14, 2013
Page 91 of 346
BOX HIMC4
BOX HIMC4
Page Order # :
2270
BOX INSTRUCTIONS
( HIQ4500 )
IF FALL ROUND AND (SP IS ALIVE AND NOT INSTITUTIONALIZED) AND
(SP HAS A MEDICARE MANAGED CARE PLAN THAT IS "CURRENT"), GO
TO HIMC19 - RECMHMO ( HIQ4510 ).
ELSE GO TO BOX HI1 - (HIQ4670 ).
.
ASSIGNMENTS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
65
MHMOCurrent
SP has a current Medicare Managed Care plan
(Medicare Advantage plan) =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:02:04 AM Tuesday, May 14, 2013
Page 92 of 346
HIMC19
HIMC19
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
RECMHMO
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2280
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
Question display:
Display the name of the "current" Medicare Managed Care Plan,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MA PLAN: (CURRENT MEDICARE MANAGED CARE PLAN
NAME)
Int. Instr I:
Question Text:
Would you recommend (CURRENT MEDICARE MANAGED CARE
PLAN NAME) to your family or friends?
Int. Instr II:
INPUT FIELDS / ROUTING
9:02:05 AM Tuesday, May 14, 2013
Page 93 of 346
HIMC19
Field1:
( HIQ4510 )
RECMHMO
Cheshire Name:
ACCS.RECMHMO
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HIMC5 - (HIQ4640 )
English text: YES
No
BOX HIMC5 - (HIQ4640 )
English text: NO
Attribute
Route
Don't know
BOX HIMC5 - (HIQ4640 )
Refusal
BOX HIMC5 - (HIQ4640 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
9:02:06 AM Tuesday, May 14, 2013
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 94 of 346
HIMC19
65
MHMOCurrent
SP has a current Medicare Managed Care plan
(Medicare Advantage plan) =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:02:06 AM Tuesday, May 14, 2013
Page 95 of 346
BOX HIMC5
BOX HIMC5
Page Order # :
2340
BOX INSTRUCTIONS
( HIQ4640 )
IF (SP HAS A MEDICARE MANAGED CARE PLAN THAT IS "CURRENT")
AND (THE NUMBER OF YEARS THE SP WAS COVERED BY A MANAGED
CARE PLAN HAS NEVER BEEN COLLECTED), GO TO HIMC24
HMONUMYR ( HIQ4660 ).
ELSE GO TO BOX HI1 - (HIQ4670 ).
ASSIGNMENTS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
65
MHMOCurrent
SP has a current Medicare Managed Care plan
(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.
87
HIMC24NeverAsked
The number of years the SP was covered by a managed
care plan has never been collected =
BASE.HIMC24FL ^= 1/Yes.
DESIGN NOTES
9:02:06 AM Tuesday, May 14, 2013
Page 96 of 346
HIMC24
HIMC24
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
HMONUMYR
Field 2:
HMONUM96
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
2360
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
How many years [have you/has (SP)] been enrolled in a managed
care plan?
Int. Instr II:
INPUT FIELDS / ROUTING
9:02:07 AM Tuesday, May 14, 2013
Page 97 of 346
HIMC24
Field1:
HMONUMYR
Cheshire Name:
( HIQ4660 )
ACCS.HMONUMYR
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF YEARS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THnumyr
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Empty
HIMC24 - HMONUM96 ( HIQ4662 )
Don't know
HIMC24 - HMONUM96 ( HIQ4662 )
Refusal
HIMC24 - HMONUM96 ( HIQ4662 )
9:02:10 AM Tuesday, May 14, 2013
FieldSize:
Min Value:
Max Value:
Mask:
1
96
Route
HIMC24 - HMONUM96 ( HIQ4662 )
Page 98 of 346
HIMC24
Field2:
HMONUM96
Cheshire Name:
( HIQ4662 )
NONE
If HMONUM96 = 1/LessThanYear, set Cheshire field
ACCS.HMONUMYR = 96 during data transformation.
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THMONum96
1
No
No
Number Label
1 LessThanYear
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HI1 - (HIQ4670 )
English text: LESS THAN ONE YEAR
Attribute
Route
Empty
BOX HI1 - (HIQ4670 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1
If HMONUMYR ^= EMPTY then HMONUMYR = 1-25.
If not true, display message "UNLIKELY NUMBER OF YEARS.
PLEASE VERIFY."
HARD EDIT CHECKS
Edit #1
HMONUMYR and HMONUM96 cannot both be EMPTY.
If not true, display message "ENTRY REQUIRED. PLEASE ENTER
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
Edit #2
HMONUMYR and HMONUM96 cannot both be FILLED.
If not true, display message "INVALID ENTRY. PLEASE ENTER
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
TECHNICAL NOTES
9:02:11 AM Tuesday, May 14, 2013
Page 99 of 346
HIMC24
DESIGN NOTES
9:02:11 AM Tuesday, May 14, 2013
Page 100 of 346
BOX HI1
BOX HI1
Page Order # :
2370
BOX INSTRUCTIONS
( HIQ4670 )
IF A MEDICAID PLAN WAS "CURRENT" AT THE TIME OF THE PREVIOUS
ROUND INTERVIEW, GO TO HI6 - COVTIME ( HIQ4770 ).
ELSE GO TO HI5INTRO - MCAIDINT ( HIQ4721 ).
ASSIGNMENTS
If Medicaid was current at the time of the previous round interview, then the SP was also
covered by Medicaid for some time during the current round.
If Medicaid was current at the time of the previous round interview, current round plan
details will be collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of Medicaid plan.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of Medicaid plan.
PLRO.PLRORND = current round.
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below.
PLROPLAN
PLRO.PLROPLAN = PLAN.PLANNUM of Medicaid
Plan current at time of previous round.
PLRORND
PLRO.PLRORND = current round.
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
67
MedicaidCurrentPrevRn
d
Medicaid "current" at the time of the previous round
interview =
There is a PLAN where PLAN.PLANTYPE=2/Medicaid
and PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=previous round & (COVTIME=1/WholeTime
or COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:02:11 AM Tuesday, May 14, 2013
Page 101 of 346
HI5INTRO
HI5INTRO
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
MCAIDINT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2420
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
If the Medicaid program is known by a name other than "Medicaid" in
the state where the SP currently lives, display SP’s state name for
Medicaid in the context header.
If there is more than one name, separate them by commas and
insert "or" as appropriate (e.g., NAME1, NAME2, or NAME3).
Else do not display.
A list of Medicaid Program names is shown in Attachment HI1 of the
general specifications.
Question display:
Display first instance of "Medicaid" in BOLD.
If the Medicaid program is known by a name other than "Medicaid"
in the state where SP currently lives, display ", also known as
[READ FROM ABOVE],".
Else do not display.
A list of Medicaid Program names is shown in Attachment HI1 of the
General Specs.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
9:02:11 AM Tuesday, May 14, 2013
Page 102 of 346
HI5INTRO
TEXT:
[MEDICAID PROGRAM NAME(S)]
Context Header:
Int. Instr I:
SHOW CARD HI3
PLEASE READ THIS INTRODUCTION SLOWLY AND CLEARLY:
Medicaid (, also known as [READ FROM ABOVE],) is a state
program for low income persons or for persons on public
assistance. Sometimes persons with very large medical bills are
also covered by Medicaid. People covered by Medicaid usually have
a card that looks like this.
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
MCAIDINT
Field1:
Cheshire Name:
( HIQ4721 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HI1B - (HIQ4730 )
English text: CONTINUE
Attribute
Route
Empty
BOX HI1B - (HIQ4730 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
9:02:13 AM Tuesday, May 14, 2013
Page 103 of 346
HI5INTRO
TECHNICAL NOTES
DESIGN NOTES
9:02:13 AM Tuesday, May 14, 2013
Page 104 of 346
BOX HI1B
BOX HI1B
Page Order # :
2430
BOX INSTRUCTIONS
( HIQ4730 )
IF STATE IN WHICH SP LIVES DOES NOT OFFER A MEDICAID MANAGED
CARE PLAN, GO TO HI5 - AIDCOVER ( HIQ4750 ).
ELSE GO TO HI5INTRB - MCAIDINTB ( HIQ4741 ).
ASSIGNMENTS
TECHNICAL NOTES
68
StateNoMedicaidHMO
SP's state does not offer Medicaid Managed Care plan =
SP's most recent ADDR where ADDR.ADDRNUM="01"
has ADDR.STATE = AK, AL, AR, IA, LA, ME, MS, MT,
NC, ND, NH, SD, VT, or WY.
DESIGN NOTES
9:02:13 AM Tuesday, May 14, 2013
Page 105 of 346
HI5INTRB
HI5INTRB
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
MCAIDINTB
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2440
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD HI4
Question Text:
Some people receive their Medicaid benefits from plans that have
names like those listed on this card.
Int. Instr II:
INPUT FIELDS / ROUTING
9:02:13 AM Tuesday, May 14, 2013
Page 106 of 346
HI5INTRB
Field1:
MCAIDINTB
Cheshire Name:
( HIQ4741 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI5 - AIDCOVER ( HIQ4750 )
English text: CONTINUE
Attribute
Route
Empty
HI5 - AIDCOVER ( HIQ4750 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
9:02:14 AM Tuesday, May 14, 2013
Page 107 of 346
HI5
HI5
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
AIDCOVER
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2450
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is deceased or institutionalized, display "was (SP)".
Else display "[have you/has (SP)] been".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERERNCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
At any time [since (REFERENCE DATE)/between (REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], [have you/has (SP) been/was (SP)]
covered by Medicaid?
Int. Instr II:
INPUT FIELDS / ROUTING
9:02:15 AM Tuesday, May 14, 2013
Page 108 of 346
HI5
Field1:
AIDCOVER
Cheshire Name:
( HIQ4750 )
HRND.AIDCOVER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI6 - COVTIME ( HIQ4770 )
English text: YES
No
BOX HIT1 - (HIQ5310 )
English text: NO
Attribute
Route
Don't know
BOX HIT1 - (HIQ5310 )
Refusal
BOX HIT1 - (HIQ5310 )
BACKGROUND VARIABLE ASSIGNMENTS
HI5 is asking if SP was covered by Medicaid anytime since the previous round interview
date.
If AIDCOVER=1/Yes, then
If there is a PLAN where PLAN.PLANTYPE=2/Medicaid, regardless if
PLAN.PLANDFLG=1/Yes, LOSEPLFG ^= empty, or PLAN.PLANSFLG=1/Yes, this
stopped Medicaid plan will be restarted. See detailed instructions below.
Else if there is no PLAN where PLAN.PLANTYPE=2/Medicaid, create a new PLAN
where PLAN.PLANNUM equals the next sequential plan number.
PLAN KEY= PLAN.PLANBASE + PLAN.PLANNUM.
To set current round status of this plan, create a current round PLRO where
PLRO.PLROPLAN = this PLAN.PLANNUM.
PLRO KEY = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
See detailed instructions below:
9:02:16 AM Tuesday, May 14, 2013
Page 109 of 346
HI5
PLANNUM
If creating new plan, set PLAN.PLANNUM = highest
PLAN.PLANNUM + 01.
PLANRNDC
If creating new plan, set PLAN.PLANRNDC = current
round.
PLANTYPE
If creating a new plan, set PLAN.PLANTYPE =
2/Medicaid.
PLNAME
If creating a new plan, set PLAN.PLNAME =
"MEDICAID".
PLANDFLG
If restarting an existing Medicaid plan and
PLAN.PLANDFLG=1/Yes, update PLAN.PLANDFLG
= empty (-1).
LOSEPLFG
If restarting an existing Medicaid plan and
PLAN.LOSEPLFG ^= empty (-1), update
PLAN.LOSEPLFG = empty (-1).
PLROPLAN
PLRO.PLROPLAN = this PLAN.PLANNUM.
PLRORND
PLRO.PLRORND=current round.
PLANSFLG
If restarting an existing Medicaid plan and
PLAN.PLANSFLG=1/Yes, update PLAN.PLANSFLG
= empty.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
9:02:16 AM Tuesday, May 14, 2013
Page 110 of 346
HI6
HI6
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
COVTIME
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2470
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
If Medicaid plan was "current" at the time of the previous round
interview and the Medicaid program is known by a name other than
"Medicaid" in the state where the SP currently lives, display context
header. Display SP's state name for Medicaid. If there is more than
one name, separate them by commas and insert "or" as appropriate
(e.g., NAME1, NAME2, or NAME3).
Else do not display.
A list of Medicaid Program names is shown in Attachment HI1 in the
general specifications.
Question display:
If Medicaid plan was "current" at the time of the previous round
interview then
Display first sentence "At the time of the last interview [you
were/(SP) was] covered by Medicaid".
If the Medicaid program is known by a name other than
"Medicaid" in the state where SP currently lives, display ",also
known as [READ FROM ABOVE]".
Else do not display.
Else do not display first sentence.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
9:02:17 AM Tuesday, May 14, 2013
Page 111 of 346
HI6
Report display:
TEXT:
[MEDICAID PROGRAM NAME]
REFERERNCE DATE: (REFERENCE DATE)
Context Header:
Int. Instr I:
(At the time of the last interview [you were/(SP) was] covered by
Medicaid, (also known as [READ FROM ABOVE].) [Were you/Was
(SP)] covered by Medicaid the whole time between (REFERENCE
DATE) and (today/DATE OF DEATH/DATE OF
INSTITUTIONALIZATION), or only part of the time?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
COVTIME
Field1:
Cheshire Name:
( HIQ4770 )
PLRO.COVTIME
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TCovtime
1
No
No
Number Label
1 WholeTime
2
English text: THE WHOLE TIME
PartOfTime
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI10A - MCAIDHMO ( HIQ4885 )
HI7 - COVNOW ( HIQ4790 )
English text: PART OF THE TIME
Attribute
Don't know
Route
HI7 - COVNOW ( HIQ4790 )
Refusal
HI7 - COVNOW ( HIQ4790 )
BACKGROUND VARIABLE ASSIGNMENTS
9:02:18 AM Tuesday, May 14, 2013
Page 112 of 346
HI6
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
67
MedicaidCurrentPrevRn
d
Medicaid "current" at the time of the previous round
interview =
There is a PLAN where PLAN.PLANTYPE=2/Medicaid
and PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=previous round & (COVTIME=1/WholeTime
or COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
HI6 is called from ST, NS, CPS when a Medicaid plan is added at the
Source of Payment roster.
9:02:18 AM Tuesday, May 14, 2013
Page 113 of 346
HI7
HI7
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
COVNOW
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2490
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is deceased or intitutionalized, display second sentence: "Was
SP covered by...".
Else display first sentence: "[Are you/Is (SP)) now...".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[Are you/Is (SP)] now covered by Medicaid?] [Was (SP) covered by
Medicaid on (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)?]
Int. Instr II:
INPUT FIELDS / ROUTING
9:02:19 AM Tuesday, May 14, 2013
Page 114 of 346
HI7
Field1:
( HIQ4790 )
COVNOW
Cheshire Name:
PLRO.COVNOW
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HI4 - (HIQ4800 )
English text: YES
No
HI9 - COVENDMM ( HIQ4860 )
English text: NO
Attribute
Route
Don't know
HI10A - MCAIDHMO ( HIQ4885 )
Refusal
HI10A - MCAIDHMO ( HIQ4885 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
9:02:20 AM Tuesday, May 14, 2013
Page 115 of 346
HI7
MRES.SPALIVE=3/Deceased.
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
9:02:20 AM Tuesday, May 14, 2013
Page 116 of 346
BOX HI4
BOX HI4
Page Order # :
2500
BOX INSTRUCTIONS
( HIQ4800 )
IF THIS MEDICAID PLAN WAS "CURRENT" AT THE TIME OF THE
PREVIOUS ROUND INTERVIEW, GO TO HI10A - MCAIDHMO ( HIQ4885 ).
ELSE GO TO HI8 - COVBEGMM ( HIQ4810 ).
ASSIGNMENTS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
63
ThisPlanCurrentPrevRn
d
This Plan was "current" at the time of the previous round
interview =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:02:20 AM Tuesday, May 14, 2013
Page 117 of 346
HI8
HI8
Page Order # :
Design Screen Type:
Date
Fields:
Field 1:
COVBEGMM
Field 2:
COVBEGDD
Field 3:
COVBEGYY
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
2510
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERERNCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
On what date did [your/(SP’s)] Medicaid start between
(REFERENCE DATE) and (today/DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)?
Int. Instr II:
INPUT FIELDS / ROUTING
9:02:22 AM Tuesday, May 14, 2013
Page 118 of 346
HI8
Field1:
COVBEGMM
Cheshire Name:
( HIQ4810 )
PLRO.COVBEGMM
Item Text display:
Item Text:
Label:
Label Position:
MM
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMonthInt
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
HI8 - COVBEGDD ( HIQ4820 )
Refusal
HI8 - COVBEGDD ( HIQ4820 )
9:02:24 AM Tuesday, May 14, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
01
12
Route
HI8 - COVBEGDD ( HIQ4820 )
Page 119 of 346
HI8
Field2:
COVBEGDD
Cheshire Name:
( HIQ4820 )
PLRO.COVBEGDD
Item Text display:
Item Text:
Label:
Label Position:
DD
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDayDKRF
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
HI8 - COVBEGYY ( HIQ4830 )
Refusal
HI8 - COVBEGYY ( HIQ4830 )
9:02:26 AM Tuesday, May 14, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
1
31
Route
HI8 - COVBEGYY ( HIQ4830 )
Page 120 of 346
HI8
Field3:
( HIQ4830 )
COVBEGYY
Cheshire Name:
PLRO.COVBEGYY
Item Text display:
Item Text:
Label:
Label Position:
YY
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMcyear
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
0
99
Route
HI10A - MCAIDHMO ( HIQ4885 )
Attribute
Route
Don't know
HI10A - MCAIDHMO ( HIQ4885 )
Refusal
HI10A - MCAIDHMO ( HIQ4885 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
PLAN BEGIN DATE, COVBEGMM/COVBEGDD/COVBEGYY,
should be on or between (REFERENCE DATE) and (REFERENCE
PERIOD END DATE).
If not true, display message: "DATE MUST BE ON OR BETWEEN
(REFERENCE DATE) AND (REFERENCE PERIOD END DATE).
PLEASE REENTER.".
TECHNICAL NOTES
114
CoverageStartDate
Health Insurance Plan coverage start date =
PLRO.COVBEGMM / PLRO.COVBEGDD /
PLRO.COVBEGYY.
Check PLRO where PLRO.PLROPLAN =
PLAN.PLANNUM and PLRO.PLRORND = round #
checking.
DESIGN NOTES
9:02:27 AM Tuesday, May 14, 2013
Page 121 of 346
HI8
9:02:27 AM Tuesday, May 14, 2013
Page 122 of 346
HI9
HI9
Page Order # :
Design Screen Type:
Date
Fields:
Field 1:
COVENDMM
Field 2:
COVENDDD
Field 3:
COVENDYY
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
2540
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is deceased or institutionalized, display "between (PREVIOUS
ROUND INTERVIEW DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)" and "last".
Else display "since (REFERENCE DATE)" and "most recently".
Multi Field display:
Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
SUMMARY REFERENCE PERIOD: (SUMMARY REFERENCE
DATE) - (REFERENCE DATE)
Int. Instr I:
Question Text:
9:02:28 AM Tuesday, May 14, 2013
On what date [since (REFERENCE DATE)/between (REFERENCE
DATE) and (DATE OF DEATH/
DATE OF INSTITUTIONALIZATION)], did [your/(SP’s)] Medicaid
coverage (most recently/last) stop?
Page 123 of 346
HI9
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
COVENDMM
Cheshire Name:
( HIQ4860 )
PLRO.COVENDMM
Item Text display:
Item Text:
Label:
Label Position:
MM
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMonthInt
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
HI9 - COVENDDD ( HIQ4870 )
Refusal
HI9 - COVENDDD ( HIQ4870 )
9:02:31 AM Tuesday, May 14, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
01
12
Route
HI9 - COVENDDD ( HIQ4870 )
Page 124 of 346
HI9
Field2:
COVENDDD
Cheshire Name:
( HIQ4870 )
PLRO.COVENDDD
Item Text display:
Item Text:
Label:
Label Position:
DD
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDayDKRF
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
HI9 - COVENDYY ( HIQ4880 )
Refusal
HI9 - COVENDYY ( HIQ4880 )
9:02:33 AM Tuesday, May 14, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
1
31
Route
HI9 - COVENDYY ( HIQ4880 )
Page 125 of 346
HI9
Field3:
( HIQ4880 )
COVENDYY
Cheshire Name:
PLRO.COVENDYY
Item Text display:
Item Text:
Label:
Label Position:
YY
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMcyear
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
0
99
Route
HI10A - MCAIDHMO ( HIQ4885 )
Attribute
Route
Don't know
HI10A - MCAIDHMO ( HIQ4885 )
Refusal
HI10A - MCAIDHMO ( HIQ4885 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
PLAN END DATE, COVENDMM/COVENDDD/COVENDYY, should
be on or betwee (REFERENCE DATE) and (REFERENCE PERIOD
END DATE).
