CMS-10615 Debriefing Script - New Enrollee Survey

OMB Control Number: 0938-1300
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 0938-1300. 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
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21244-1850. Please do not send applications, claims, payments, medical records or any
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note that any correspondence not pertaining to the information collection burden approved
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forwarded, or retained. If you have questions or concerns regarding where to submit your
documents, please contact Teresa DeCaro, [email protected].

DEBRIEFING SCRIPT – NEW ENROLLEES

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OMB Control Number: 0938-1300

Healthy Indiana Plan (HIP) 2.0
New Enrollee 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.
The new enrollee HIP 2.0 includes the HIP Basic and H IP Plus beneficiary benefits packages. However,
the new enrollee HIP 2.0 beneficiaries will encompass HIP 2.0 beneficiaries who have enrolled in HIP 2.0
in 2016. The new enrollees will represent beneficiaries not previously in HIP 2.0 in 2015.
This survey testing script serves as a guide for the interviewer debriefing on the HIP 2.0 New
Enrollee Beneficiary Survey.
Pretest Introduction [Interviewer reads]
On behalf of the Centers for Medicare & Medicaid Services and Social and Scientific Systems, Inc.,
thank you for agreeing to participate in this study of the Healthy Indiana Plan 2.0 (HIP 2.0). Your
comments and opinions are very important to us.
The purpose of this interview is not to collect data, but to test a questionnaire. The questionnaire we are
testing will be provided to Hoosiers as a paper questionnaire and an online (Web) questionnaire. Some of
the questions we will review today may be difficult to understand, hard to answer, or can be understood in
different ways. I am more interested in what you were thinking when you answered these questions than
your actual answers. I would like to know your experience with deciding how to answer certain questions.
We expect that some of questions will not be perfect, and that is what you will be helping us identify
today. Do you have any questions about what I just told you?
After you complete the questionnaire, I will go through it with you and sometimes ask what you think
about a question or what a particular word means to you. We will not go through every question. Please
feel free to give me any other comments you might have at the end of the interview.
Your comments will be kept private. Please answer the questions as freely as you can. You may refuse to
answer any question that you do not wish to answer. This interview should take no more than 45 minutes
of your time.
Do you have any questions?
OK, let’s begin. Please feel free to use your questionnaire to help you answer my questions.

General Interviewer Probes
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OMB Control Number: 0938-1300
[Interviewer Instructions: The following questions are general probes that interviewers may
use during the debriefing.]
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Could you please tell me more about that?
Was that easy or hard to answer?
How did you decide on that answer?
How confident are you in your answer?
Were any of the answer choices not clear, or confusing?
I noticed that you hesitated – please tell me what you were thinking.
Were there any questions that were asked that did not seem to belong in this questionnaire?

Overarching/General Beneficiary Survey Interview Questions
INTERVIEWER: How easy or difficult was it to for you to understand the purpose of the survey?
INTERVIEWER: Based on your experience with the survey, how likely would you be to complete the
actual paper mail in survey if you were selected to participate? Why/Why not?
INTERVIEWER: Did you think you were able to answer most of these questions?
INTERVIEWER: Thinking about the length of time you were enrolled in HIP, was that long enough for
you to understand these questions?

Survey Section: Healthy Indiana Plan (HIP) 2.0
Question #: 2
INTERVIEWER: What does “enroll” mean to you?
INTERVIEWER: What did you think of as “the enrollment process?”
PROBE: What steps or actions did you think of?
PROBE: Did you think of your application, how long it took for you to listen to what you were
eligible for, the processing of your application, or something else?
Question #: 3
INTERVIEWER: What does “benefits package” mean to you?
INTERVIEWER: Did the answer choices make sense?
INTERVIEWER: Do you think there are any answer choices that are missing but should be included?
Question #: 6
INTERVIEWER: Who did you think of as a “customer service representative?”

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OMB Control Number: 0938-1300
PROBE: Did you think of someone from HIP?
PROBE: Did you think of the managed care plans/entities (MCEs), such as MDwise, MHS, or
Anthem?
Question #: 9
INTERVIEWER: What did the word “forms” mean to you?
Question #: 10
INTERVIEWER: What time period did you think about when answering this question?
Question #: 11
INTERVIEWER: If you were told you were only eligible for HIP Plus, how would you answer this
question?
Question #: 12
INTERVIEWER: Do you think there are any missing answer choices or any answer choices that do not
fit?
Question #: 14
INTERVIEWER: Are there any missing answer choices or any answer choices that do not fit?
Question #: 16
INTERVIEWER: What does “getting your HIP coverage quickly” mean to you?
PROBE: What did you think about when you answered this question?
Question #: 19
INTERVIEWER: Which HIP benefits package or health plan does this question refer to?
INTERVIEWER: How easy or hard was it to know which HIP benefits package or health plan was
being asked about?
INTERVIEWER: If you pay HIP Basic copays which answer would you choose?
If you do not pay anything at your health care visits which answer would you choose?

Survey Section: Demographics
Question #: 31
INTERVIEWER: Was this question easy or hard to answer? Why?

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