CMS-10615 Debriefing Script - Alternate Policy Survey Questions

OMB Control Number: 0938-TBD

PRA Disclosure Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0938-TBD.  The time required to complete this information collection is estimated to average 60 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.  If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.  Please do not send applications, claims, payments, medical records or any documents containing sensitive information to the PRA Reports Clearance Office.  Please note that any correspondence not pertaining to the information collection burden approved under the associated OMB control number listed on this form will not be reviewed, forwarded, or retained. If you have questions or concerns regarding where to submit your documents, please contact Teresa DeCaro, [email protected].

Healthy Indiana Plan (HIP) 2.0
Disenrollee and Lockout Survey Testing Debriefing Script

Survey Background

Part of the federal evaluation of the Healthy Indiana Plan (HIP) 2.0 Demonstration will be based on information collected using three beneficiary survey instruments. The three target populations for the instruments include: (1) current HIP 2.0 beneficiaries; (2) newly enrolled HIP 2.0 beneficiaries; and (3) HIP 2.0 disenrollees and beneficiaries who have been “locked out.” All instruments contain survey questions from existing beneficiary questionnaires, survey questions adapted from existing beneficiary questionnaires, and newly developed survey questions. The newly developed survey questions are especially important for testing, and focus on specific policies of interest to CMS. The beneficiary feedback captured by these instruments will help inform CMS decision making on health care policies.

There is a separate set of survey questions that will be included in the HIP 2.0 beneficiary survey instruments focusing on obtaining HIP 2.0 beneficiary thoughts on their health coverage cost and payment options/choices. The intention of the additional survey section is to provide valuable data on the unique features within the HIP 2.0 demonstration and to explore options within a health policy. This survey section serves as the opportunity for exploring beneficiary preference regarding health plan choices and payment options.

This survey testing script serves as a guide for the interviewer debriefing focusing on the HIP 2.0 Beneficiary Survey Section: Health Coverage Cost and Payment Options.

Survey Section: Health Coverage Cost and Payment Options

General Interviewer Probes

[Interviewer Instructions: The following questions are probes that interviewers should use during the interview to help facilitate a meaningful conversation with respondents.]

• Could you please tell me more about that?

• Was that hard or easy to answer?

• How did you decide on that answer?

• How confident are you in your answer?

• Were any of the answer options unclear or confusing?

• I noticed that you hesitated – please tell me what you were thinking.

• Were there any questions that were asked that you did not seem to belong in this questionnaire?

INTERVIEWER: How easy or difficult was it to for you to understand and answer this survey section on health coverage cost and payment options?

INTERVIEWER: When thinking about the survey questions, were the time references easy or hard to follow?

INTERVIEWER: Was it hard to shift your thinking from your current or previous HIP experience, to a new role as a health care customer?

Question #: 2

INTERVIEWER: How easy or hard was it to answer this question?

INTERVIEWER: When thinking about Health Plan A and Health Plan B – was it hard to think of the health plan descriptions together (i.e., items listed in (1) and (2))?

PROBE: Did you think of (1) and (2) as two different concepts, or one concept within a Health Plan?

INTERVIEWER: When thinking about Health Plan A and Health Plan B – how easy or hard was it to compare and choose between the two plans?

Question #: 3

INTERVIEWER: How easy or hard was it to answer?

INTERVIEWER: Was it difficult to choose only one health plan?

Question #: 6

INTERVIEWER: What did the word “choice” mean to you?

DEBRIEFING SCRIPT – DISENROLLEES & LOCKOUTS 3