If not true, display error message "DATE MUST BE ON OR
BETWEEN (REFERENCE DATE) AND (REFERENCE PERIOD
END DATE). PLEASE REENTER.".
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
9:02:34 AM Tuesday, May 14, 2013
Page 126 of 346
HI9
SP is Deceased =
MRES.SPALIVE=3/Deceased.
115
CoverageStopDate
Health Insurance Plan coverage stop date =
PLRO.COVENDMM / PLRO.COVENDDD /
PLRO.COVENDYY.
Check PLRO where PLRO.PLROPLAN =
PLAN.PLANNUM and PLRO.PLRORND = round #
checking.
DESIGN NOTES
9:02:34 AM Tuesday, May 14, 2013
Page 127 of 346
HI10A
HI10A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MCAIDHMO
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2580
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If this Medicaid plan was "current" at the time of the previous round
interview and SP reported this Medicaid plan was a Medicaid
Managed Care plan in the previous round, display sentence "At the
time of the last interview…".
Else display sentence "Some states now use managed care
plans…" and display "(Health Maintenance Organizations)".
If (this Medicaid plan is "current") and (SP is alive and not
institutionalized), display "[Are you now/Is (SP) now]".
Else display "[Were you/Was (SP)]".
If SP is deceased, display "as of (DATE OF DEATH)".
Else if SP is institutionalized, display "as of (DATE OF
INSTITUTIONALIZATION)".
Else if this Medicaid plan is not "current" and the plan coverage stop
date does not = DK or RF, display "as of (MEDICAID COVERAGE
STOP DATE)".
Else if this Medicaid plan is not "current" and the plan coverage stop
date = DK or RF, display "as of the date [your/(SP’s)] Medicaid
coverage stopped".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
9:02:35 AM Tuesday, May 14, 2013
Page 128 of 346
HI10A
Report display:
TEXT:
Context Header:
Int. Instr I:
[Some states now use managed care plans, such as HMOs (Health
Maintenance Organizations), to provide some or all health care for
Medicaid beneficiaries.] [At the time of the last interview [you
were/(SP) was] enrolled in a Medicaid Managed Care Plan.] [Are
you now/Is (SP) now/Were you/Was (SP)] enrolled in a Medicaid
Managed Care Plan [as of (DATE OF DEATH)/(DATE OF
INSTITUTIONALIZATION)/(MEDICAID COVERAGE STOP
DATE)/the date [your/(SP’s)] Medicaid coverage stopped]?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
MCAIDHMO
Cheshire Name:
( HIQ4885 )
PLRO.MCAIDHMO
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HI5D - (HIQ5050 )
English text: YES
No
BOX HI5D - (HIQ5050 )
English text: NO
Attribute
Route
Don't know
BOX HI5D - (HIQ5050 )
Refusal
BOX HI5D - (HIQ5050 )
BACKGROUND VARIABLE ASSIGNMENTS
9:02:36 AM Tuesday, May 14, 2013
Page 129 of 346
HI10A
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
71
ThisPlanCurrent
This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
69
ThisPlanMedicaidHMO
SP reported this Medicaid plan was a Medicaid Managed
Care plan in previous round =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.MCAIDHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
115
CoverageStopDate
Health Insurance Plan coverage stop date =
PLRO.COVENDMM / PLRO.COVENDDD /
PLRO.COVENDYY.
Check PLRO where PLRO.PLROPLAN =
PLAN.PLANNUM and PLRO.PLRORND = round #
checking.
63
ThisPlanCurrentPrevRn
d
This Plan was "current" at the time of the previous round
interview =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
9:02:36 AM Tuesday, May 14, 2013
Page 130 of 346
BOX HI5D
BOX HI5D
Page Order # :
2630
BOX INSTRUCTIONS
( HIQ5050 )
IF ((ADMINISTERING ST, NS OR CPS) AND SP WAS COVERED BY A
MEDICARE PRESCRIPTION DRUG PLAN ANYTIME DURING THE
CURRENT ROUND) OR (ADMINSTERING HI AND THERE WAS A
MEDICARE PRESCRIPTION DRUG PLAN THAT WAS "CURRENT" AT THE
TIME OF THE PREVIOUS ROUND INTERVIEW), GO TO BOX HIT1
(HIQ5310 ).
ELSE IF (ADMINISTERING ST, NS OR CPS) AND SP WAS NOT COVERED
BY A MEDICARE PRESCRIPTION DRUG PLAN ANYTIME DURING THE
CURRENT ROUND, GO TO HI10D - MCDRXCOV ( HIQ5060 ).
ELSE GO TO HI10C1 - MPDCOVER ( HIQ5051 ).
ASSIGNMENTS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
351
MPDPAnytimeCurrRnd
SP covered by an MPDP plan anytime during current
round =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
343
MPDPCurrPrevRnd
Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes). Exclude Deleted Plans. See
T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:02:36 AM Tuesday, May 14, 2013
Page 131 of 346
HI10C1
HI10C1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MPDCOVER
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2635
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If no Medicare Prescription Drug plan ever reported in any round,
display "Some people who receive Medicaid...".
Else do not display.
If SP is deceased or institutionalized, display "covered".
Else display "covers".
If SP is deceased or institutionalized, display "was (SP)".
Else if SP is respondent, display "have you been".
Else display "has (SP) been".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
9:02:37 AM Tuesday, May 14, 2013
(Some people who receive Medicaid benefits are also enrolled in a
Medicare Prescription Drug plan, or Medicare Part D plan, that pays
Page 132 of 346
HI10C1
for some or all of their prescribed medicines. The Medicare program
automatically enrolls such beneficiaries into a Medicare Prescription
Drug plan, although the beneficiary may choose to switch to a
different prescription plan.)
At any time [since (REFERENCE DATE)/between (REFERENCE
DATE) AND (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], [have you been/has (SP) been/was
(SP)] enrolled in a Medicare Prescription Drug plan that
(covers/covered) medicines prescribed by a doctor?
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
MPDCOVER
Cheshire Name:
( HIQ5051 )
HRND.MPDCOVER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI10C2 - PDPCURR ( HIQ5052 )
English text: YES
No
HI10D - MCDRXCOV ( HIQ5060 )
English text: NO
Attribute
Route
Don't know
HI10D - MCDRXCOV ( HIQ5060 )
Refusal
HI10D - MCDRXCOV ( HIQ5060 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
9:02:38 AM Tuesday, May 14, 2013
Page 133 of 346
HI10C1
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
341
NeverMedicarePresDru
gPlan
No Medicare Prescription Drug plan ever reported in any
round =
There is no PLAN where PLAN.PLANTYPE = 7/MPDP.
Exclude Deleted Plans. See T.N. 52.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
9:02:38 AM Tuesday, May 14, 2013
Page 134 of 346
HI10C2
HI10C2
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PDPCURR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2645
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is alive and not institutionalized, display "currently".
Else do not display.
If SP is deceased, display "on (DATE OF DEATH)".
Else if SP is institutionalized, display "on (DATE OF
INSTITUTIONALIZATION)".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Are you/Is (SP)/Was (SP)] (currently) covered by or enrolled in a
Medicare Prescription Drug plan [on (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]?
Int. Instr II:
9:02:39 AM Tuesday, May 14, 2013
Page 135 of 346
HI10C2
INPUT FIELDS / ROUTING
( HIQ5052 )
PDPCURR
Field1:
Cheshire Name:
HRND.PDPCURR
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI10C3 - PLAN_CAIDMPDP ( HIQ5053 )
English text: YES
No
HI10C5 - PLAN_CAIDMPDPOTHR ( HIQ5056 )
English text: NO
Attribute
Don't know
Route
HI10C5 - PLAN_CAIDMPDPOTHR ( HIQ5056 )
Refusal
HI10C5 - PLAN_CAIDMPDPOTHR ( HIQ5056 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
9:02:40 AM Tuesday, May 14, 2013
Page 136 of 346
HI10C2
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
9:02:40 AM Tuesday, May 14, 2013
Page 137 of 346
HI10C3
HI10C3
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PLAN_CAIDMPDP
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Name:
Plan Roster
Roster Type:
Single Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
2655
Display as ' Add a Plan '
Display as ' Edit a Plan '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display brackets around question text.
If SP is deceased, display "on (DATE OF DEATH)".
Else if SP is institutionalized, display "on (DATE OF
INSTITUTIONALIZATION)" .
Else do not display.
If SP is deceased or institutionalized, display "covered".
Else display "covers".
Multi Field display:
Roster/Grid Instructions:
Display all health insurance plans from the Plan Roster.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare plan
Medicare Managed Care Plans
Medicaid
Tricare
Public Plans
Private Plans
Medicare Prescription Drug plan if "current" at the time of the
previous round interview
Roster/Grid display:
COL #
1
9:02:41 AM Tuesday, May 14, 2013
HEADER
Plan Name
INSTRUCTIONS
Display PLAN.PLNAME.
Page 138 of 346
HI10C3
2
Plan Type
Display PLAN.PLANTYPE:
1/Medicare, display "MCAR"
2/Medicaid, display "MCAD"
3/PublicPlan, display "PUBL"
4/PrivatePlan, display "PRIV"
5/MHMO, display "MHMO"
6/Tricare, display "TRIC"
7/MPDP, display "MPDP"
3
Plan Status
Display CURRENT ROUND PLAN
STATUS.
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[What is the name of the Medicare Prescription Drug plan that
(currently covers/covered) [you/(SP)] [on (DATE OF DEATH)/(DATE
OF INSTITUTIONALIZATION)]?]
Int. Instr II:
SELECT OR ADD ONLY ONE MEDICARE PRESCRIPTION DRUG
PLAN AT THIS ROSTER.
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
PLAN_CAIDMPDP
( HIQ5053 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TPlanPick32
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
32
Route
HI10C4 - PDPMORE ( HIQ5055 )
BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
9:02:41 AM Tuesday, May 14, 2013
Page 139 of 346
HI10C3
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at HI10C3.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HI10C3.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
The plan selected at HI10C3 is the SP's current Medicare Prescription Drug plan for the
current round.
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
COVANYTM
Set PLRO.COVANYTM=1/Yes for plan selected at
HI10C3.
COVCURNT
Set PLRO.COVCURNT=1/Yes for plan selected at
HI10C3.
PLANTYPE
If PLAN added to roster, set
PLAN.PLANTYPE=7/MPDP.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
95
PlanIsCurrent
If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
342
MPDPCurrent
SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
9:02:41 AM Tuesday, May 14, 2013
Page 140 of 346
HI10C3
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
53
PlanTypes
Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Advantage: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.
343
MPDPCurrPrevRnd
Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes). Exclude Deleted Plans. See
T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:02:42 AM Tuesday, May 14, 2013
Page 141 of 346
HI10C4
HI10C4
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PDPMORE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2665
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Question display:
If SP is deceased or institutionalized, display "had (SP)".
Else display "[have you/has (SP)]".
Display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE)
MPDP: (CURRENT MEDICARE PRESCRIPTION DRUG PLAN)
Int. Instr I:
Question Text:
9:02:42 AM Tuesday, May 14, 2013
[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/INSTITUTIONALIZATION)], [have you/has
(SP)/had (SP)] been covered by any other Medicare Prescription
Drug plans besides (CURRENT MEDICARE PRESCRIPTION DRUG
PLAN)?
Page 142 of 346
HI10C4
[PROBE IF NECESSARY: Please include Medicare Prescription
Drug plans [you were/(SP) was] automatically enrolled in through
Medicaid as well as any (you/he/she) enrolled in on (your/his/her)
own.]
Int. Instr II:
INPUT FIELDS / ROUTING
PDPMORE
Field1:
Cheshire Name:
( HIQ5055 )
HRND.PDPMORE
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI10C5 - PLAN_CAIDMPDPOTHR ( HIQ5056 )
English text: YES
No
BOX HIT1 - (HIQ5310 )
English text: NO
Attribute
Don't know
Route
BOX HIT1 - (HIQ5310 )
Refusal
BOX HIT1 - (HIQ5310 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9:02:43 AM Tuesday, May 14, 2013
Page 143 of 346
HI10C4
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
342
MPDPCurrent
SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
DESIGN NOTES
9:02:43 AM Tuesday, May 14, 2013
Page 144 of 346
HI10C5
HI10C5
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PLAN_CAIDMPDPOTH
R
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Plan Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
Yes
Grid Functions:
Add Line
Delete Line
No
No
2675
Display as ' Add a Plan '
Display as ' Edit a Plan '
DISPLAY INSTRUCTIONS:
Context header display:
If SP has a "current" Medicare Prescription Drug plan, then display
"besides (CURRENT MEDICARE PRESCRIPTION DRUG PLAN)"
and the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else do not display.
Question display:
If SP has a "current" Medicare Prescription Drug plan, then display
"the other".
Else display "all".
If SP has a "current" Medicare Prescription Drug plan, then display
"besides (CURRENT MEDICARE PRESCRIPTION DRUG PLAN)"
and the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Display all health insurance plans from the Plan Roster.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare plan
Medicare Managed Care Plans
Medicaid
Tricare
Public Plans
9:02:44 AM Tuesday, May 14, 2013
Page 145 of 346
HI10C5
Private Plans
Medicare Prescription Drug plan if "current" at the time of the
previous round interview
Medicare Prescription Drug plan if "current" in the current round
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Plan Name
Display PLAN.PLNAME.
2
Plan Type
Display PLAN.PLANTYPE:
1/Medicare, display "MCAR"
2/Medicaid, display "MCAD"
3/PublicPlan, display "PUBL"
4/PrivatePlan, display "PRIV"
5/MHMO, display "MHMO"
6/Tricare, display "TRIC"
7/MPDP, display "MPDP"
3
Plan Status
Display CURRENT ROUND PLAN
STATUS.
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE)
MPDP: (CURRENT MEDICARE PRESCRIPTION DRUG PLAN)
Int. Instr I:
Question Text:
Please tell me the names of (the other/all) Medicare Prescription
Drug plans that (you have/he has/she has) been enrolled in since
(REFERENCE DATE) [besides (CURRENT MEDICARE
PRESCRIPTION DRUG PLAN)].
[PROBE IF NECESSARY: Please include Medicare Prescription
Drug plans [you were/(SP) was] automatically enrolled in through
Medicaid as well as any (you/he/she) enrolled in on (your/his/her)
own.]
Int. Instr II:
SELECT OR ADD MEDICARE PRESCRIPTION DRUG PLAN
NAMES AT THIS ROSTER.
INPUT FIELDS / ROUTING
9:02:44 AM Tuesday, May 14, 2013
Page 146 of 346
HI10C5
Field1:
Cheshire Name:
PLAN_CAIDMPDPOTH ( HIQ5056 )
R
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TPlanPick30
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX HIT1 - (HIQ5310 )
BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at HI10C5.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HI10C5.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
Plans selected at HI10C5 are Medicare Prescription Drug plans that the SP was enrolled in
for some time in the current round but are not the SP's current Medicare Prescription Drug
plan.
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
COVANYTM
9:02:45 AM Tuesday, May 14, 2013
Set PLRO.COVANYTM = 1/Yes for all plan selected
at HI10C5.
Page 147 of 346
HI10C5
COVCURNT
Set PLRO.COVCURNT = 2/No for all plan selected
at HI10C5.
PLANTYPE
If PLAN added to roster, set
PLAN.PLANTYPE=7/MPDP.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
343
MPDPCurrPrevRnd
Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes). Exclude Deleted Plans. See
T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
95
PlanIsCurrent
If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
53
PlanTypes
Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Advantage: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.
342
MPDPCurrent
SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:02:45 AM Tuesday, May 14, 2013
Page 148 of 346
HI10D
HI10D
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MCDRXCOV
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2685
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If (this Medicaid plan is not "current") or (SP is deceased or
institutionalized), display "Did".
Else display "Does".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
(Does/Did) [your/(SP’s)] Medicaid plan cover medicines prescribed
by a doctor?
Int. Instr II:
INPUT FIELDS / ROUTING
9:02:45 AM Tuesday, May 14, 2013
Page 149 of 346
HI10D
Field1:
MCDRXCOV
Cheshire Name:
( HIQ5060 )
PLRO.MCDRXCOV
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HIT1 - (HIQ5310 )
English text: YES
No
BOX HIT1 - (HIQ5310 )
English text: NO
Attribute
Route
Don't know
BOX HIT1 - (HIQ5310 )
Refusal
BOX HIT1 - (HIQ5310 )
BACKGROUND VARIABLE ASSIGNMENTS
HI10D is a plan detail for the SP's Medicaid plan.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
9:02:47 AM Tuesday, May 14, 2013
Page 150 of 346
HI10D
SP is Deceased =
MRES.SPALIVE=3/Deceased.
71
ThisPlanCurrent
This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:02:47 AM Tuesday, May 14, 2013
Page 151 of 346
BOX HIT1
BOX HIT1
9:02:47 AM Tuesday, May 14, 2013
Page Order # :
2790
Page 152 of 346
BOX HIT1
BOX INSTRUCTIONS
( HIQ5310 )
IF ADMINISTERING ST, GO TO BOX ST69A - (STQ2825 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS69A - (NSQ2825 ).
ELSE IF ADMINISTERIGN CPS, GO TO BOX CPS29A - (CPS1710 ).
ELSE IF A TRICARE PLAN WAS "CURRENT" AT THE TIME OF THE
PREVIOUS ROUND INTERVIEW, GO TO HIT2 - COVTIME ( HIQ5330 ).
ELSE GO TO HIT1 - TRICOVER ( HIQ5320 ).
ASSIGNMENTS
If Tricare was current at the time of the previous round interview, then the SP was also
covered by Tricare for some time during the current round.
If Tricare was current at the time of the previous round interview, current round plan details
will be collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of Tricare plan.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of Tricare plan.
PLRO.PLRORND = current round.
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below.
PLROPLAN
PLRO.PLROPLAN = PLAN.PLANNUM of Tricare
Plan current at time of previous round.
PLRORND
PLRO.PLRORND = current round.
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
76
TricareCurrentPrevRnd
Tricare "current" at the time of previous round interview =
MRES.INTTYPE ^= 2,5,6 and there is ((a PLAN where
PLAN.PLANTYPE=6/Tricare) and a PLRO where
(PLROPLAN=this PLAN.PLANNUM and
PLRORND=previous round and
(COVTIME=1/WholeTime or COVNOW=1/Yes))).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
If administering ST, NS, CPS, you have completed the Medicaid detail
9:02:47 AM Tuesday, May 14, 2013
Page 153 of 346
BOX HIT1
questions for the Medicaid plan added at the Source of Payment roster.
Return to the section being administered as specified above.
9:02:47 AM Tuesday, May 14, 2013
Page 154 of 346
HIT1
HIT1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
TRICOVER
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2800
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(may)" in parenthesis.
If SP is deceased or institutionalized, display "was (SP)".
Else display "[have you/has (SP)] been".
Always display "(BACK OF SHOWCARD HIT1)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD HIT1
Question Text:
As you (may) know, the Department of Defense sponsors a
regionally managed health care program called TRICARE for active
duty and retired members of the uniformed Armed Forces, their
families, and survivors.
Please look at this card. At any time [since (REFERENCE DATE)/
9:02:48 AM Tuesday, May 14, 2013
Page 155 of 346
HIT1
between (PREVIOUS ROUND INTERVIEW DATE) and (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)], [have you/has (SP)
been/was (SP)] enrolled in or covered by any of these TRICARE
plans?
[EXPLAIN IF NECESSARY: You may have received a reference
card that looks like this (BACK OF SHOWCARD HIT1).]
Int. Instr II:
INPUT FIELDS / ROUTING
TRICOVER
Field1:
Cheshire Name:
( HIQ5320 )
HRND.TRICOVER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HIT2 - COVTIME ( HIQ5330 )
English text: YES
No
BOX HIT3 - (HIQ5700 )
English text: NO
Attribute
Route
Don't know
BOX HIT3 - (HIQ5700 )
Refusal
BOX HIT3 - (HIQ5700 )
BACKGROUND VARIABLE ASSIGNMENTS
HIT1 is asking if SP was covered by Tricare anytime since the previous round interview
date.
If TRICOVER=1/Yes, then
If there is a PLAN where PLAN.PLANTYPE=6/Tricare, regardless if
PLAN.PLANDFLG=1/Yes, LOSEPLFG ^= empty, or PLANSFLG=1/Yes, this stopped
Tricare plan will be restarted. See detailed instructions below.
9:02:49 AM Tuesday, May 14, 2013
Page 156 of 346
HIT1
Else if there is no PLAN where PLAN.PLANTYPE=6/Tricare, create a new PLAN where
PLAN.PLANNUM equals the next sequential plan number.
PLAN KEY= PLAN.PLANBASE + PLAN.PLANNUM.
To set current round status of this plan, create a current round PLRO where
PLRO.PLROPLAN = this PLAN.PLANNUM.
PLRO KEY = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
See detailed instructions below:
PLANNUM
If creating new plan, set PLAN.PLANNUM = highest
PLAN.PLANNUM + 01.
PLANRNDC
If creating new plan, set PLAN.PLANRNDC = current
round.
PLANTYPE
If creating a new plan, set PLAN.PLANTYPE =
6/Tricare.
PLNAME
If creating a new plan, set PLAN.PLNAME =
"TRICARE".
PLANDFLG
If restarting an existing Tricare plan and
PLAN.PLANDFLG=1/Yes, update PLAN.PLANDFLG
= empty (-1).
LOSEPLFG
If restarting an existing Tricare plan and
PLAN.LOSEPLFG ^= empty (-1), update
PLAN.LOSEPLFG = empty (-1).
PLROPLAN
PLRO.PLROPLAN = this PLAN.PLANNUM.
PLRORND
PLRO.PLRORND = current round.
PLANSFLG
If restarting an existing Tricare plan and
PLAN.PLANSFLG=1/Yes, update PLAN.PLANSFLG
= empty.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
9:02:49 AM Tuesday, May 14, 2013
Page 157 of 346
HIT2
HIT2
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
COVTIME
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2810
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If Tricare plan was "current" at the time of the previous round
interview, display first sentence: "At the time...".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[At the time of the last interview [you were/(SP) was] covered by
TRICARE.] [Were you/Was (SP)] covered by TRICARE the whole
time between (REFERENCE DATE) and (today/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION), or only part of the
time?
Int. Instr II:
9:02:50 AM Tuesday, May 14, 2013
Page 158 of 346
HIT2
INPUT FIELDS / ROUTING
( HIQ5330 )
COVTIME
Field1:
Cheshire Name:
PLRO.COVTIME
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TCovtime
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 WholeTime
2
Route
HIT4 - TRIRXCOV ( HIQ5360 )
English text: THE WHOLE TIME
PartOfTime
HIT3 - COVNOW ( HIQ5340 )
English text: PART OF THE TIME
Attribute
Don't know
Route
HIT3 - COVNOW ( HIQ5340 )
Refusal
HIT3 - COVNOW ( HIQ5340 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
9:02:52 AM Tuesday, May 14, 2013
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 159 of 346
HIT2
76
TricareCurrentPrevRnd
Tricare "current" at the time of previous round interview =
MRES.INTTYPE ^= 2,5,6 and there is ((a PLAN where
PLAN.PLANTYPE=6/Tricare) and a PLRO where
(PLROPLAN=this PLAN.PLANNUM and
PLRORND=previous round and
(COVTIME=1/WholeTime or COVNOW=1/Yes))).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
HIT2 is called from ST, NS, CPS if Tricare was added at the Source of
Payment roster.
9:02:52 AM Tuesday, May 14, 2013
Page 160 of 346
HIT3
HIT3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
COVNOW
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2820
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is deceased or institutionalized, display second sentence:
"Was SP covered by ...".
Else display first sentence: "[Are you/Is (SP)] now covered by
TRICARE?".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[Are you/Is (SP)] now covered by TRICARE?] [Was (SP) covered by
TRICARE on (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION?]
Int. Instr II:
INPUT FIELDS / ROUTING
9:02:53 AM Tuesday, May 14, 2013
Page 161 of 346
HIT3
Field1:
( HIQ5340 )
COVNOW
Cheshire Name:
PLRO.COVNOW
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HIT4 - TRIRXCOV ( HIQ5360 )
English text: YES
No
HIT4 - TRIRXCOV ( HIQ5360 )
English text: NO
Attribute
Route
Don't know
HIT4 - TRIRXCOV ( HIQ5360 )
Refusal
HIT4 - TRIRXCOV ( HIQ5360 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
9:02:55 AM Tuesday, May 14, 2013
Page 162 of 346
HIT3
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
9:02:55 AM Tuesday, May 14, 2013
Page 163 of 346
HIT4
HIT4
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
TRIRXCOV
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2840
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If (Tricare plan is not "current") or (if SP is deceased or
institutionalized), display "Did".
Else display "Does".
If SP is respondent, display "you personally have".
Else display "(SP) personally has".
Display "you" or "(SP)" in "[you personally have/(SP) personally
has]" in bold.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
9:02:55 AM Tuesday, May 14, 2013
(Does/Did) [your/(SP’s)] TRICARE plan cover medicines prescribed
by a doctor?
Page 164 of 346
HIT4
[PROBE: I am asking about the type of insurance coverage that
[you personally have/(SP) personally has], not what the plan offers
everyone.]
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
( HIQ5360 )
TRIRXCOV
Cheshire Name:
PLRO.TRIRXCOV
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HIT4A1 - TRIMEDS ( HIQ5363 )
English text: YES
No
BOX HIT3 - (HIQ5700 )
English text: NO
Attribute
Route
Don't know
BOX HIT3 - (HIQ5700 )
Refusal
BOX HIT3 - (HIQ5700 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
9:02:57 AM Tuesday, May 14, 2013
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
Page 165 of 346
HIT4
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
71
ThisPlanCurrent
This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
9:02:57 AM Tuesday, May 14, 2013
Page 166 of 346
HIT4A1
HIT4A1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
TRIMEDS
Field 2:
TRIMEDOS
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
2845
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If ((this Tricare plan is not "current") and (proxy is respondent)) or
(SP is deceased or institutionalized), display "did (SP)" and "Did
(SP)".
Else if this Tricare plan is not "current" and SP is respondent,
display "did you" and "Did you".
Else if this Tricare plan is "current" and SP is respondent, display
"do you" and "Do you".
Else display "does (SP)" and "Does (SP)".
Display the first instance of "usually" in BOLD.
Always display "(TMOP)", "(TRRx)", and "(MTF)" in parenthesis.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
9:02:58 AM Tuesday, May 14, 2013
Page 167 of 346
HIT4A1
Int. Instr I:
SHOW CARD HIT2
Question Text:
Where [do you/does (SP)/did you/did (SP)] usually obtain
(your/his/her) medicines? [Do you/Does (SP)/Did you/Did (SP)]
usually obtain them at a TRICARE mail order pharmacy (TMOP), a
TRICARE retail pharmacy network pharmacy (TRRx), a military
treatment facility pharmacy (MTF), a non-network retail pharmacy, or
somewhere else?
Int. Instr II:
INPUT FIELDS / ROUTING
TRIMEDS
Field1:
Cheshire Name:
( HIQ5363 )
PLRO.TRIMEDS
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
Ttrimeds
1
No
No
Number Label
1 TMOP
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HIT3 - (HIQ5700 )
2
English text: A TRICARE MAIL ORDER PHARMACY (TMOP)
TRRX
BOX HIT3 - (HIQ5700 )
3
English text: A TRICARE RETAIL PHARMACY NETWORK PHARMACY (TRRX)
MTF
BOX HIT3 - (HIQ5700 )
4
English text: A MILITARY TREATMENT FACILITY PHARMACY (MTF)
NonNetworkRetail
BOX HIT3 - (HIQ5700 )
91
English text: A NON-NETWORK RETAIL PHARMACY
Other
HIT4A1 - TRIMEDOS ( HIQ5365 )
English text: SOMEWHERE ELSE
Attribute
Route
Don't know
BOX HIT3 - (HIQ5700 )
Refusal
BOX HIT3 - (HIQ5700 )
9:03:00 AM Tuesday, May 14, 2013
Page 168 of 346
HIT4A1
Field2:
( HIQ5365 )
TRIMEDOS
Cheshire Name:
PLRO.TRIMEDOS
Item Text display:
Display "(SPECIFY)" in same blue font used for interviewer
instructions.
Item Text:
SOMEWHERE ELSE (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
30
Route
BOX HIT3 - (HIQ5700 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
71
ThisPlanCurrent
9:03:00 AM Tuesday, May 14, 2013
This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Page 169 of 346
HIT4A1
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
9:03:00 AM Tuesday, May 14, 2013
Page 170 of 346
BOX HIT3
BOX HIT3
9:03:00 AM Tuesday, May 14, 2013
Page Order # :
3060
Page 171 of 346
BOX HIT3
BOX INSTRUCTIONS
( HIQ5700 )
IF ADMINISTERING ST, GO TO BOX ST69A - (STQ2825 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS69A - (NSQ2825 ).
ELSE IF ADMINISTERING CPS, GO BOX CPS29A - (CPS1710 ).
ELSE IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO BOX HI7 (HIQ5740 ).
ELSE IF ((SP DID NOT REPORT RECEIVING HEALTH CARE SERVICES
FROM M.T.F IN THE PREVIOUS ROUND) AND ((SP WAS COVERED BY
TRICARE IN THE CURRENT OR PREVIOUS ROUND) OR (SP SERVED IN
THE ARMED FORCES)), GO TO HIT11 - MTFCOVER ( HIQ5710 ).
ELSE GO TO BOX HI20 - (HIQ5720 ).
ASSIGNMENTS
If HRND.MTFCOVER=1/Yes in the previous round, the interviewer will not ask HIT11 in the
current round. However, the response from the previous round will get copied to the
current round HRND. See detailed instructions below.
MTFCOVER
If previous round HRND.MTFCOVER=1/Yes, set
current round HRND.MTFCOVER=1/Yes.
TECHNICAL NOTES
92
HIT11NotYes
SP did not report receiving health care servces from
M.T.F in the previous round =
HRND.MTFCOVER^=1/Yes on HRND where
HRND.HRNDRND=previous round.
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
77
TricareCurrOrPrevRnd
SP was covered by Tricare in the current or previous
round =
There is a PLAN where PLAN.PLANTYPE=6/Tricare &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
(PLRO.PLRORND=current round or previous round) &
COVTIME^=empty).
Exclude Deleted Plans. See T.N. 52.
78
SPServedArmedForces
SP served in the armed forces =
HOME.SPAFEVER=1/Yes or HOME.SPNGEVER =
1/Yes.
DESIGN NOTES
If administering ST, NS, CPS, you have completed the Tricare detail
questions for the Tricare plan added at the Source of Payment roster.
Return to the section being administered as specified above.
9:03:00 AM Tuesday, May 14, 2013
Page 172 of 346
HIT11
HIT11
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MTFCOVER
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3070
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If (SP served in the Armed Forces) and (SP is not covered by
Tricare in the current or the previous round), display "We recorded
that [you/(SP)] served in the Armed Forces of the United States.".
Else do not display.
If SP deceased or institutionalized, display "did (SP) receive".
Else display "[have you/has (SP)] received".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
9:03:01 AM Tuesday, May 14, 2013
[We recorded that [you/(SP)] served in the Armed Forces of the
United States.] Since (REFERENCE DATE), [have you/has (SP)
received/did (SP) receive] health care or health services or
prescribed medicines at a Military Treatment Facility or MTF?
Page 173 of 346
HIT11
[EXPLAIN IF NECESSARY: A Military Treatment Facility is any
military hospital, clinic, or NAVCARE clinic.]
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
( HIQ5710 )
MTFCOVER
Cheshire Name:
HRND.MTFCOVER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HI20 - (HIQ5720 )
English text: YES
No
BOX HI20 - (HIQ5720 )
English text: NO
Attribute
Route
Don't know
BOX HI20 - (HIQ5720 )
Refusal
BOX HI20 - (HIQ5720 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
78
SPServedArmedForces
9:03:02 AM Tuesday, May 14, 2013
SP served in the armed forces =
HOME.SPAFEVER=1/Yes or HOME.SPNGEVER =
1/Yes.
Page 174 of 346
HIT11
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
77
TricareCurrOrPrevRnd
SP was covered by Tricare in the current or previous
round =
There is a PLAN where PLAN.PLANTYPE=6/Tricare &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
(PLRO.PLRORND=current round or previous round) &
COVTIME^=empty).
Exclude Deleted Plans. See T.N. 52.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
9:03:02 AM Tuesday, May 14, 2013
Page 175 of 346
BOX HI20
BOX HI20
Page Order # :
3080
BOX INSTRUCTIONS
( HIQ5720 )
IF (SP DID NOT REPORT RECEIVING HEALTH CARE SERVICES
THROUGH V.A. IN THE PREVIOUS ROUND) AND (SP SERVED IN THE
ARMED FORCES), GO TO HI36 - VACOVER ( HIQ5730 ).
ELSE GO TO BOX HI7 - (HIQ5740 ).
ASSIGNMENTS
If HRND.VACOVER=1/Yes in the previous round, the interviewer will not ask HI36 in the
current round. However, the response from the previous round will get copied to the
current round HRND. See detailed instructions below.
If previous round HRND.VACOVER=1/Yes, set
current round HRND.VACOVER=1/Yes.
VACOVER
TECHNICAL NOTES
132
HI36NotYes
SP did not report receiving health care services through
V.A.in the previous round =
HRND.VACOVER ^= 1/Yes on HRND where
HRND.HRNDRND=previous round.
78
SPServedArmedForces
SP served in the armed forces =
HOME.SPAFEVER=1/Yes or HOME.SPNGEVER =
1/Yes.
DESIGN NOTES
9:03:02 AM Tuesday, May 14, 2013
Page 176 of 346
HI36
HI36
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
VACOVER
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3090
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
NOTE: The first sentence in Question text will only be displayed if
we did not ask HIT11 in the current round.
If HIT11 - MTFCOVER not asked in the current round, display first
sentence "We recorded that…".
Else do not display.
If SP is deceased or institutionalized. display "did (SP) receive".
Else display "[have you/has (SP) received]".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
9:03:03 AM Tuesday, May 14, 2013
[We recorded that [you/(SP)] served in the Armed Forces of the
United States.] Since (REFERENCE DATE), [have you/has (SP)
received/did (SP) receive] health care or health services or
Page 177 of 346
HI36
prescribed medicines through the Department of Veterans Affairs or
V.A.?
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
( HIQ5730 )
VACOVER
Cheshire Name:
HRND.VACOVER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HI7 - (HIQ5740 )
English text: YES
No
BOX HI7 - (HIQ5740 )
English text: NO
Attribute
Route
Don't know
BOX HI7 - (HIQ5740 )
Refusal
BOX HI7 - (HIQ5740 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
9:03:04 AM Tuesday, May 14, 2013
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
Page 178 of 346
HI36
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
9:03:04 AM Tuesday, May 14, 2013
Page 179 of 346
BOX HI7
BOX HI7
Page Order # :
3100
BOX INSTRUCTIONS
( HIQ5740 )
IF AT LEAST ONE PUBLIC PLAN WAS "CURRENT" AT THE TIME OF THE
PREVIOUS ROUND INTERVIEW, GO TO HI11PREV - PUBINTRO (
HIQ5743 ).
ELSE GO TO HI11 - PUBCOVER ( HIQ5750 ).
ASSIGNMENTS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
80
PublicCurrentPrevRnd
Public plan "current" at the time of previous round
interview =
There is a PLAN where PLAN.PLANTYPE=3/PublicPlan
& PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=previous round & (COVTIME=1/WholeTime
or COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:03:04 AM Tuesday, May 14, 2013
Page 180 of 346
HI11PREV
HI11PREV
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
PUBINTRO
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3103
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
The next questions are about public plans [you were/(SP) was]
covered by as of (REFERENCE DATE).
Int. Instr II:
INPUT FIELDS / ROUTING
9:03:05 AM Tuesday, May 14, 2013
Page 181 of 346
HI11PREV
Field1:
PUBINTRO
Cheshire Name:
( HIQ5743 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI11PREV_IN - NAVIGATOR ( HIQ5744 )
English text: CONTINUE
Attribute
Route
Empty
HI11PREV_IN - NAVIGATOR ( HIQ5744 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
9:03:06 AM Tuesday, May 14, 2013
Page 182 of 346
HI11PREV_IN
HI11PREV_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
3104
Roster Name:
Roster Type:
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display all public plans that were "current" at the time of the
previous round interview.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
9:03:06 AM Tuesday, May 14, 2013
Page 183 of 346
HI11PREV_IN
Field1:
NAVIGATOR
Cheshire Name:
( HIQ5744 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HI7A - (HIQ5745 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
HI11 - PUBCOVER ( HIQ5750 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of public plan being asked about from the previous round.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of public plan being asked about from the previous
round.
PLRO.PLRORND = current round.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
9:03:07 AM Tuesday, May 14, 2013
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 184 of 346
HI11PREV_IN
80
PublicCurrentPrevRnd
Public plan "current" at the time of previous round
interview =
There is a PLAN where PLAN.PLANTYPE=3/PublicPlan
& PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=previous round & (COVTIME=1/WholeTime
or COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:03:07 AM Tuesday, May 14, 2013
Page 185 of 346
BOX HI7A
BOX HI7A
Page Order # :
3105
BOX INSTRUCTIONS
( HIQ5745 )
CREATE CURRENT ROUND PLRO FOR PUBLIC PLAN .
GO TO HI13 - COVTIME ( HIQ5780 ).
ASSIGNMENTS
If Public plan was current at the time of the previous round interview, then the SP was also
covered by the Public plan for some time during the current round.
Create a current round PLRO to store the status of this public plan in the current round.
PLRO KEY = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
See detailed instructions below.
PLROPLAN
PLRO.PLROPLAN = PLAN.PLANNUM of Public
Plan current at time of previous round.
PLRORND
PLRO.PLRORND = current round.
TECHNICAL NOTES
DESIGN NOTES
9:03:07 AM Tuesday, May 14, 2013
Page 186 of 346
HI11
HI11
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PUBCOVER
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3110
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
If state where SP currently lives has no State Pharmaceutical
Assistance programs, display "NONE".
Else if state where SP currently lives has one State Pharmaceutical
Assistance program, display "(STATE PHARMACEUTICAL
ASSISTANCE PROGRAM)"
Else if state where SP currently lives has two State Pharmaceutical
Assistance programs, display (STATE PHARMACEUTICAL
ASSISTANCE PROGRAM1) OR (STATE PHARMACEUTICAL
ASSISTANCE PROGRAM2)
Else display "(STATE PHARMACEUTICAL ASSISTANCE
PROGRAM1), (STATE PHARMACEUTICAL ASSISTANCE
PROGRAM2), OR (STATE PHARMACEUTICAL ASSISTANCE
PROGRAM3)
See Attachment HI2 in General Specifications for a list of State
Pharmaceutical Assistance programs.
Question display:
If SP is deceased or institutionalized, display "was (SP)".
Else display "[have you/has (SP)] been".
If state where SP currently lives has no State Pharmaceutical
Assistance programs, display first phrase: "[for example, a public
program that pays for prescribed medicines]?".
Else if state where SP currently lives has one State Pharmaceutical
Assistance program, display second phrase: "[for example (STATE
PHARMACEUTICAL ASSISTANCE PROGRAM), a public program
that pays for prescribed medicines]?".
Else if state where SP currently lives has two State Pharmaceutical
Assistance programs, display third phrase: "[for example (STATE
PHARMACEUTICAL ASSISTANCE PROGRAM1) or (STATE
PHARMACEUTICAL ASSISTANCE PROGRAM2), public programs
9:03:08 AM Tuesday, May 14, 2013
Page 187 of 346
HI11
that pay for prescribed medicines]?".
Else display fourth phrase "[for example (STATE
PHARMACEUTICAL ASSISTANCE PROGRAM1), (STATE
PHARMACEUTICAL ASSISTANCE PROGRAM2), or (STATE
PHARMACEUTICAL ASSISTANCE PROGRAM3), public programs
that pay for prescribed medicines]?".
Always display "[for example…]" in brackets.
See Attachment HI2 in General Specifications for a list of State
Pharmaceutical Assistance programs.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE)
STATE PHARMACEUTICAL ASSISTANCE PROGRAM: (STATE
PHARMACEUTICAL ASSISTANCE PROGRAM)
Int. Instr I:
Question Text:
At any time [since (REFERENCE DATE)/between (PREVIOUS
ROUND INTERVIEW DATE) and (DATE OF DEATH/
DATE OF INSTITUTIONALIZATION)], [have you/has (SP) been/was
(SP)] covered by any public program other than Medicaid that pays
for medical care [for example, a public program that pays for
prescribed medicines/for example (STATE PHARMACEUTICAL
ASSISTANCE PROGRAM), a public program that pays for
prescribed medicines/
for example (STATE PHARMACEUTICAL ASSISTANCE
PROGRAM1) or (STATE PHARMACEUTICAL ASSISTANCE
PROGRAM2)/for example (STATE PHARMACEUTICAL
ASSISTANCE PROGRAM1), (STATE PHARMACEUTICAL
ASSISTANCE PROGRAM2), or (STATE PHARMACEUTICAL
ASSISTANCE PROGRAM3), public programs that pay for
prescribed medicines]?
Int. Instr II:
INPUT FIELDS / ROUTING
9:03:09 AM Tuesday, May 14, 2013
Page 188 of 346
HI11
Field1:
( HIQ5750 )
PUBCOVER
Cheshire Name:
HRND.PUBCOVER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI12 - PLAN_PUBLIC ( HIQ5770 )
English text: YES
No
BOX HI12AA - (HIQ6155 )
English text: NO
Attribute
Route
Don't know
BOX HI12AA - (HIQ6155 )
Refusal
BOX HI12AA - (HIQ6155 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
9:03:10 AM Tuesday, May 14, 2013
Page 189 of 346
HI11
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
9:03:10 AM Tuesday, May 14, 2013
Page 190 of 346
HI12
HI12
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PLAN_PUBLIC
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Plan Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
Yes
Grid Functions:
Add Line
Delete Line
No
No
3130
Display as ' Add a Plan '
Display as ' Edit a Plan '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all health insurance plans from the Plan Roster.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare
Medicare Managed Care plans.
Medicaid
Tricare
Private plans
Public plans that SP has already reported being covered by during
the current round, this includes plans that are current or have
stopped in current round.
Medicare Prescription Drug Plans
Roster/Grid display:
COL #
1
9:03:10 AM Tuesday, May 14, 2013
HEADER
Plan Name
INSTRUCTIONS
Display PLAN.PLNAME.
Page 191 of 346
HI12
2
Plan Type
Display PLAN.PLANTYPE:
1/Medicare, display "MCAR"
2/Medicaid, display "MCAD"
3/PublicPlan, display "PUBL"
4/PrivatePlan, display "PRIV"
5/MHMO, display "MHMO"
6/Tricare, display "TRIC"
7/MPDP, display "MPDP"
3
Plan Status
Display CURRENT ROUND PLAN
STATUS.
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What is the name of each of the public programs other than
Medicaid that covered [you/(SP)]?
Int. Instr II:
SELECT OR ADD ALL PUBLIC PROGRAM NAMES AT THIS
ROSTER.
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
PLAN_PUBLIC
( HIQ5770 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TPlanPick32
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
32
Route
HI12_IN - NAVIGATOR ( HIQ5775 )
BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
9:03:11 AM Tuesday, May 14, 2013
Page 192 of 346
HI12
PLAN.PLANNUM = Number of plan selected at HI12.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HI12.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
Plans selected at HI12 are Public plans that the SP was enrolled in for some time in the
current round.
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
PLROPLAN
PLRO.PLROPLAN = this PLAN.PLANNUM.
PLRORND
PLRO.PLRORND=current round.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
53
PlanTypes
Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Advantage: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.
93
AnyPlansCurrentRnd
SP reported being covered by any plans during the
current round =
There is PLAN & PLRO where (PLRO.PLROPLAN =
PLAN.PLANNUM & PLRO.PLRORND = current round &
(PLRO.COVTIME ^= empty or PLRO.COVANYTIM =
1/Yes)).
Exclude Deleted Plans. See T.N. 52.
95
PlanIsCurrent
If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
9:03:11 AM Tuesday, May 14, 2013
Page 193 of 346
HI12
DESIGN NOTES
9:03:11 AM Tuesday, May 14, 2013
Page 194 of 346
HI12_IN
HI12_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
3135
Roster Name:
Roster Type:
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display all plans selected at HI12.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
9:03:11 AM Tuesday, May 14, 2013
Page 195 of 346
HI12_IN
Field1:
NAVIGATOR
Cheshire Name:
( HIQ5775 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI13 - COVTIME ( HIQ5780 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
BOX HI12AA - (HIQ6155 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at HI12.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HI12.
PLRO.PLRORND = current round.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
9:03:12 AM Tuesday, May 14, 2013
Page 196 of 346
HI13
HI13
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
COVTIME
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3140
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the public plan being asked about,
PLAN.PLNAME.
Question display:
If public plan was "current" at the time of the previous round
interview, display first sentence: "At the time of the last interview...".
Else do not display.
Display plan name for the public plan being asked about,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
PUBLIC PLAN: (PUBLIC PLAN NAME)
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
9:03:13 AM Tuesday, May 14, 2013
[At the time of the last interview [you were/(SP) was] covered by
(PUBLIC PLAN NAME).] [Were you/Was (SP)] covered by (PUBLIC
PLAN NAME) the whole time between (REFERENCE DATE) and
(today/DATE OF DEATH/DATE OF INSTITUTIONALIZATION), or
Page 197 of 346
HI13
only part of the time?
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
( HIQ5780 )
COVTIME
Cheshire Name:
PLRO.COVTIME
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TCovtime
1
No
No
Number Label
1 WholeTime
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI16A - PUBRXCOV ( HIQ5900 )
English text: THE WHOLE TIME
PartOfTime
HI14 - COVNOW ( HIQ5800 )
English text: PART OF THE TIME
Attribute
Route
Don't know
HI14 - COVNOW ( HIQ5800 )
Refusal
HI14 - COVNOW ( HIQ5800 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
9:03:14 AM Tuesday, May 14, 2013
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 198 of 346
HI13
63
ThisPlanCurrentPrevRn
d
This Plan was "current" at the time of the previous round
interview =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
HI13 is called from ST, NS, CPS when a public plan is added at the Source
of Payment roster.
9:03:14 AM Tuesday, May 14, 2013
Page 199 of 346
HI14
HI14
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
COVNOW
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3160
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the public plan being asked about,
PLAN.PLNAME.
Question display:
If SP is deceased or institutionalized, display second sentence:
"Was (SP) covered by...".
Else display first sentence "[Are you/Is (SP)] now covered...".
Display plan name for the public plan being asked about,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
PUBLIC PLAN: (PUBLIC PLAN NAME)
Int. Instr I:
Question Text:
[[Are you/Is (SP)] now covered by (PUBLIC PLAN NAME)?] [Was
(SP) covered by (PUBLIC PLAN NAME) on (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)?]
Int. Instr II:
9:03:15 AM Tuesday, May 14, 2013
Page 200 of 346
HI14
INPUT FIELDS / ROUTING
( HIQ5800 )
COVNOW
Field1:
Cheshire Name:
PLRO.COVNOW
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HI10 - (HIQ5810 )
English text: YES
No
HI16 - COVENDMM ( HIQ5860 )
English text: NO
Attribute
Don't know
Route
HI16A - PUBRXCOV ( HIQ5900 )
Refusal
HI16A - PUBRXCOV ( HIQ5900 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
9:03:16 AM Tuesday, May 14, 2013
Page 201 of 346
HI14
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
9:03:16 AM Tuesday, May 14, 2013
Page 202 of 346
BOX HI10
BOX HI10
Page Order # :
3170
BOX INSTRUCTIONS
( HIQ5810 )
IF THIS PUBLIC PLAN WAS "CURRENT" AT THE TIME OF THE PREVIOUS
ROUND INTERVIEW, GO TO HI16A - PUBRXCOV ( HIQ5900 ).
ELSE GO TO HI15 - COVBEGMM ( HIQ5820 ).
ASSIGNMENTS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
63
ThisPlanCurrentPrevRn
d
This Plan was "current" at the time of the previous round
interview =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:03:16 AM Tuesday, May 14, 2013
Page 203 of 346
HI15
HI15
Page Order # :
Design Screen Type:
Date
Fields:
Field 1:
COVBEGMM
Field 2:
COVBEGDD
Field 3:
COVBEGYY
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
3180
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the public plan being asked about,
PLAN.PLNAME.
Question display:
Display plan name for the public plan being asked about,
PLAN.PLNAME.
Multi Field display:
Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
PUBLIC PLAN: (PUBLIC PLAN NAME)
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
On what date did [your/(SP’s)] (PUBLIC PLAN NAME) coverage start
between (REFERENCE DATE) and (today/DATE OF DEATH/DATE
OF INSTITUTIONALIZATION)?
Int. Instr II:
9:03:17 AM Tuesday, May 14, 2013
Page 204 of 346
HI15
INPUT FIELDS / ROUTING
COVBEGMM
Field1:
Cheshire Name:
( HIQ5820 )
PLRO.COVBEGMM
Item Text display:
Item Text:
Label:
Label Position:
MM
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMonthInt
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
HI15 - COVBEGDD ( HIQ5830 )
Refusal
HI15 - COVBEGDD ( HIQ5830 )
9:03:19 AM Tuesday, May 14, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
01
12
Route
HI15 - COVBEGDD ( HIQ5830 )
Page 205 of 346
HI15
Field2:
COVBEGDD
Cheshire Name:
( HIQ5830 )
PLRO.COVBEGDD
Item Text display:
Item Text:
Label:
Label Position:
DD
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDayDKRF
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
HI15 - COVBEGYY ( HIQ5840 )
Refusal
HI15 - COVBEGYY ( HIQ5840 )
9:03:22 AM Tuesday, May 14, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
1
31
Route
HI15 - COVBEGYY ( HIQ5840 )
Page 206 of 346
HI15
Field3:
( HIQ5840 )
COVBEGYY
Cheshire Name:
PLRO.COVBEGYY
Item Text display:
Item Text:
Label:
Label Position:
YY
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMcyear
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
0
99
Route
HI16A - PUBRXCOV ( HIQ5900 )
Attribute
Route
Don't know
HI16A - PUBRXCOV ( HIQ5900 )
Refusal
HI16A - PUBRXCOV ( HIQ5900 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
PLAN BEGIN DATE, COVBEGMM/COVBEGDD/COVBEGYY,
should be on or between (REFERENCE DATE) and (REFERENCE
PERIOD END DATE).
If not true, display message: "DATE MUST BE ON OR BETWEEN
(REFERENCE DATE) AND (REFERENCE PERIOD END DATE).
PLEASE REENTER.".
TECHNICAL NOTES
114
CoverageStartDate
Health Insurance Plan coverage start date =
PLRO.COVBEGMM / PLRO.COVBEGDD /
PLRO.COVBEGYY.
Check PLRO where PLRO.PLROPLAN =
PLAN.PLANNUM and PLRO.PLRORND = round #
checking.
DESIGN NOTES
9:03:23 AM Tuesday, May 14, 2013
Page 207 of 346
HI15
9:03:23 AM Tuesday, May 14, 2013
Page 208 of 346
HI16
HI16
Page Order # :
Design Screen Type:
Date
Fields:
Field 1:
COVENDMM
Field 2:
COVENDDD
Field 3:
COVENDYY
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
3200
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the public plan being asked about,
PLAN.PLNAME.
Question display:
Display plan name for the public plan being asked about,
PLAN.PLNAME.
If SP is deceased or institutionalized, display "last".
Else display "most recently".
Multi Field display:
Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
PUBLIC PLAN: (PUBLIC PLAN NAME)
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
9:03:24 AM Tuesday, May 14, 2013
On what date [since (REFERENCE DATE)/between (PREVIOUS
ROUND INTERVIEW DATE) and (DATE OF DEATH/
Page 209 of 346
HI16
DATE OF INSTITUTIONALIZATION)] did [your/(SP’s)] (PUBLIC
PLAN NAME) coverage (most recently/last) stop?
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
COVENDMM
Cheshire Name:
( HIQ5860 )
PLRO.COVENDMM
Item Text display:
Item Text:
Label:
Label Position:
MM
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMonthInt
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
HI16 - COVENDDD ( HIQ5870 )
Refusal
HI16 - COVENDDD ( HIQ5870 )
9:03:26 AM Tuesday, May 14, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
01
12
Route
HI16 - COVENDDD ( HIQ5870 )
Page 210 of 346
HI16
Field2:
COVENDDD
Cheshire Name:
( HIQ5870 )
PLRO.COVENDDD
Item Text display:
Item Text:
Label:
Label Position:
DD
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDayDKRF
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
HI16 - COVENDYY ( HIQ5880 )
Refusal
HI16 - COVENDYY ( HIQ5880 )
9:03:28 AM Tuesday, May 14, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
1
31
Route
HI16 - COVENDYY ( HIQ5880 )
Page 211 of 346
HI16
Field3:
( HIQ5880 )
COVENDYY
Cheshire Name:
PLRO.COVENDYY
Item Text display:
Item Text:
Label:
Label Position:
YY
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMcyear
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
0
99
Route
HI16A - PUBRXCOV ( HIQ5900 )
Attribute
Route
Don't know
HI16A - PUBRXCOV ( HIQ5900 )
Refusal
HI16A - PUBRXCOV ( HIQ5900 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
EDIT #1
PLAN END DATE, COVENDMM/COVENDDD/COVENDYY, should
be on or between (REFERENCE DATE) and (REFERENCE
PERIOD END DATE).
If not true, display message: "DATE MUST BE ON OR BETWEEN
(REFERENCE DATE) AND (REFERENCE PERIOD END DATE).
PLEASE REENTER.".
TECHNICAL NOTES
115
CoverageStopDate
9:03:29 AM Tuesday, May 14, 2013
Health Insurance Plan coverage stop date =
PLRO.COVENDMM / PLRO.COVENDDD /
PLRO.COVENDYY.
Check PLRO where PLRO.PLROPLAN =
PLAN.PLANNUM and PLRO.PLRORND = round #
checking.
Page 212 of 346
HI16
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
9:03:29 AM Tuesday, May 14, 2013
Page 213 of 346
HI16A
HI16A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PUBRXCOV
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3202
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the public plan being asked about,
PLAN.PLNAME
Question display:
If (this public plan is not "current") or (SP is deceased or
institutionalized), display "Did".
Else display "Does".
Display plan name for the public plan being asked about,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
PUBLIC PLAN: (PUBLIC PLAN NAME)
Int. Instr I:
Question Text:
(Does/Did) [your/(SP’s)] (PUBLIC PLAN NAME) plan cover
medicines prescribed by a doctor?
Int. Instr II:
9:03:30 AM Tuesday, May 14, 2013
Page 214 of 346
HI16A
INPUT FIELDS / ROUTING
( HIQ5900 )
PUBRXCOV
Field1:
Cheshire Name:
PLRO.PUBRXCOV
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HI12 - (HIQ6150 )
English text: YES
No
BOX HI12 - (HIQ6150 )
English text: NO
Attribute
Don't know
Route
BOX HI12 - (HIQ6150 )
Refusal
BOX HI12 - (HIQ6150 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
9:03:31 AM Tuesday, May 14, 2013
Page 215 of 346
HI16A
SP is Deceased =
MRES.SPALIVE=3/Deceased.
71
ThisPlanCurrent
This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:03:31 AM Tuesday, May 14, 2013
Page 216 of 346
BOX HI12
BOX HI12
9:03:31 AM Tuesday, May 14, 2013
Page Order # :
3213
Page 217 of 346
BOX HI12
BOX INSTRUCTIONS
( HIQ6150 )
IF ADMINISTERING ST, GO TO BOX ST69A - (STQ2825 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS69A - (NSQ2825 ).
ELSE IF ADMINISTERIGN CPS, GO TO BOX CPS29A - (CPS1710 ).
ELSE IF REVIEWING PUBLIC PLANS THAT WERE "CURRENT" AT THE
TIME OF THE PREVIOUS ROUND INTERVIEW, GO TO HI11PREV_IN
NAVIGATOR ( HIQ5744 ).
ELSE GO TO HI12_IN - NAVIGATOR ( HIQ5775 ).
ASSIGNMENTS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
80
PublicCurrentPrevRnd
Public plan "current" at the time of previous round
interview =
There is a PLAN where PLAN.PLANTYPE=3/PublicPlan
& PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=previous round & (COVTIME=1/WholeTime
or COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
85
PublicNew
Public Plan is new =
PLAN.PLANTYPE=3/PublicPlan and PLAN.PLANRNDC
= current round and PLAN.PLANSUMM ^= 1/Yes.
Exclude Deleted Plans. See T.N. 52.
86
PublicRestarted
Public Plan has been restarted =
For this PLAN, there is no PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND = previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
If administering ST, NS, CPS, you have completed the Public plan detail
questions for the Public plan(s) added at the Source of Payment roster.
Return to the section being administered as specified above.
NOTE ON ELSE CONDITION:
ASKING ABOUT PREVIOUS ROUND PLANS:
Once all items at HI11PREV_IN Instance Navigator screen are DONE,
9:03:32 AM Tuesday, May 14, 2013
Page 218 of 346
BOX HI12
routing will return to HI11PREV_IN until Interviewer selects CONTINUE
INTERVIEW.
ASKING ABOUT CURRENT ROUND PLANS:
Once all items at HI12_IN Instance Navigator screen are DONE, routing
will return to HI12_IN until Interviewer selects CONTINUE INTERVIEW.
9:03:32 AM Tuesday, May 14, 2013
Page 219 of 346
BOX HI12AA
BOX HI12AA
Page Order # :
3218
BOX INSTRUCTIONS
( HIQ6155 )
IF (SP HAS A MEDICARE PRESCRIPTION DRUG PLAN THAT WAS
"CURRENT" AT THE TIME OF THE PREVIOUS ROUND INTERVIEW), GO
TO HI16AB - PDPSAME ( HIQ6157 ).
ELSE IF ((SP DOES NOT HAVE A MEDICARE PRESCRIPTION DRUG PLAN
THAT WAS "CURRENT" AT THE TIME OF THE PREVIOUS ROUND
INTERVIEW) AND (SP DOES NOT HAVE A "CURRENT" MEDICARE
MANAGED CARE PLAN WITH RX COVERAGE) AND (HI10C1 - MPDCOVER
= empty)), GO TO HI16B - PDPCOVER ( HIQ6165 ).
ELSE IF ((SP DOES NOT HAVE A MEDICARE PRESCRIPTION DRUG PLAN
THAT WAS "CURRENT" AT THE TIME OF THE PREVIOUS ROUND
INTERVIEW) AND (SP DOES NOT HAVE A "CURRENT" MEDICARE
MANAGED CARE PLAN WITH RX COVERAGE) AND (HI10C1 - MPDCOVER
= 2/No)), GO TO HI16B1 - PDPCOVER ( HIQ6167 ).
ELSE GO TO BOX HI12A - (HIQ6185 ).
ASSIGNMENTS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
343
MPDPCurrPrevRnd
Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes). Exclude Deleted Plans. See
T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
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.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:03:32 AM Tuesday, May 14, 2013
Page 220 of 346
HI16AB
HI16AB
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PDPSAME
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3323
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display Medicare Prescription Drug plan that was "current' at the
time of the previous round interview, PLAN.PLNAME.
Question display:
Display the name of the Medicare Prescription Drug plan that was
"current' at the time of the previous round interview, PLAN.PLNAME.
If SP is deceased or institutionalized, display "Was (SP) covered
by...".
Else display "[Are you/Is (SP)] now covered...".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MPDP: (MEDICARE PRESCRIPTION DRUG PLAN NAME)
Int. Instr I:
Question Text:
At the time of the last interview [you were/(SP) was] covered by
(MEDICARE PRESCRIPTION DRUG PLAN NAME).
[[Are you/Is (SP)] now covered by (MEDICARE PRESCRIPTION
DRUG PLAN NAME)?] [Was (SP) covered by (MEDICARE
9:03:32 AM Tuesday, May 14, 2013
Page 221 of 346
HI16AB
PRESCRIPTION DRUG PLAN NAME) on (DATE OF DEATH/DATE
OF INSTITUTIONALIZATION)?]
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
PDPSAME
Cheshire Name:
( HIQ6157 )
HRND.PDPSAME
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HI12A - (HIQ6185 )
English text: YES
No
HI16AC - PDPYSTOP ( HIQ6159 )
English text: NO
Attribute
Route
Don't know
BOX HI12A - (HIQ6185 )
Refusal
HI16AD - PDPOTHER ( HIQ6163 )
BACKGROUND VARIABLE ASSIGNMENTS
The Medicare Prescription Drug plan being asked about at HI16AB was SP's current
Medicare Prescription Drug plan at the time of the previous round interview. This also
means that the SP was covered by this Medicare Prescription Drug plan for some time
during the current round.
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of Medicare Prescription Drug plan
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of Medicare Prescription Drug plan
PLRO.PLRORND = current round
9:03:34 AM Tuesday, May 14, 2013
Page 222 of 346
HI16AB
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
Based on response to HI16AB, HRND.PDPSAME, set the status of this plan on the current
round PLRO.
See detailed instructions below:
PLROPLAN
PLRO.PLROPLAN = PLAN.PLANNUM of MPDP
current at time of previous round.
PLRORND
PLRO.PLRORND = current round.
COVANYTM
PLRO.COVANYTM = 1/Yes.
COVCURNT
If HI16AB - PDPSAME = 1/Yes, set
PLRO.COVCURNT = 1/Yes.
Else set PLRO.COVCURNT = 2/No.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
343
MPDPCurrPrevRnd
Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes). Exclude Deleted Plans. See
T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:03:34 AM Tuesday, May 14, 2013
Page 223 of 346
HI16AC
HI16AC
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
PDPYSTOP
Field 2:
PDPYSTOS
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
3328
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the name of the Medicare Prescription Drug plan that was
"current" at the time of the previous round interview, PLAN.PLNAME.
Question display:
Display the name of the Medicare Prescription Drug plan that was
"current" at the time of the previous round interview,
PLAN.PLNAME.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MPDP: (MEDICARE PRESCRIPTION DRUG PLAN NAME)
Int. Instr I:
Question Text:
What is the most important reason [you/(SP)] stopped the
(MEDICARE PRESCRIPTION DRUG PLAN NAME) coverage?
Int. Instr II:
INPUT FIELDS / ROUTING
9:03:35 AM Tuesday, May 14, 2013
Page 224 of 346
HI16AC
Field1:
PDPYSTOP
Cheshire Name:
( HIQ6159 )
PLRO.PDPYSTOP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TPdpStop
1
No
No
Number Label
1 TooExpensive
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI16AD - PDPOTHER ( HIQ6163 )
2
English text: TOO EXPENSIVE OR COULDN'T AFFORD
DissatisfiedWithCoverage
HI16AD - PDPOTHER ( HIQ6163 )
3
English text: SP DISSATISFIED WITH PLAN'S COVERAGE
GetRxCoverage
HI16AD - PDPOTHER ( HIQ6163 )
4
English text: TO GET RX COVERAGE IN ANOTHER PLAN
DiffHealthCareCov
HI16AD - PDPOTHER ( HIQ6163 )
5
English text: TO GET DIFFERENT HEALTH CARE COVERAGE
NotMedicareRx
HI16AD - PDPOTHER ( HIQ6163 )
6
English text: PLAN NO LONGER CONTRACTS FOR MEDICARE RX COVERAGE
ChangedName
HI16C - PDPCURR ( HIQ6169 )
7
English text: PLAN NAME CHANGED OR PLAN WAS BOUGHT BY/MERGED WITH
ANOTHER PLAN
SPMoved
HI16AD - PDPOTHER ( HIQ6163 )
91
English text: SP MOVED OUT OF PLAN AREA
Other
HI16AC - PDPYSTOS ( HIQ6161 )
English text: OTHER
Attribute
Don't know
Route
HI16AD - PDPOTHER ( HIQ6163 )
Refusal
HI16AD - PDPOTHER ( HIQ6163 )
9:03:37 AM Tuesday, May 14, 2013
Page 225 of 346
HI16AC
Field2:
( HIQ6161 )
PDPYSTOS
Cheshire Name:
PLRO.PDPYSTOS
Item Text display:
Display "(SPECIFY)" in same blue font used for interviewer
instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
30
Route
HI16AD - PDPOTHER ( HIQ6163 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
343
MPDPCurrPrevRnd
Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes). Exclude Deleted Plans. See
T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:03:38 AM Tuesday, May 14, 2013
Page 226 of 346
HI16AD
HI16AD
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PDPOTHER
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3333
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Question display:
If SP is deceased or institutionalized, display "had (SP)".
Else display "[have you/has (SP)]".
Display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE)
LAST ROUND MPDP: (MEDICARE PRESCRIPTION DRUG PLAN
NAME CURRENT LAST ROUND)
Int. Instr I:
Question Text:
9:03:38 AM Tuesday, May 14, 2013
[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/INSTITUTIONALIZATION)], [have you/has
(SP)/had (SP)] been covered by any other Medicare Prescription
Drug plans besides (MEDICARE PRESCRIPTION DRUG PLAN
Page 227 of 346
HI16AD
CURRENT LAST ROUND)?
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
( HIQ6163 )
PDPOTHER
Cheshire Name:
HRND.PDPOTHER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI16C - PDPCURR ( HIQ6169 )
English text: YES
No
BOX HI12A - (HIQ6185 )
English text: NO
Attribute
Route
Don't know
BOX HI12A - (HIQ6185 )
Refusal
BOX HI12A - (HIQ6185 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
9:03:40 AM Tuesday, May 14, 2013
Page 228 of 346
HI16AD
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
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
9:03:40 AM Tuesday, May 14, 2013
Page 229 of 346
HI16B
HI16B
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PDPCOVER
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3338
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If no Medicare Prescription Drug plan ever reported in any round,
display "Medicare beneficiaries can receive insurance...".
Else do not display.
If SP is deceased or institutionalized, display "covered".
Else display "covers".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
(Medicare beneficiaries can receive insurance coverage for
prescription drugs through Medicare Prescription Drug plans. These
plans are also called "Medicare Part D" plans.)
At any time since (REFERENCE DATE), [have you/has (SP)/had
(SP)] been enrolled in a Medicare Prescription Drug plan that
9:03:41 AM Tuesday, May 14, 2013
Page 230 of 346
HI16B
(covers/covered) medicines prescribed by a doctor?
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
( HIQ6165 )
PDPCOVER
Cheshire Name:
HRND.PDPCOVER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI16C - PDPCURR ( HIQ6169 )
English text: YES
No
BOX HI12A - (HIQ6185 )
English text: NO
Attribute
Route
Don't know
BOX HI12A - (HIQ6185 )
Refusal
BOX HI12A - (HIQ6185 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
9:03:42 AM Tuesday, May 14, 2013
Page 231 of 346
HI16B
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
341
NeverMedicarePresDru
gPlan
No Medicare Prescription Drug plan ever reported in any
round =
There is no PLAN where PLAN.PLANTYPE = 7/MPDP.
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:03:42 AM Tuesday, May 14, 2013
Page 232 of 346
HI16B1
HI16B1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PDPCOVER
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3343
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
You mentioned that [you have/(SP) has/(SP) had] not been enrolled
in a Medicare Prescription Drug plan associated with (your/his/her)
Medicaid coverage.
At any time since (REFERENCE DATE), [have you/has (SP)/had
(SP)] been enrolled in a Medicare Prescription Drug plan in any way
other than through Medicaid?
Int. Instr II:
9:03:42 AM Tuesday, May 14, 2013
Page 233 of 346
HI16B1
INPUT FIELDS / ROUTING
( HIQ6167 )
PDPCOVER
Field1:
Cheshire Name:
HRND.PDPCOVER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI16C - PDPCURR ( HIQ6169 )
English text: YES
No
BOX HI12A - (HIQ6185 )
English text: NO
Attribute
Don't know
Route
BOX HI12A - (HIQ6185 )
Refusal
BOX HI12A - (HIQ6185 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
341
NeverMedicarePresDru
gPlan
No Medicare Prescription Drug plan ever reported in any
round =
There is no PLAN where PLAN.PLANTYPE = 7/MPDP.
Exclude Deleted Plans. See T.N. 52.
9:03:44 AM Tuesday, May 14, 2013
Page 234 of 346
HI16B1
DESIGN NOTES
9:03:44 AM Tuesday, May 14, 2013
Page 235 of 346
HI16C
HI16C
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PDPCURR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3348
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is alive and not institutionalized, display "currently".
Else do not display.
If SP is deceased, display "on (DATE OF DEATH)".
Else if SP is institutionalized, display "on (DATE OF
INSTITUTIONALIZATION)".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Are you/Is (SP)/Was (SP)] (currently) covered by or enrolled in a
Medicare Prescription Drug plan [on (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]?
Int. Instr II:
9:03:44 AM Tuesday, May 14, 2013
Page 236 of 346
HI16C
INPUT FIELDS / ROUTING
( HIQ6169 )
PDPCURR
Field1:
Cheshire Name:
HRND.PDPCURR
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI16E - PLAN_MPDP ( HIQ6171 )
English text: YES
No
HI16G - PLAN_MPDPOTHR ( HIQ6177 )
English text: NO
Attribute
Don't know
Route
HI16G - PLAN_MPDPOTHR ( HIQ6177 )
Refusal
HI16G - PLAN_MPDPOTHR ( HIQ6177 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
9:03:46 AM Tuesday, May 14, 2013
Page 237 of 346
HI16C
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
9:03:46 AM Tuesday, May 14, 2013
Page 238 of 346
HI16E
HI16E
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PLAN_MPDP
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Name:
Plan Roster
Roster Type:
Single Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
3353
Display as ' Add a Plan '
Display as ' Edit a Plan '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display brackets around question text.
If SP is deceased, display "on (DATE OF DEATH)".
Else if SP is institutionalized, display "on (DATE OF
INSTITUTIONALIZATION)" .
Else do not display.
If SP is deceased or institutionalized, display "covered".
Else display "covers".
Multi Field display:
Roster/Grid Instructions:
Display all health insurance plans from the Plan Roster.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare plan
Medicare Managed Care Plans
Medicaid
Tricare
Public Plans
Private Plans
Medicare Prescription Drug plan if "current" at the time of the
previous round interview
Roster/Grid display:
COL #
1
9:03:46 AM Tuesday, May 14, 2013
HEADER
Plan Name
INSTRUCTIONS
Display PLAN.PLNAME.
Page 239 of 346
HI16E
2
Plan Type
Display PLAN.PLANTYPE:
1/Medicare, display "MCAR"
2/Medicaid, display "MCAD"
3/PublicPlan, display "PUBL"
4/PrivatePlan, display "PRIV"
5/MHMO, display "MHMO"
6/Tricare, display "TRIC"
7/MPDP, display "MPDP"
3
Plan Status
Display CURRENT ROUND PLAN
STATUS.
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[What is the name of the Medicare Prescription Drug plan that
(currently covers/covered) [you/(SP)] [on (DATE OF DEATH/DATE
OF INSTITUTIONALIZATION)]?]
Int. Instr II:
SELECT OR ADD ONLY ONE MEDICARE PRESCRIPTION DRUG
PLAN AT THIS ROSTER.
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
PLAN_MPDP
( HIQ6171 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TPlanPick32
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
32
Route
HI16F - PDPMORE ( HIQ6175 )
BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
9:03:47 AM Tuesday, May 14, 2013
Page 240 of 346
HI16E
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at HI16E.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HI16E.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
The plan selected at HI16E is the SP's current Medicare Prescription Drug plan for the
current round.
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
COVANYTM
Set PLRO.COVANYTM=1/Yes for plan selected at
HI16E.
COVCURNT
Set PLRO.COVCURNT=1/Yes for plan selected at
HI16E.
PLANTYPE
If PLAN added to roster, set
PLAN.PLANTYPE=7/MPDP.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
95
PlanIsCurrent
If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
342
MPDPCurrent
SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
9:03:47 AM Tuesday, May 14, 2013
Page 241 of 346
HI16E
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
53
PlanTypes
Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Advantage: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.
343
MPDPCurrPrevRnd
Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes). Exclude Deleted Plans. See
T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
HI16E is called from ST, NS, CPS when a Medicare Prescription Drug Plan
is added at the Source of Payment roster and SP has already reported a
current Medicare Prescription Drug plan but has now reported a change
regarding which Medicare Prescription Drug plan is current.
9:03:47 AM Tuesday, May 14, 2013
Page 242 of 346
HI16F
HI16F
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PDPMORE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3363
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Question display:
If SP is deceased or institutionalized, display "had (SP)".
Else display "(have you/has SP)".
Display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE)
MPDP: (CURRENT MEDICARE PRESCRIPTION DRUG PLAN)
Int. Instr I:
Question Text:
9:03:47 AM Tuesday, May 14, 2013
[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/ INSTITUTIONALIZATION)], [have you/has
(SP)/had (SP)] been covered by any other Medicare Prescription
Drug plans besides (CURRENT MEDICARE PRESCRIPTION DRUG
PLAN)?
Page 243 of 346
HI16F
Int. Instr II:
INPUT FIELDS / ROUTING
( HIQ6175 )
PDPMORE
Field1:
Cheshire Name:
HRND.PDPMORE
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI16G - PLAN_MPDPOTHR ( HIQ6177 )
English text: YES
No
BOX HI12A - (HIQ6185 )
English text: NO
Attribute
Route
Don't know
BOX HI12A - (HIQ6185 )
Refusal
BOX HI12A - (HIQ6185 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
9:03:49 AM Tuesday, May 14, 2013
Page 244 of 346
HI16F
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
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
9:03:49 AM Tuesday, May 14, 2013
Page 245 of 346
HI16G
HI16G
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PLAN_MPDPOTHR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Plan Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
Yes
Grid Functions:
Add Line
Delete Line
No
No
3368
Display as ' Add a Plan '
Display as ' Edit a Plan '
DISPLAY INSTRUCTIONS:
Context header display:
If SP has a "current" Medicare Prescription Drug plan, display
"(CURRENT PRESCRIPTION DRUG PLAN)". Display the name of
the Medicare Prescription drug plan that is "current' in the current
round, PLAN.PLNAME.
Else if SP had a Medicare Prescription Drug plan was "current" at
the time of the previous round interview, display display
"(PREVIOUS ROUND PRESCRPTION DRUG PLAN)". Display the
name of the Medicare Prescription drug plan that was "current" at
the time of the previous round interview, PLAN.PLNAME.
Else display "NONE".
Question display:
If SP has a "current" Medicare Prescription Drug plan, display
"Besides (CURRENT PRESCRIPTION DRUG PLAN), what other".
Display the name of the Medicare Prescription drug plan that is
"current' in the current round, PLAN.PLNAME
Else if SP had a Medicare Prescription Drug plan was "current" at
the time of the previous round interview, display "Besides
(PREVIOUS ROUND PRESCRPTION DRUG PLAN), what other".
Display the name of the Medicare Prescription drug plan that was
"current" at the time of the previous round interview,
PLAN.PLNAME.
Else display "What".
Multi Field display:
Roster/Grid Instructions:
9:03:49 AM Tuesday, May 14, 2013
Display all health insurance plans from the Plan Roster.
Page 246 of 346
HI16G
Display plans in order of entry.
Display the following plans as protected rows:
Medicare plan
Medicare Managed Care Plans
Medicaid
Tricare
Public Plans
Private Plans
Medicare Prescription Drug plan if "current" at the time of the
previous round interview
Medicare Prescription Drug plan if "current" in the current round
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Plan Name
Display PLAN.PLNAME.
2
Plan Type
Display PLAN.PLANTYPE:
1/Medicare, display "MCAR"
2/Medicaid, display "MCAD"
3/PublicPlan, display "PUBL"
4/PrivatePlan, display "PRIV"
5/MHMO, display "MHMO"
6/Tricare, display "TRIC"
7/MPDP, display "MPDP"
3
Plan Status
Display CURRENT ROUND PLAN
STATUS.
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE)
MPDP: [(CURRENT MEDICARE PRESCRIPTION DRUG
PLAN)/(PREVIOUS ROUND PRESCRIPTION DRUG PLAN)/NONE]
Int. Instr I:
Question Text:
[Besides (CURRENT PRESCRIPTION DRUG PLAN), what
other/Besides (PREVIOUS ROUND PRESCRIPTION DRUG PLAN),
what other/What] Medicare Prescription Drug plans covered
[your/(SP’s)] medicines since (REFERENCE DATE)?
Int. Instr II:
SELECT OR ADD MEDICARE PRESCRIPTION DRUG PLAN
NAMES AT THIS ROSTER.
INPUT FIELDS / ROUTING
9:03:49 AM Tuesday, May 14, 2013
Page 247 of 346
HI16G
Field1:
Cheshire Name:
PLAN_MPDPOTHR
( HIQ6177 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TPlanPick30
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX HI12A - (HIQ6185 )
BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at HI16G.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HI16G.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
Plans selected at HI16G are Medicare Prescription Drug plans that the SP was enrolled in
for some time in the current round but are not the SP's current Medicare Prescription Drug
plan.
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
COVANYTM
Set PLRO.COVANYTM = 1/Yes for all plan selected
at HI16G.
COVCURNT
Set PLRO.COVCURNT = 2/No for all plan selected
at HI16G.
9:03:50 AM Tuesday, May 14, 2013
Page 248 of 346
HI16G
If PLAN added to roster, set
PLAN.PLANTYPE=7/MPDP.
PLANTYPE
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
343
MPDPCurrPrevRnd
Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes). Exclude Deleted Plans. See
T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
95
PlanIsCurrent
If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
53
PlanTypes
Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Advantage: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.
342
MPDPCurrent
SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:03:50 AM Tuesday, May 14, 2013
Page 249 of 346
BOX HI12A
BOX HI12A
Page Order # :
3371
BOX INSTRUCTIONS
( HIQ6185 )
IF AT LEAST ONE PRIVATE PLAN WAS "CURRENT" AT THE TIME OF THE
PREVIOUS ROUND INTERVIEW, GO TO HI17PREV - PRIVINTRO (
HIQ6190 ).
ELSE GO TO HI17 - PRVCOVER ( HIQ6205 ).
ASSIGNMENTS
If a private plan was current at the time of the previous round interview, then the SP was
also covered by this private plan for some time during the current round.
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
81
PrivateCurrentPrevRnd
Private plan "current" at the time of previous round
interview =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=prev. round & (COVTIME=1/WholeTime or
COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:03:50 AM Tuesday, May 14, 2013
Page 250 of 346
HI17PREV
HI17PREV
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
PRIVINTRO
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3372
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
The next questions are about private plans [you were/(SP) was]
covered by as of (REFERENCE DATE).
Int. Instr II:
INPUT FIELDS / ROUTING
9:03:51 AM Tuesday, May 14, 2013
Page 251 of 346
HI17PREV
Field1:
PRIVINTRO
Cheshire Name:
( HIQ6190 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI17PREV_IN - NAVIGATOR ( HIQ6195 )
English text: CONTINUE
Attribute
Route
Empty
HI17PREV_IN - NAVIGATOR ( HIQ6195 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
9:03:51 AM Tuesday, May 14, 2013
Page 252 of 346
HI17PREV_IN
HI17PREV_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
3373
Roster Name:
Roster Type:
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display all private plans that were "current" at the time of the
previous round interview.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
9:03:52 AM Tuesday, May 14, 2013
Page 253 of 346
HI17PREV_IN
Field1:
NAVIGATOR
Cheshire Name:
( HIQ6195 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HI12B - (HIQ6200 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
HI17 - PRVCOVER ( HIQ6205 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of private plan being asked about from the previous round.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of private plan being asked about from the previous
round.
PLRO.PLRORND = current round.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
9:03:53 AM Tuesday, May 14, 2013
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 254 of 346
HI17PREV_IN
81
PrivateCurrentPrevRnd
Private plan "current" at the time of previous round
interview =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=prev. round & (COVTIME=1/WholeTime or
COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:03:53 AM Tuesday, May 14, 2013
Page 255 of 346
BOX HI12B
BOX HI12B
Page Order # :
3374
BOX INSTRUCTIONS
( HIQ6200 )
CREATE A CURRENT ROUND PLRO FOR PRIVATE PLAN .
GO TO HI21 - COVTIME ( HIQ6230 ).
ASSIGNMENTS
If Private plan was current at the time of the previous round interview, then the SP was also
covered by the Private plan for some time during the current round.
Create a current round PLRO to store the status of this private plan in the current round.
PLRO KEY = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
In addition, set HMO flag, PLRO.PPRVHMO, to equal value from previous round.
See detailed instructions below.
PLROPLAN
PLRO.PLROPLAN = PLAN.PLANNUM of Private
Plan current at time of previous round.
PLRORND
PLRO.PLRORND = current round.
PPRVHMO
Set current round PLRO.PPRVHMO = previous
round PLRO.PPRVHMO.
TECHNICAL NOTES
DESIGN NOTES
9:03:53 AM Tuesday, May 14, 2013
Page 256 of 346
HI17
HI17
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PRVCOVER
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3380
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
If SP is deceased or institutionalized, display "[- (REFERENCE
PERIOD END DATE)]".
Else do not display.
Question display:
If no private plans were "current" at the time of the previous round
interview, display "Now, I would like to ask about other types of
health insurance.".
Else do not display.
If SP is deceased or institutionalized, display "was (SP)".
Else is SP is the respondent, display "have you".
Else display "has (SP) been".
If SP has reported being covered by any private plan in the current
round, display "any other" and "plan".
Else display "plans".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report above question text.
Display all insurance plans SP reported being covered by in the
current round in the following order:
First line:
9:03:53 AM Tuesday, May 14, 2013
Page 257 of 346
HI17
If SP was covered by a Medicare Managed care plan, display name
of this Medicare Managed care plan.
Else display "MEDICARE" for the Medicare plan.
Next list Medicaid, Tricare, all Public Plans, all Private Plans and all
Medicare Prescription Drug Plans. If there is more than one plan of
any type, display in order of entry.
Report header: PLANS REPORTED IN THE CURRENT ROUND
Column 1, header = "Plan Name", display PLAN.PLNAME.
Column 2, header = "Plan Type", display PLAN.PLANTYPE:
If PLANTYPE=1/Medicare, display "MCAR".
If PLANTYPE=2/Medicaid, display "MCAD".
If PLANTYPE=3/PublicPlan, display "PUBL".
If PLANTYPE=4/PrivatePlan, display "PRIV".
If PLANTYPE=5/MHMO, display "MHMO".
If PLANTYPE=6/Tricare, display "TRIC".
If PLANTYPE=7MPDP, display "MPDP".
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE) [- (REFERENCE
PERIOD END DATE)]
Int. Instr I:
Question Text:
We’ve talked about [READ PLAN(S) LISTED ABOVE].
(Now, I would like to ask about other types of health insurance.) At
any time [since (REFERENCE DATE)/between (PREVIOUS ROUND
INTERVIEW DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], [have you/has (SP) been/was (SP)]
covered by (any other) private health insurance or private managed
care (plan/plans)?
By "private", I mean a supplemental or Medigap plan, or a plan that
is provided by a former or current employer. Such plans cover the
cost of hospital or doctor visits, prescribed medicines, or dental care.
Int. Instr II:
INPUT FIELDS / ROUTING
9:03:54 AM Tuesday, May 14, 2013
Page 258 of 346
HI17
Field1:
( HIQ6205 )
PRVCOVER
Cheshire Name:
Item Text display:
HRND.PRVCOVER
Do not display response option 3/YesButOriginallyNo.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TPrvCover
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI20 - PLAN_PRIVATE ( HIQ6220 )
2
English text: YES
No
3
English text: NO
YesButOriginallyNo
BOX HI13A - (HIQ6210 )
DO NOT DISPLAY.
English text: DATA EDITING ONLY.
Attribute
Route
Don't know
BOX HI13A - (HIQ6210 )
Refusal
BOX HI13A - (HIQ6210 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
9:03:56 AM Tuesday, May 14, 2013
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 259 of 346
HI17
53
PlanTypes
Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Advantage: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.
93
AnyPlansCurrentRnd
SP reported being covered by any plans during the
current round =
There is PLAN & PLRO where (PLRO.PLROPLAN =
PLAN.PLANNUM & PLRO.PLRORND = current round &
(PLRO.COVTIME ^= empty or PLRO.COVANYTIM =
1/Yes)).
Exclude Deleted Plans. See T.N. 52.
81
PrivateCurrentPrevRnd
Private plan "current" at the time of previous round
interview =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=prev. round & (COVTIME=1/WholeTime or
COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
9:03:56 AM Tuesday, May 14, 2013
Page 260 of 346
BOX HI13A
BOX HI13A
Page Order # :
3410
BOX INSTRUCTIONS
( HIQ6210 )
IF (SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP IS NEW FROM
FACILITY), GO TO HI19 - GAPCOVER ( HIQ6215 ).
ELSE GO TO HI35 - PRVOCOV ( HIQ7590 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
25
NewFromFacility
SP is new from facility (i.e. all previous round interviews
were in a facility) =
MRES.INTTYPE=2/NewFromFacility on MRES where
MRES.MRESRND = current round.
DESIGN NOTES
9:03:56 AM Tuesday, May 14, 2013
Page 261 of 346
HI19
HI19
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
GAPCOVER
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3420
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
Some people who are eligible for Medicare have additional coverage
through a private insurance carrier. This is sometimes referred to as
Medigap or Medicare Supplement. At any time since (REFERENCE
DATE) did [you/(SP)] have this type of health insurance coverage?
Int. Instr II:
INPUT FIELDS / ROUTING
9:03:56 AM Tuesday, May 14, 2013
Page 262 of 346
HI19
Field1:
GAPCOVER
Cheshire Name:
( HIQ6215 )
HRND.GAPCOVER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI20 - PLAN_PRIVATE ( HIQ6220 )
English text: YES
No
HI35 - PRVOCOV ( HIQ7590 )
English text: NO
Attribute
Route
Don't know
HI35 - PRVOCOV ( HIQ7590 )
Refusal
HI35 - PRVOCOV ( HIQ7590 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
9:03:58 AM Tuesday, May 14, 2013
Page 263 of 346
HI20
HI20
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PLAN_PRIVATE
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Name:
Plan Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
3430
Display as ' Add a Plan '
Display as ' Edit a Plan '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(other)" in parenthesis.
If SP is deceased or institutionalized, display "provided".
Else display "provide".
Multi Field display:
Roster/Grid Instructions:
Display all health insurance plans from the Plan Roster.
Display plans in order of entry.
Display the following plans as protected rows:
Medicare
Medicare Managed Care plans.
Medicaid
Tricare
Public plans
Private plans that SP has already reported being covered by durng
the current round, this includes plans that are current or have
stopped in current round.
Medicare Prescription Drug Plans
SELECTION IS NOT REQUIRED ON THIS ROSTER.
Roster/Grid display:
COL #
1
9:03:58 AM Tuesday, May 14, 2013
HEADER
Plan Name
INSTRUCTIONS
Display PLAN.PLNAME.
Page 264 of 346
HI20
2
Plan Type
Display PLAN.PLANTYPE:
1/Medicare, display "MCAR"
2/Medicaid, display "MCAD"
3/PublicPlan, display "PUBL"
4/PrivatePlan, display "PRIV"
5/MHMO, display "MHMO"
6/Tricare, display "TRIC"
7/MPDP, display "MPDP"
3
Plan Status
Display CURRENT ROUND PLAN
STATUS.
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What is the name of each of the (other) private plans that
(provide/provided) [your/(SP’s)] medical insurance coverage?
Int. Instr II:
SELECT OR ADD ALL PRIVATE PLAN NAMES AT THIS ROSTER.
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
PLAN_PRIVATE
( HIQ6220 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TPlanPick32
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
32
Route
HI20_IN - NAVIGATOR ( HIQ6225 )
BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at HI20.
9:03:59 AM Tuesday, May 14, 2013
Page 265 of 346
HI20
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HI20.
PLRO.PLRORND = current round.
If Plan added, see PLAN ROSTER POP-UP specifications for pop-up window programming
instructions:
Variables populated in Plan Roster Pop-Up Window:
PLAN.PLANNUM
PLAN.PLANRNDC
PLAN.PLANTYPE
PLAN.PLNAME
Plans selected at HI20 are Private plans that the SP was enrolled in for some time in the
current round.
To set status of PLAN, create current round PLRO where PLRO.PLROPLAN=this
PLAN.PLANNUM and PLRO.PLRORND = current round.
See detailed instructions below:
PLROPLAN
PLRO.PLROPLAN=this PLAN.PLANNUM.
PLRORND
PLRO.PLRORND=current round.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
53
PlanTypes
Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Advantage: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.
93
AnyPlansCurrentRnd
SP reported being covered by any plans during the
current round =
There is PLAN & PLRO where (PLRO.PLROPLAN =
PLAN.PLANNUM & PLRO.PLRORND = current round &
(PLRO.COVTIME ^= empty or PLRO.COVANYTIM =
1/Yes)).
Exclude Deleted Plans. See T.N. 52.
95
PlanIsCurrent
If plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
9:03:59 AM Tuesday, May 14, 2013
Page 266 of 346
HI20
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
61
ThisPlanNew
This Plan is new =
PLAN.PLANRNDC = current round and
PLAN.PLANSUMM ^= 1/Yes.
Exclude Deleted Plans. See T.N. 52.
474
ThisPlanNewPrevRnd
This Plan added in HIS and was a new Plan during the
previous round reference period =
PLAN.PLANRNDC=previous round and
PLAN.PLANSUMM = 1/Yes. Exclude Deleted Plans. See
T.N. 52.
DESIGN NOTES
9:03:59 AM Tuesday, May 14, 2013
Page 267 of 346
HI20_IN
HI20_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
3440
Roster Name:
Roster Type:
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display plans selected at HI20.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
9:03:59 AM Tuesday, May 14, 2013
Page 268 of 346
HI20_IN
Field1:
NAVIGATOR
Cheshire Name:
( HIQ6225 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI21 - COVTIME ( HIQ6230 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
HI35 - PRVOCOV ( HIQ7590 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
Plan details are collected on PLAN and PLRO:
PLAN key = PLAN.PLANBASE + PLAN.PLANNUM
PLAN.PLANNUM = Number of plan selected at HI20.
PLRO key = PLRO.PLROBASE + PLRO.PLROPLAN + PLRO.PLRORND
PLRO.PLROPLAN = PLAN.PLANNUM of plan selected at HI20.
PLRO.PLRORND = current round.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
9:04:00 AM Tuesday, May 14, 2013
Page 269 of 346
HI21
HI21
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
COVTIME
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3450
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
Question display:
If asking about a private plan that was "current" at the time of the
previous round interview, display "At the time of the last interview...".
Else do not display.
Display plan name for the private plan being asked about,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
PRIVATE INSURANCE PLAN: (PRIVATE PLAN NAME)
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
9:04:00 AM Tuesday, May 14, 2013
[At the time of the last interview [you were/(SP) was] covered by
(PRIVATE PLAN NAME).] [Were you/Was (SP)] covered by
(PRIVATE PLAN NAME) the whole time between (REFERENCE
DATE) and (today/ DATE OF DEATH/DATE OF
Page 270 of 346
HI21
INSTITUTIONALIZATION), or only part of the time?
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
( HIQ6230 )
COVTIME
Cheshire Name:
PLRO.COVTIME
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TCovtime
1
No
No
Number Label
1 WholeTime
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HI17 - (HIQ6940 )
English text: THE WHOLE TIME
PartOfTime
HI22 - COVNOW ( HIQ6260 )
English text: PART OF THE TIME
Attribute
Route
Don't know
HI22 - COVNOW ( HIQ6260 )
Refusal
HI22 - COVNOW ( HIQ6260 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
9:04:02 AM Tuesday, May 14, 2013
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 271 of 346
HI21
81
PrivateCurrentPrevRnd
Private plan "current" at the time of previous round
interview =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=prev. round & (COVTIME=1/WholeTime or
COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
HI21 called from ST, NS, CPS when private plan is added at the Source of
Payment Roster.
9:04:02 AM Tuesday, May 14, 2013
Page 272 of 346
HI22
HI22
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
COVNOW
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3480
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
Question display:
If SP is deceased or institutionalized, display "Was (SP) covered by
(PRIVATE PLAN NAME) on (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)?".
Else display "[Are you/Is (SP)] now covered by (PRIVATE PLAN
NAME)?".
Display plan name for the private plan being asked about,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
PRIVATE PLAN: (PRIVATE PLAN NAME)
Int. Instr I:
Question Text:
9:04:03 AM Tuesday, May 14, 2013
[[Are you/Is (SP)] now covered by (PRIVATE PLAN NAME)?] [Was
(SP) covered by (PRIVATE PLAN NAME) on (DATE OF DEATH/
DATE OF INSTITUTIONALIZATION)?]
Page 273 of 346
HI22
Int. Instr II:
INPUT FIELDS / ROUTING
( HIQ6260 )
COVNOW
Field1:
Cheshire Name:
PLRO.COVNOW
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HI16 - (HIQ6270 )
English text: YES
No
HI24 - COVENDMM ( HIQ6910 )
English text: NO
Attribute
Route
Don't know
BOX HI17 - (HIQ6940 )
Refusal
BOX HI17 - (HIQ6940 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
9:04:04 AM Tuesday, May 14, 2013
Page 274 of 346
HI22
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
9:04:04 AM Tuesday, May 14, 2013
Page 275 of 346
BOX HI16
BOX HI16
Page Order # :
3490
BOX INSTRUCTIONS
( HIQ6270 )
IF THIS PRIVATE PLAN WAS "CURRENT" AT THE TIME OF THE
PREVIOUS ROUND INTERVIEW, GO TO BOX HI17 - (HIQ6940 ).
ELSE GO TO HI23 - COVBEGMM ( HIQ6880 ).
ASSIGNMENTS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
63
ThisPlanCurrentPrevRn
d
This Plan was "current" at the time of the previous round
interview =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:04:04 AM Tuesday, May 14, 2013
Page 276 of 346
HI23
HI23
Page Order # :
Design Screen Type:
Date
Fields:
Field 1:
COVBEGMM
Field 2:
COVBEGDD
Field 3:
COVBEGYY
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
3860
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
Question display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
Multi Field display:
Horizontal Alignment
Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
PRIVATE PLAN: (PRIVATE PLAN NAME)
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
On what date did [your/(SP’s)] coverage under (PRIVATE PLAN
NAME) start between (REFERENCE DATE) and (today/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)?
Int. Instr II:
9:04:05 AM Tuesday, May 14, 2013
Page 277 of 346
HI23
INPUT FIELDS / ROUTING
COVBEGMM
Field1:
Cheshire Name:
( HIQ6880 )
PLRO.COVBEGMM
Item Text display:
Item Text:
Label:
Label Position:
MM
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMonthInt
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
HI23 - COVBEGDD ( HIQ6890 )
Refusal
HI23 - COVBEGDD ( HIQ6890 )
9:04:07 AM Tuesday, May 14, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
01
12
Route
HI23 - COVBEGDD ( HIQ6890 )
Page 278 of 346
HI23
Field2:
COVBEGDD
Cheshire Name:
( HIQ6890 )
PLRO.COVBEGDD
Item Text display:
Item Text:
Label:
Label Position:
DD
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDayDKRF
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
HI23 - COVBEGYY ( HIQ6900 )
Refusal
HI23 - COVBEGYY ( HIQ6900 )
9:04:09 AM Tuesday, May 14, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
1
31
Route
HI23 - COVBEGYY ( HIQ6900 )
Page 279 of 346
HI23
Field3:
( HIQ6900 )
COVBEGYY
Cheshire Name:
PLRO.COVBEGYY
Item Text display:
Item Text:
Label:
Label Position:
YY
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMcyear
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
0
99
Route
BOX HI17 - (HIQ6940 )
Attribute
Route
Don't know
BOX HI17 - (HIQ6940 )
Refusal
BOX HI17 - (HIQ6940 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
EDIT #1
PLAN BEGIN DATE, COVBEGMM/COVBEGDD/COVBEGYY,
should be on or between (REFERENCE DATE) and (REFERENCE
PERIOD END DATE).
If not true, display message: "DATE MUST BE ON OR BETWEEN
(REFERENCE DATE) AND (REFERENCE PERIOD END DATE).
PLEASE REENTER."
TECHNICAL NOTES
114
CoverageStartDate
Health Insurance Plan coverage start date =
PLRO.COVBEGMM / PLRO.COVBEGDD /
PLRO.COVBEGYY.
Check PLRO where PLRO.PLROPLAN =
PLAN.PLANNUM and PLRO.PLRORND = round #
checking.
DESIGN NOTES
9:04:10 AM Tuesday, May 14, 2013
Page 280 of 346
HI23
9:04:10 AM Tuesday, May 14, 2013
Page 281 of 346
HI24
HI24
Page Order # :
Design Screen Type:
Date
Fields:
Field 1:
COVENDMM
Field 2:
COVENDDD
Field 3:
COVENDYY
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
3870
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
Question display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
Multi Field display:
Horizontal Alignment
Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
PRIVATE PLAN: (PRIVATE PLAN NAME)
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
9:04:12 AM Tuesday, May 14, 2013
On what date since [(REFERENCE DATE)/between (PREVIOUS
ROUND INTERVIEW DATE) and (DATE OF DEATH/
DATE OF INSTITUTIONALIZATION)] did [your/(SP’s)] coverage
under (PRIVATE PLAN NAME) stop?
Page 282 of 346
HI24
Int. Instr II:
INPUT FIELDS / ROUTING
COVENDMM
Field1:
Cheshire Name:
( HIQ6910 )
PLRO.COVENDMM
Item Text display:
Item Text:
Label:
Label Position:
MM
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMonthInt
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
HI24 - COVENDDD ( HIQ6920 )
Refusal
HI24 - COVENDDD ( HIQ6920 )
9:04:14 AM Tuesday, May 14, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
01
12
Route
HI24 - COVENDDD ( HIQ6920 )
Page 283 of 346
HI24
Field2:
COVENDDD
Cheshire Name:
( HIQ6920 )
PLRO.COVENDDD
Item Text display:
Item Text:
Label:
Label Position:
DD
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDayDKRF
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
HI24 - COVENDYY ( HIQ6930 )
Refusal
HI24 - COVENDYY ( HIQ6930 )
9:04:16 AM Tuesday, May 14, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
1
31
Route
HI24 - COVENDYY ( HIQ6930 )
Page 284 of 346
HI24
Field3:
( HIQ6930 )
COVENDYY
Cheshire Name:
PLRO.COVENDYY
Item Text display:
Item Text:
Label:
Label Position:
YY
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMcyear
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
0
99
Route
BOX HI17 - (HIQ6940 )
Attribute
Route
Don't know
BOX HI17 - (HIQ6940 )
Refusal
BOX HI17 - (HIQ6940 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
EDIT #1
PLAN END DATE, COVENDMM/COVENDDD/COVENDYY, should
be on or between (REFERENCE DATE) and (REFERENCE
PERIOD END DATE).
If not true, display message: "DATE MUST BE ON OR BETWEEN
(REFERENCE DATE) AND (REFERENCE PERIOD END DATE).
PLEASE REENTER."
TECHNICAL NOTES
115
CoverageStopDate
Health Insurance Plan coverage stop date =
PLRO.COVENDMM / PLRO.COVENDDD /
PLRO.COVENDYY.
Check PLRO where PLRO.PLROPLAN =
PLAN.PLANNUM and PLRO.PLRORND = round #
checking.
DESIGN NOTES
9:04:17 AM Tuesday, May 14, 2013
Page 285 of 346
HI24
9:04:17 AM Tuesday, May 14, 2013
Page 286 of 346
BOX HI17
BOX HI17
Page Order # :
3880
BOX INSTRUCTIONS
( HIQ6940 )
IF THIS PRIVATE PLAN IS NEW OR HAS BEEN "RESTARTED", GO TO
HI25 - PPRVHMO ( HIQ6970 ).
ELSE IF THIS PRIVATE PLAN WAS "CURRENT" AT THE TIME OF THE
PREVIOUS ROUND INTERVIEW AND IS STILL "CURRENT", AND IT IS A
FALL ROUND, GO TO HI26 - PERS_MIPNUM ( HIQ6990 ).
ELSE GO TO HI30 - PRVRXCOV ( HIQ7155 ).
ASSIGNMENTS
TECHNICAL NOTES
61
ThisPlanNew
This Plan is new =
PLAN.PLANRNDC = current round and
PLAN.PLANSUMM ^= 1/Yes.
Exclude Deleted Plans. See T.N. 52.
62
ThisPlanRestarted
This Plan has been restarted =
For this PLAN, there is no PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND = previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
63
ThisPlanCurrentPrevRn
d
This Plan was "current" at the time of the previous round
interview =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
71
ThisPlanCurrent
This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
98
FallRound
If the remainder of (Current round divided by 3) = 1, then
it is a Fall round.
DESIGN NOTES
9:04:17 AM Tuesday, May 14, 2013
Page 287 of 346
HI25
HI25
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PPRVHMO
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3890
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
Question display:
If (this private plan not "current") or (SP is deceased or
institutionalized), display "Was".
Else display "Is".
Always display "(Health Maintenance Organization)" and
"(Preferred Provider Organization)" in parenthesis.
Always display "(network)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
PRIVATE INSURANCE PLAN = (PRIVATE PLAN NAME)
Int. Instr I:
CODE WITHOUT ASKING IF VOLUNTEERED.
Question Text:
(Is/Was) this a managed care plan, such as an HMO (Health
Maintenance Organization) or PPO (Preferred Provider
Organization)?
9:04:18 AM Tuesday, May 14, 2013
Page 288 of 346
HI25
[EXPLAIN IF NECESSARY: Managed care plans generally provide
a full range of health care services for a prepaid fee. Health care is
generally provided by primary care doctors, specialists, or hospitals
on the plan’s list (network) except in an emergency.]
Int. Instr II:
INPUT FIELDS / ROUTING
PPRVHMO
Field1:
Cheshire Name:
( HIQ6970 )
PLRO.PPRVHMO
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI26 - PERS_MIPNUM ( HIQ6990 )
English text: YES
No
HI26 - PERS_MIPNUM ( HIQ6990 )
English text: NO
Attribute
Don't know
Route
HI26 - PERS_MIPNUM ( HIQ6990 )
Refusal
HI26 - PERS_MIPNUM ( HIQ6990 )
BACKGROUND VARIABLE ASSIGNMENTS
If PLAN is new in the current round, store response to HI25 - PPRVHMO also on PLAN
record. Set variable as instructed below.
PRVHMO
If PLAN is new in the current round, set
PLAN.PRVHMO=PLRO.PPRVHMO.
SOFT EDIT CHECKS
HARD EDIT CHECKS
9:04:20 AM Tuesday, May 14, 2013
Page 289 of 346
HI25
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
71
ThisPlanCurrent
This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:04:20 AM Tuesday, May 14, 2013
Page 290 of 346
HI26
HI26
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PERS_MIPNUM
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Name:
Person Roster
Roster Type:
Single Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
Yes
Grid Functions:
Add Line
Delete Line
No
No
3900
Display as ' Add a Person '
Display as ' Edit a Person '
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
Question display:
If (this private plan is not "current") or (SP is deceased or
institutionalized), display "was".
Else display "is".
Display plan name for the private plan being asked about,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Display all persons from the Person Roster.
Display SP on first line, followed by the name of the SP's spouse.
Display remaining persons in the order that they were entered in
Person Roster.
Do not allow SP to be edited.
Roster/Grid display:
9:04:20 AM Tuesday, May 14, 2013
COL #
HEADER
INSTRUCTIONS
1
First Name
Display ROST.ROSTFNAM.
2
Last Name
Display ROST.ROSTLNAM.
Page 291 of 346
HI26
3
Relationship to SP
Display Relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.
Report display:
TEXT:
PRIVATE PLAN: (PRIVATE PLAN NAME)
Context Header:
Int. Instr I:
Question Text:
Who (is/was) listed as the main insured person on the (PRIVATE
PLAN NAME) policy or contract?
Int. Instr II:
SELECT OR ADD ONLY ONE PERSON.
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
PERS_MIPNUM
( HIQ6990 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TRostPick4
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
4
Route
HI27 - PPRVGET ( HIQ7010 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on ROST:
ROST key = ROST.ROSTBASE + ROST.ROSTNUM
ROST.ROSTNUM = Number of Person selected at HI26.
If Person added, see PERSON ROSTER POP-UP specifications for pop-up window
programming instructions:
Variables populated in Person Roster Pop-Up Window:
ROST.ROSTNUM
9:04:21 AM Tuesday, May 14, 2013
Page 292 of 346
HI26
ROST.ROSTRNDC
ROST.ROSTREAS
ROST.ROSTFNAM
ROST.ROSTLNAM
ROST.ROSTREL
ROST.ROSTREOS
Person selected at HI26 is the Main Insured Person (MIP). The ROST.ROSTNUM for the
MIP is stored on PLAN and the PLAN's current round PLRO.
If person added to roster, set reason on ROST where ROST.ROSTNUM = number of
person added.
If a Person is edited then the following fields may be updated in the Person Roster Pop-Up:
If the Person's relationship is updated and ROST.ROSTSEX ^= Null and the Person's
gender no longer matches the Person's relationship, update ROST.ROSTSEX based on
the specifications below. Note, if ROST.ROSTSEX has never been collected,
ROST.ROSTSEX = Null, do not set ROST.ROSTSEX.
If the Person's relationship is updated and original relationship = 91/OtherRelative or
92/OtherNon_Relative and updated relationship ^= 91/OtherRelative and ^=
92/OtherNon_Relative, update ROST.ROSTREOS = empty.
See detailed instructions below.
ROSTREAS
If person added to roster, set
ROST.ROSTREAS=6/MIP.
MIPNUM
PLRO.MIPNUM=ROST.ROSTNUM of person
selected.
PLMIPNUM
PLAN.PLMIPNUM=PLRO.MIPNUM. (NOTE for
future reference. Will need to create TRNS if
PLMIPNUM is being updated from previous round).
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
96
SPsSpouse
SP's Spouse =
There is a ROST where ROST.ROSTREL=2/Spouse.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
9:04:21 AM Tuesday, May 14, 2013
Page 293 of 346
HI26
71
ThisPlanCurrent
This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:04:21 AM Tuesday, May 14, 2013
Page 294 of 346
HI27
HI27
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
PPRVGET
Field 2:
PPRVGTOS
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
3910
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
MIP:
If the respondent is the MIP, display "SP" .
Else display the name of the MIP.
Question display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
If the respondent is the MIP, display "you" .
Else display the name of the MIP.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
PRIVATE PLAN: (PRIVATE PLAN NAME)
MIP: [SP/(MIP)]
Int. Instr I:
9:04:22 AM Tuesday, May 14, 2013
Page 295 of 346
HI27
Question Text:
For the (PRIVATE PLAN NAME) plan, did [you/(MIP)] sign up
directly, or did [you/(MIP)] get this insurance through a current
employer, a former employer, a union, a family business, AARP, or
some other way?
Int. Instr II:
INPUT FIELDS / ROUTING
9:04:24 AM Tuesday, May 14, 2013
Page 296 of 346
HI27
Field1:
PPRVGET
Cheshire Name:
Item Text display:
( HIQ7010 )
PLRO.PPRVGET
Display name of MIP in response categories.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TPrvget
1
No
No
Number Label
1 Directly
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI29 - PRVNMCOV ( HIQ7150 )
2
English text: DIRECTLY
CurrentEmployer
3
English text: (MIP'S) CURRENT EMPLOYER
FormerEmployer
HI29 - PRVNMCOV ( HIQ7150 )
4
English text: (MIP'S) FORMER EMPLOYER
Union
HI29 - PRVNMCOV ( HIQ7150 )
5
English text: (MIP'S) UNION
FamilyBusiness
HI29 - PRVNMCOV ( HIQ7150 )
6
English text: (MIP'S) FAMILY BUSINESS
Aarp
HI29 - PRVNMCOV ( HIQ7150 )
7
English text: AARP
DecSpousesEmployer
HI29 - PRVNMCOV ( HIQ7150 )
8
English text: DECEASED SPOUSE'S EMPLOYER
DecSpousesUnion
HI29 - PRVNMCOV ( HIQ7150 )
9
English text: DECEASED SPOUSE'S UNION
ProfessionalOrg
91
HI29 - PRVNMCOV ( HIQ7150 )
HI29 - PRVNMCOV ( HIQ7150 )
English text: PROFESSIONAL/FRATERNAL ORGANIZATION
Other
HI27 - PPRVGTOS ( HIQ7030 )
English text: SOME OTHER WAY
Attribute
Route
Don't know
HI29 - PRVNMCOV ( HIQ7150 )
Refusal
HI29 - PRVNMCOV ( HIQ7150 )
9:04:26 AM Tuesday, May 14, 2013
Page 297 of 346
HI27
Field2:
( HIQ7030 )
PPRVGTOS
Cheshire Name:
PLRO.PPRVGTOS
Item Text display:
Display "(SPECIFY)" in same blue font used for interviewer
instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
30
Route
HI29 - PRVNMCOV ( HIQ7150 )
BACKGROUND VARIABLE ASSIGNMENTS
If PLAN is new in the current round, store response to HI27 - PPRVGET and PPRVGTOS
also on PLAN record. Set variable as instructed below.
PRVGET
If PLAN is new in the current round, set
PLAN.PRVGET=PLRO.PPRVGET.
PRVGETOS
If PLAN is new in the current round, set
PLAN.PRVGETOS=PLRO.PPRVGTOS.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
82
MIP
9:04:27 AM Tuesday, May 14, 2013
Main insured person (MIP) for this PLAN =
PLAN.PLMIPNUM.
MIP name = ROST.ROSTFNAM + ROST.ROSTLNAM on
ROST where ROST.ROSTNUM = PLAN.PLMIPNUM.
Page 298 of 346
HI27
DESIGN NOTES
9:04:27 AM Tuesday, May 14, 2013
Page 299 of 346
HI29
HI29
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
PRVNMCOV
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3960
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
MIP:
If the respondent is the MIP, display "SP" .
Else display the name of the MIP.
Question display:
If (this private plan is not "current") or (SP is deceased or
institutionalized), display "were".
Else display "are".
If the respondent is the MIP display "your".
Else display name of the MIP selected at HI26.
Display plan name for the private plan being asked about,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
9:04:27 AM Tuesday, May 14, 2013
PRIVATE PLAN: (PRIVATE PLAN NAME)
Page 300 of 346
HI29
MIP: [SP/(MIP)]
REFERENCE PERIOD: (SURVEY REFERENCE DATE)
(REFERENCE DATE)
Int. Instr I:
How many family members, including [yourself/(SP)], (are/were)
covered by [your/(MIP’s)] (PRIVATE PLAN NAME)?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
PRVNMCOV
Field1:
Cheshire Name:
( HIQ7150 )
PLRO.PRVNMCOV
Item Text display:
Item Text:
Label:
Label Position:
NUMBER COVERED:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TPrvnmcov
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
HI30 - PRVRXCOV ( HIQ7155 )
Refusal
HI30 - PRVRXCOV ( HIQ7155 )
FieldSize:
Min Value:
Max Value:
Mask:
1
15
Route
HI30 - PRVRXCOV ( HIQ7155 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
PRVNMCOV = 1-4.
If not true, display message "THE AMOUNT ENTERED SEEMS
UNLIKELY. PLEASE VERIFY.".
HARD EDIT CHECKS
TECHNICAL NOTES
9:04:28 AM Tuesday, May 14, 2013
Page 301 of 346
HI29
82
MIP
Main insured person (MIP) for this PLAN =
PLAN.PLMIPNUM.
MIP name = ROST.ROSTFNAM + ROST.ROSTLNAM on
ROST where ROST.ROSTNUM = PLAN.PLMIPNUM.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
71
ThisPlanCurrent
This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:04:28 AM Tuesday, May 14, 2013
Page 302 of 346
HI30
HI30
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PRVRXCOV
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3990
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
MIP:
If the respondent is the MIP, display "SP" .
Else display the name of the MIP.
Question display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
If (this private plan is not "current") or (SP is deceased or
institutionalized), display "included".
Else display "includes".
Display "[you/(SP)]" in text of probe in BOLD.
If (this private plan is not "current") or (SP is deceased or
institutionalized), display "had".
Else if SP is respondent, display "have".
Else display "has".
If (this private plan is not "current") or (SP is deceased or
institutionalized), display "Did".
Else display "Does".
If the respondent is the MIP display "your".
Else display the name of the MIP.
Multi Field display:
9:04:29 AM Tuesday, May 14, 2013
Page 303 of 346
HI30
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MIP: [SP/(MIP)]
PRIVATE PLAN: (PRIVATE PLAN NAME)
Int. Instr I:
Question Text:
Supplemental insurance plans may cover a variety of services or
may be specific to only certain services, such as prescribed
medicines or dental coverage. I’d like to know what [your/(SP’s)]
(PLAN NAME) coverage (includes/included).
[PROBE: I am asking about the type of insurance coverage that
[you/(SP)] personally (have/has/had), not what the plan offers
everyone.]
(Does/Did) [your/(MIP’s)] (PRIVATE PLAN NAME) plan cover
prescribed medicines?
Int. Instr II:
INPUT FIELDS / ROUTING
9:04:30 AM Tuesday, May 14, 2013
Page 304 of 346
HI30
Field1:
( HIQ7155 )
PRVRXCOV
Cheshire Name:
PLRO.PRVRXCOV
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HI17AB - (HIQ7160 )
English text: YES
No
BOX HI17AB - (HIQ7160 )
English text: NO
Attribute
Route
Don't know
BOX HI17AB - (HIQ7160 )
Refusal
BOX HI17AB - (HIQ7160 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
9:04:32 AM Tuesday, May 14, 2013
Page 305 of 346
HI30
82
MIP
Main insured person (MIP) for this PLAN =
PLAN.PLMIPNUM.
MIP name = ROST.ROSTFNAM + ROST.ROSTLNAM on
ROST where ROST.ROSTNUM = PLAN.PLMIPNUM.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
71
ThisPlanCurrent
This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:04:32 AM Tuesday, May 14, 2013
Page 306 of 346
BOX HI17AB
BOX HI17AB
Page Order # :
3995
BOX INSTRUCTIONS
( HIQ7160 )
IF (THIS PRIVATE PLAN IS NEW OR HAS BEEN "RESTARTED") OR (THIS
PRIVATE PLAN WAS "CURRENT" AT THE TIME OF THE PREVIOUS
ROUND INTERVIEW AND IS STILL "CURRENT", AND IT IS A FALL
ROUND), GO TO HI31A - PRVMSCOV ( HIQ7190 ).
ELSE GO TO BOX HI19 - (HIQ7570 ).
ASSIGNMENTS
TECHNICAL NOTES
61
ThisPlanNew
This Plan is new =
PLAN.PLANRNDC = current round and
PLAN.PLANSUMM ^= 1/Yes.
Exclude Deleted Plans. See T.N. 52.
62
ThisPlanRestarted
This Plan has been restarted =
For this PLAN, there is no PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND = previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
63
ThisPlanCurrentPrevRn
d
This Plan was "current" at the time of the previous round
interview =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
71
ThisPlanCurrent
This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
98
FallRound
If the remainder of (Current round divided by 3) = 1, then
it is a Fall round.
DESIGN NOTES
9:04:32 AM Tuesday, May 14, 2013
Page 307 of 346
HI31A
HI31A
Page Order # :
Design Screen Type:
List
Fields:
Field 1:
PRVMSCOV
Field 2:
PRVIPCOV
Field 3:
PRVNHCOV
Field 4:
MHMODENT
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
4005
Roster Name:
Roster Type:
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
MIP:
If the respondent is the MIP, display "SP" .
Else display the name of the MIP.
Question display:
If (this private plan is not "current") or (SP is deceased or
institutionalized), display "Did".
Else display "Does".
If the respondent is the MIP display "your".
Else display the name of the MIP.
Display plan name for the private plan being asked about,
PLAN.PLNAME.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
9:04:33 AM Tuesday, May 14, 2013
Page 308 of 346
HI31A
TEXT:
MIP: [SP/(MIP)]
PRIVATE PLAN: (PRIVATE PLAN NAME)
Context Header:
Int. Instr I:
(Does/Did) [your/(MIP’s)] (PRIVATE PLAN NAME) cover...
Question Text:
[PROBE IF NECESSARY: I am asking about the type of insurance
coverage that [you/(SP)] personally (have/has/had), not what the
plan offers everyone.]
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
PRVMSCOV
Cheshire Name:
( HIQ7190 )
PLRO.PRVMSCOV
Item Text display:
Display "b." before the question text.
Item Text:
doctor visits or lab work?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI31A - PRVIPCOV ( HIQ7200 )
English text: YES
No
HI31A - PRVIPCOV ( HIQ7200 )
English text: NO
Attribute
Don't know
Route
HI31A - PRVIPCOV ( HIQ7200 )
Refusal
HI31A - PRVIPCOV ( HIQ7200 )
9:04:35 AM Tuesday, May 14, 2013
Page 309 of 346
HI31A
Field2:
PRVIPCOV
Cheshire Name:
( HIQ7200 )
PLRO.PRVIPCOV
Item Text display:
Display "c." before the question text.
Item Text:
inpatient hospital care?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI31A - PRVNHCOV ( HIQ7210 )
English text: YES
No
HI31A - PRVNHCOV ( HIQ7210 )
English text: NO
Attribute
Route
Don't know
HI31A - PRVNHCOV ( HIQ7210 )
Refusal
HI31A - PRVNHCOV ( HIQ7210 )
9:04:38 AM Tuesday, May 14, 2013
Page 310 of 346
HI31A
Field3:
PRVNHCOV
Cheshire Name:
( HIQ7210 )
PLRO.PRVNHCOV
Item Text display:
Display "d." before the question text.
Item Text:
nursing home or long term care?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI31A - MHMODENT ( HIQ7220 )
English text: YES
No
HI31A - MHMODENT ( HIQ7220 )
English text: NO
Attribute
Route
Don't know
HI31A - MHMODENT ( HIQ7220 )
Refusal
HI31A - MHMODENT ( HIQ7220 )
9:04:41 AM Tuesday, May 14, 2013
Page 311 of 346
HI31A
Field4:
MHMODENT
Cheshire Name:
( HIQ7220 )
PLRO.MHMODENT
Item Text display:
Display "e." before the question text.
Item Text:
dental care?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI32 - MIPPINS ( HIQ7470 )
English text: YES
No
HI32 - MIPPINS ( HIQ7470 )
English text: NO
Attribute
Route
Don't know
HI32 - MIPPINS ( HIQ7470 )
Refusal
HI32 - MIPPINS ( HIQ7470 )
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'.
9:04:42 AM Tuesday, May 14, 2013
Page 312 of 346
HI31A
82
MIP
Main insured person (MIP) for this PLAN =
PLAN.PLMIPNUM.
MIP name = ROST.ROSTFNAM + ROST.ROSTLNAM on
ROST where ROST.ROSTNUM = PLAN.PLMIPNUM.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
71
ThisPlanCurrent
This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:04:42 AM Tuesday, May 14, 2013
Page 313 of 346
HI32
HI32
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MIPPINS
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
4180
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
MIP:
If the respondent is the MIP, display "SP" .
Else display the name of the MIP.
Question display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
If (this private plan is not "current") or (SP is deceased or
institutionalized), display "have had".
Else display "have" .
If (this private plan is not "current") or (SP is deceased or
institutionalized) display "Did".
Else if respondent is the MIP, display "Do".
Else display "Does".
If respondent is MIP, display "you".
Else display the name of the MIP.
Always display "[Do not include the cost of any deductibles...]" in
brackets.
Multi Field display:
Roster/Grid Instructions:
9:04:43 AM Tuesday, May 14, 2013
Page 314 of 346
HI32
Roster/Grid display:
Report display:
TEXT:
MIP: [SP/(MIP)]
PRIVATE PLAN: (PRIVATE PLAN NAME)
Context Header:
Int. Instr I:
(Do/Does/Did) [you/(MIP)] pay any or all of the premium or cost for
the (PRIVATE PLAN NAME) coverage?
Question Text:
[Do not include the cost of any deductibles [you/(SP)] or [your/(SP’s)]
family may (have/have had) to pay.]
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
MIPPINS
Cheshire Name:
( HIQ7470 )
PLRO.MIPPINS
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI33 - MIPPAMT ( HIQ7490 )
English text: YES
No
HI33A - MHMOCOST ( HIQ7520 )
English text: NO
Attribute
Route
Don't know
HI33A - MHMOCOST ( HIQ7520 )
Refusal
HI33A - MHMOCOST ( HIQ7520 )
9:04:44 AM Tuesday, May 14, 2013
Page 315 of 346
HI32
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
82
MIP
Main insured person (MIP) for this PLAN =
PLAN.PLMIPNUM.
MIP name = ROST.ROSTFNAM + ROST.ROSTLNAM on
ROST where ROST.ROSTNUM = PLAN.PLMIPNUM.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
71
ThisPlanCurrent
This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
9:04:44 AM Tuesday, May 14, 2013
Page 316 of 346
HI33
HI33
Page Order # :
Design Screen Type:
Quantity Unit Hybrid
Fields:
Field 1:
MIPPAMT
Field 2:
MIPPUNIT
Field 3:
MIPPUNOS
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
4200
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
MIP:
If the respondent is the MIP, display "SP" .
Else display the name of the MIP.
Question display:
If (this private plan is not "current") or (SP is deceased or
institutionalized) display "did".
Else if respondent is the MIP, display "do".
Else display "does".
If respondent is MIP, display "you".
Else display the name of the MIP.
Display plan name for the private plan being asked about,
PLAN.PLNAME.
If this private plan is not "current", display "Was".
Else display "Is".
Always display "[Please do not include any…]" in brackets.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
9:04:46 AM Tuesday, May 14, 2013
Page 317 of 346
HI33
Roster/Grid display:
Report display:
TEXT:
MIP: [SP/(MIP)]
PRIVATE PLAN: (PRIVATE PLAN NAME)
Context Header:
Int. Instr I:
How much (do/does/did) [you/(MIP)] pay for the (PRIVATE PLAN
NAME) coverage?
[Please do not include any amount that may be paid for anyone
other than [you/(SP)].]
Question Text:
[PROBE IF NECESSARY: (Is/Was) that per year, per month, per
week, or what?]
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
MIPPAMT
Cheshire Name:
( HIQ7490 )
PLRO.MIPPAMT
Item Text display:
Item Text:
Label:
Label Position:
AMOUNT:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Real
TMippamt
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
HI33A - MHMOCOST ( HIQ7520 )
Refusal
HI33A - MHMOCOST ( HIQ7520 )
9:04:48 AM Tuesday, May 14, 2013
FieldSize:
Min Value:
Max Value:
Mask:
0.01
99999.99
Dollars
Route
HI33 - MIPPUNIT ( HIQ7500 )
Page 318 of 346
HI33
Field2:
MIPPUNIT
Cheshire Name:
( HIQ7500 )
PLRO.MIPPUNIT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TMippunit
1
No
No
Number Label
1 PerYear
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI33A - MHMOCOST ( HIQ7520 )
2
English text: PER YEAR
Quarterly
3
English text: QUARTERLY/EVERY 3 MONTHS
Bimonthly
HI33A - MHMOCOST ( HIQ7520 )
4
English text: BIMONTHLY/EVERY 2 MONTHS
PerMonth
HI33A - MHMOCOST ( HIQ7520 )
5
English text: PER MONTH
PerWeek
HI33A - MHMOCOST ( HIQ7520 )
6
English text: PER WEEK
SemiAnnually
HI33A - MHMOCOST ( HIQ7520 )
7
English text: SEMI-ANNUALLY/2 TIMES PER YEAR
SemiMonthly
HI33A - MHMOCOST ( HIQ7520 )
91
HI33A - MHMOCOST ( HIQ7520 )
English text: SEMI-MONTHLY/2 TIMES PER MONTH
Other
HI33 - MIPPUNOS ( HIQ7510 )
English text: OTHER
Attribute
Route
Don't know
HI33A - MHMOCOST ( HIQ7520 )
Refusal
HI33A - MHMOCOST ( HIQ7520 )
9:04:51 AM Tuesday, May 14, 2013
Page 319 of 346
HI33
Field3:
( HIQ7510 )
MIPPUNOS
Cheshire Name:
PLRO.MIPPUNOS
Item Text display:
Display "(SPECIFY)" in same blue font used for interviewer
instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
30
Route
HI33A - MHMOCOST ( HIQ7520 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1
If MIPAMT ^= DK and MIPAMT ^= RF, then,
If MIPUNIT = 1/PerYear, then MIPAMT = $50.00 - 10,000.00.
Else if MIPUNIT = 2/Quarterly, then MIPAMT = $15.00 - 2500.00.
Else if MIPUNIT = 3/Bimonthly, then MIPAMT = $10.00 - 1650.00.
Else if MIPUNIT = 4/PerMonth, then MIPAMT = $5.00 - 850.00.
Else if MIPUNIT = 5/PerWeek, then MIPAMT = $5.00 - 200.00.
Else if MIPUNIT = 6/SemiAnnually, then MIPAMT = $25.00 -
5,000.00.
Else if MIPUNIT = 7/SemiMonthly, then MIPAMT = $2.00 - 425.00.
Else if MIPUNIT = 91/Other ,then MIPAMT = $5.00 - 15,000.00.
If not true, display message "THE AMOUNT ENTERED SEEMS
UNLIKELY. PLEASE VERIFY.".
HARD EDIT CHECKS
TECHNICAL NOTES
82
MIP
9:04:51 AM Tuesday, May 14, 2013
Main insured person (MIP) for this PLAN =
PLAN.PLMIPNUM.
MIP name = ROST.ROSTFNAM + ROST.ROSTLNAM on
ROST where ROST.ROSTNUM = PLAN.PLMIPNUM.
Page 320 of 346
HI33
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
71
ThisPlanCurrent
This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
9:04:52 AM Tuesday, May 14, 2013
Page 321 of 346
HI33A
HI33A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MHMOCOST
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
4210
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
MIP:
If the respondent is the MIP, display "SP" .
Else display the name of the MIP.
Question display:
If (this private plan is not "current") or (SP is deceased or
institutionalized) display "Did".
Else display "Does".
If the respondent is the MIP, display "your" .
Else display the name of the MIP.
Display plan name for the private plan being asked about,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
9:04:52 AM Tuesday, May 14, 2013
MIP: [SP/(MIP)]
Page 322 of 346
HI33A
PRIVATE PLAN: (PRIVATE PLAN NAME)
Int. Instr I:
(Does/Did) anyone else, such as an employer, a union or
professional organization pay all or some portion of the premium or
cost for [your/(MIP’s)] (PRIVATE PLAN NAME) coverage?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
MHMOCOST
Field1:
Cheshire Name:
( HIQ7520 )
PLRO.MHMOCOST
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI33B - MHMOWHO ( HIQ7530 )
English text: YES
No
BOX HI17B - (HIQ7550 )
English text: NO
Attribute
Route
Don't know
BOX HI17B - (HIQ7550 )
Refusal
BOX HI17B - (HIQ7550 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
9:04:54 AM Tuesday, May 14, 2013
Page 323 of 346
HI33A
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
71
ThisPlanCurrent
This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
82
MIP
Main insured person (MIP) for this PLAN =
PLAN.PLMIPNUM.
MIP name = ROST.ROSTFNAM + ROST.ROSTLNAM on
ROST where ROST.ROSTNUM = PLAN.PLMIPNUM.
DESIGN NOTES
9:04:54 AM Tuesday, May 14, 2013
Page 324 of 346
HI33B
HI33B
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MHMOWHO
Field 2:
MHMOWHOS
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
4220
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
MIP:
If the respondent is the MIP, display "SP" .
Else display the name of the MIP.
Question display:
If (this private plan is not "current") or (SP is deceased or
institutionalized) display "paid".
Else display "pays".
If the respondent is the MIP, display "your" .
Else display the name of the MIP.
Display plan name for the private plan being asked about,
PLAN.PLNAME.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
9:04:54 AM Tuesday, May 14, 2013
Page 325 of 346
HI33B
Context Header:
MIP: [SP/(MIP)]
PRIVATE PLAN: (PRIVATE PLAN NAME)
Int. Instr I:
Question Text:
Who else (pays/paid) all or some portion of the cost for
[your/(MIP’s)] (PRIVATE PLAN NAME) coverage?
Int. Instr II:
INPUT FIELDS / ROUTING
9:04:56 AM Tuesday, May 14, 2013
Page 326 of 346
HI33B
Field1:
MHMOWHO
Cheshire Name:
Item Text display:
( HIQ7530 )
PLRO.MHMOWHO
[(SP's)/(MIP's)]: Display (MIP's), name of Main Insured
person, in response text for "1/CurrentEmployer",
"2/FormerEmployer", and "3/Union".
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TMhmowho
1
No
No
Number Label
1 CurrentEmployer
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HI17B - (HIQ7550 )
2
English text: [(SP's)/(MIP's)] CURRENT EMPLOYER
FormerEmployer
BOX HI17B - (HIQ7550 )
3
English text: (SP's/MIP's) FORMER EMPLOYER
Union
BOX HI17B - (HIQ7550 )
4
English text: (SP's/MIP's) UNION
SpousesCurrentEmployer
5
English text: SPOUSE'S CURRENT EMPLOYER
SpousesFormerEmployer
BOX HI17B - (HIQ7550 )
6
English text: SPOUSE'S FORMER EMPLOYER
ProfessionalOrg
BOX HI17B - (HIQ7550 )
7
English text: PROFESSIONAL/FRATERNAL ORGANIZATION
Medicaid
BOX HI17B - (HIQ7550 )
91
BOX HI17B - (HIQ7550 )
English text: MEDICAID/MEDICAL ASSISTANCE
Other
HI33B - MHMOWHOS ( HIQ7540 )
English text: OTHER
Attribute
Don't know
Route
BOX HI17B - (HIQ7550 )
Refusal
BOX HI17B - (HIQ7550 )
9:04:59 AM Tuesday, May 14, 2013
Page 327 of 346
HI33B
Field2:
MHMOWHOS
Cheshire Name:
( HIQ7540 )
PLRO.MHMOWHOS
Item Text display:
Display "(SPECIFY)" in same blue font used for interviewer
instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
30
Route
BOX HI17B - (HIQ7550 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
71
ThisPlanCurrent
9:04:59 AM Tuesday, May 14, 2013
This Plan is "current" =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(PLRO.COVTIME=1/WholeTime or
PLRO.COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Page 328 of 346
HI33B
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
82
MIP
Main insured person (MIP) for this PLAN =
PLAN.PLMIPNUM.
MIP name = ROST.ROSTFNAM + ROST.ROSTLNAM on
ROST where ROST.ROSTNUM = PLAN.PLMIPNUM.
DESIGN NOTES
9:05:00 AM Tuesday, May 14, 2013
Page 329 of 346
BOX HI17B
BOX HI17B
Page Order # :
4230
BOX INSTRUCTIONS
( HIQ7550 )
IF THIS PRIVATE PLAN IS A MANAGED CARE PLAN, GO TO HI33C
MHMOPOS ( HIQ7560 ).
ELSE GO TO BOX HI19 - (HIQ7570 ).
ASSIGNMENTS
TECHNICAL NOTES
88
ThisPrivPlanHMO
This private plan is a managed care plan =
For this PLAN, there is a PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:05:00 AM Tuesday, May 14, 2013
Page 330 of 346
HI33C
HI33C
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MHMOPOS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
4240
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
MIP:
If the respondent is the MIP, display "SP" .
Else display the name of the MIP.
Question display:
Display plan name for the private plan being asked about,
PLAN.PLNAME.
If (this private plan is not "current") and (SP is not respondent),
display "Was".
Else if (this private plan is not "current") and (SP is respondent),
display "Were".
Else if (this private plan is "current") and (SP is not respondent),
display "Is".
Else display "Are".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
9:05:00 AM Tuesday, May 14, 2013
Page 331 of 346
HI33C
MIP: [SP/(MIP)]
PRIVATE PLAN: (PRIVATE PLAN NAME)
Context Header:
Int. Instr I:
Some managed care plans offer a point-of-service option which
allows members to receive services from out-of-plan providers even
in non-emergency situations. (Are/Were/Is/Was) [you/(SP)] enrolled
in a point-of-service option offered by (PRIVATE PLAN NAME)?
Question Text:
[EXPLAIN IF NECESSARY: In a point-of-service option, the
member typically pays a higher copayment when seeing an out-of
plan provider. For example, if a member sees an in-plan provider,
there may only be a $10 copayment. However, the member may
have to pay 20 percent of the cost and the managed care plan will
pay 80 percent of the cost to receive the same service from an out-
of-plan provider.]
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
MHMOPOS
Cheshire Name:
( HIQ7560 )
PLRO.MHMOPOS
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HI19 - (HIQ7570 )
English text: YES
No
BOX HI19 - (HIQ7570 )
English text: NO
Attribute
Route
Don't know
BOX HI19 - (HIQ7570 )
Refusal
BOX HI19 - (HIQ7570 )
BACKGROUND VARIABLE ASSIGNMENTS
9:05:02 AM Tuesday, May 14, 2013
Page 332 of 346
HI33C
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
9:05:02 AM Tuesday, May 14, 2013
Page 333 of 346
BOX HI19
BOX HI19
9:05:02 AM Tuesday, May 14, 2013
Page Order # :
4250
Page 334 of 346
BOX HI19
BOX INSTRUCTIONS
( HIQ7570 )
IF ADMINISTERING ST, GO TO BOX ST69A - (STQ2825 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS69A - (NSQ2825 ).
ELSE IF ADMINISTERING CPS, GO TO BOX CPS29A - (CPS1710 ).
ELSE IF REVIEWING PRIVATE PLANS THAT WERE "CURRENT" AT THE
TIME OF THE PREVIOUS ROUND INTERVIEW, GO TO HI17PREV_IN
NAVIGATOR ( HIQ6195 ).
ELSE GO TO HI20_IN - NAVIGATOR ( HIQ6225 ).
ASSIGNMENTS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
81
PrivateCurrentPrevRnd
Private plan "current" at the time of previous round
interview =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=prev. round & (COVTIME=1/WholeTime or
COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
Exclude plans stopped in HIS. See T.N. 476.
83
PrivateNew
Private Plan is new =
PLAN.PLANTYPE=4/PrivatePlan and PLAN.PLANRNDC
= current round and PLAN.PLANSUMM ^= 1/Yes.
Exclude Deleted Plans. See T.N. 52.
84
PrivateRestarted
Private Plan has been restarted =
For this PLAN, there is no PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND = previous round &
(COVTIME=1/WholeTime or COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
476
HISStoppedPlans
Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.
DESIGN NOTES
If administering ST, NS, CPS, you have completed the Private plan detail
questions for the Private plan(s) added at the Source of Payment roster.
Return to the section being administered as specified above.
NOTE ON ELSE CONDITION:
ASKING ABOUT PREVIOUS ROUND PLANS:
Once all items at HI17PREV_IN Instance Navigator screen are DONE,
routing will return to HI17PREV_IN until Interviewer selects CONTINUE
9:05:02 AM Tuesday, May 14, 2013
Page 335 of 346
BOX HI19
INTERVIEW.
ASKING ABOUT CURRENT ROUND PLANS:
Once all items at HI20_IN Instance Navigator screen are DONE, routing
will return to HI20_IN until Interviewer selects CONTINUE INTERVIEW.
9:05:02 AM Tuesday, May 14, 2013
Page 336 of 346
HI35
HI35
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PRVOCOV
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
4270
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(other)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report above question text.
Display all insurance plans SP reported being covered by in the
current round in the following order:
First line:
If SP was covered by a Medicare Managed care plan, display name
of this Medicare Managed care plan.
Else display "MEDICARE" for the Medicare plan.
Next list Medicaid, Tricare, all Public Plans, all Private Plans and all
Medicare Prescription Drug Plans. If there is more than one plan of
any type, display in order of entry.
Report header: PLANS DISCUSSED AT THIS POINT OF THE
INTERVIEW
Report layout:
Column 1, header="Plan Name", display PLAN.PLNAME.
Column 2, header="Plan Type", display PLAN.PLANTYPE:
9:05:02 AM Tuesday, May 14, 2013
Page 337 of 346
HI35
If PLANTYPE=1/Medicare, display "MCAR".
If PLANTYPE=2/Medicaid, display "MCAD".
If PLANTYPE=3/PublicPlan, display "PUBL".
If PLANTYPE=4/PrivatePlan, display "PRIV".
If PLANTYPE=5/MHMO, display "MHMO".
If PLANTYPE=6/Tricare, display "TRIC".
If PLANTYPE=7/MPDP, display "MPDP".
TEXT:
Context Header:
REFERENCE PERIOD: (REFERENCE DATE) to (REFERENCE
PERIOD END DATE)
Int. Instr I:
Question Text:
We’ve talked about [READ PLAN(S) LISTED ABOVE]. [Do
you/Does (SP)/Did (SP)] have medical coverage under any (other)
private insurance plans we haven’t talked about?
Int. Instr II:
INPUT FIELDS / ROUTING
9:05:04 AM Tuesday, May 14, 2013
Page 338 of 346
HI35
Field1:
( HIQ7590 )
PRVOCOV
Cheshire Name:
HRND.PRVOCOV
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HI20 - PLAN_PRIVATE ( HIQ6220 )
English text: YES
No
BOX HI19B - (HIQ7600 )
English text: NO
Attribute
Route
Don't know
BOX HI19B - (HIQ7600 )
Refusal
BOX HI19B - (HIQ7600 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
53
PlanTypes
9:05:05 AM Tuesday, May 14, 2013
Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Advantage: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.
Page 339 of 346
HI35
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
93
AnyPlansCurrentRnd
SP reported being covered by any plans during the
current round =
There is PLAN & PLRO where (PLRO.PLROPLAN =
PLAN.PLANNUM & PLRO.PLRORND = current round &
(PLRO.COVTIME ^= empty or PLRO.COVANYTIM =
1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:05:05 AM Tuesday, May 14, 2013
Page 340 of 346
BOX HI19B
BOX HI19B
Page Order # :
4275
BOX INSTRUCTIONS
( HIQ7600 )
IF (SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP IS NEW FROM
FACILITY), GO TO HI34 - OTHNHCOV ( HIQ7605 ).
ELSE GO TO BOX HI21A - (HIQ7620 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
25
NewFromFacility
SP is new from facility (i.e. all previous round interviews
were in a facility) =
MRES.INTTYPE=2/NewFromFacility on MRES where
MRES.MRESRND = current round.
DESIGN NOTES
9:05:05 AM Tuesday, May 14, 2013
Page 341 of 346
HI34
HI34
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OTHNHCOV
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
4280
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP has reported being covered by any plans in the current round
other than Medicare, display "Other than the plans you have already
told me about, [do you/does (SP)/did (SP)]".
Else display "[Do you/Does (SP)/Did (SP)]".
If SP is deceased or institutionalized, display "paid".
Else display "pays".
Display "just" and "nursing home" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report above question text.
Display all insurance plans SP reported being covered by in the
current round.
First, display MEDICARE MANAGED CARE PLANS (MHMO) name
if SP has MHMO, or MEDICARE if no MHMO.
Next list Medicaid, Tricare, Public Plans, Medicare Prescription Drug
Plans, and Private Plans.
If there is more than one Public Plan, display the Public Plans in
9:05:06 AM Tuesday, May 14, 2013
Page 342 of 346
HI34
order of entry.
If there is more than one Private Plan, display the Private Plans in
order of entry.
Report header: PLANS DISCUSSED AT THIS POINT OF THE
INTERVIEW
Report layout:
Column 1, header="Plan Name", display PLAN.PLNAME.
Column 2, header="Plan Type", display PLAN.PLANTYPE:
If PLANTYPE=1/Medicare, display "MCAR".
If PLANTYPE=2/Medicaid, display "MCAD".
If PLANTYPE=3/PublicPlan, display "PUBL".
If PLANTYPE=4/PrivatePlan, display "PRIV".
If PLANTYPE=5/MHMO, display "MHMO".
If PLANTYPE=6/Tricare, display "TRIC".
If PLANTYPE=7/MPDP, display "MPDP".
TEXT:
Context Header:
REFERENCE PERIOD: (REFERENCE DATE) to (REFERENCE
PERIOD END DATE)
Int. Instr I:
Question Text:
[Other than the plans you have already told me about, [do you/does
(SP)/did (SP)]/[Do you/Does (SP)/Did (SP)]] have any insurance that
(pays/paid) just for nursing home care or other long term care?
Int. Instr II:
INPUT FIELDS / ROUTING
9:05:07 AM Tuesday, May 14, 2013
Page 343 of 346
HI34
Field1:
OTHNHCOV
Cheshire Name:
( HIQ7605 )
HRND.OTHNHCOV
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HI21A - (HIQ7620 )
English text: YES
No
BOX HI21A - (HIQ7620 )
English text: NO
Attribute
Route
Don't know
BOX HI21A - (HIQ7620 )
Refusal
BOX HI21A - (HIQ7620 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
9:05:08 AM Tuesday, May 14, 2013
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 344 of 346
HI34
93
AnyPlansCurrentRnd
SP reported being covered by any plans during the
current round =
There is PLAN & PLRO where (PLRO.PLROPLAN =
PLAN.PLANNUM & PLRO.PLRORND = current round &
(PLRO.COVTIME ^= empty or PLRO.COVANYTIM =
1/Yes)).
Exclude Deleted Plans. See T.N. 52.
53
PlanTypes
Medicare: PLANTYPE=1/Medicare.
Medicaid: PLANTYPE=2/Medicaid.
Medicare Advantage: PLANTYPE=5/MHMO.
Tricare: PLANTYPE=6/Tricare.
Public: PLANTYPE=3/PublicPlan.
Private: PLANTYPE=4/PrivatePlan.
Medicare Prescription Drug: PLANTYPE=7/MPDP.
384
AnyPlansNotMedicare
SP covered by plan in current round other than Medicare
=
There is a PLAN where PLAN.PLANTYPE^=1/Medicare
& PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round & (COVTIME^=empty or
COVANYTM=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
9:05:08 AM Tuesday, May 14, 2013
Page 345 of 346
BOX HI21A
BOX HI21A
Page Order # :
4300
BOX INSTRUCTIONS
( HIQ7620 )
GO TO NEXT SECTION .
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
9:05:08 AM Tuesday, May 14, 2013
Page 346 of 346
| File Type | application/pdf |
| File Title | HI_17.01.0002.pdf |
| Subject | HI_17.01.0002.pdf |
| Author | CMS |
| File Modified | 2013-07-01 |
| File Created | 2013-05-14 |