Section Specifications for INF
Round 69
HEALTH INSURANCE
Created on 5/9/2014 6:12:57 PM
Box Instructions
IF INDISP = 1/ConsentRequired OR INDISP = 4/InitialRefusal, GO TO INCONREF - CONREFFN.
ELSE GO TO IN1PRE2 - IN1PR2CT.
Variable Name |
Assignment Instructions |
INMCDFLG |
If INMCDFLG = EMPTY, then INMCDFLG = 0/NotIndicated |
Question Text
PLEASE INDICATE THE FINAL (CONSENT/REFUAL) STATUS FOR THIS SECTION.
Field 1: CONREFFN
Field 1 Routing
Value |
Label |
Route |
1 |
CONSENT OBTAINED (CONTINUE INTERVIEW) |
IN1PRE2 - IN1PR2CT |
2 |
FINAL CONSENT DENIED |
INEND - INENDCT |
3 |
REFUSAL CONVERTED (CONTINUE INTERVIEW) |
IN1PRE2 - IN1PR2CT |
4 |
FINAL REFUSAL |
INEND - INENDCT |
Question Text
The following questions are about (SP's) health insurance.
IF THERE ARE NO CONSENT OR REFUSAL ISSUES FOR THIS SECTION, PRESS "1" TO CONTINUE.
Field 1: IN1PR2CT
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX IN3 |
2 |
CONSENT REQUIRED |
INEND - INENDCT |
3 |
INITIAL REFUSAL |
INEND - INENDCT |
Other Programming Instructions
Report Display
Display
report above question text.
Display all stays where STAY.XSTPLAC
<> 000 that were reported for this SP in
chronological
order by start date of the stay.
Report header: STAY
TIMELINE
Report layout:
Column 1, header="Place Name",
display PLAC.PLACNAME of
PLAC where PLAC.PLACNUM =
STAY.XSTPLAC.
Column 2, header="Start Date",
display
STAY.STAYSMM+STAY.STAYSDD+STAY.STAYSYY in month,
day
year format.
Column 3, header="End Date",
display
STAY.STAYEMM+STAY.STAYEDD+STAY.STAYEYY in month,
day
year format.
Column 4, header="Stay Type",
display STAY.STAYCLAS.
Box Instructions
IF THIS IS A BASELINE INTERVIEW AND MEDICAID NOT COLLECTED OR INMCDFLG = 1/Indicated, GO TO IN1 - ICAIDECO.
ELSE IF THIS IS A BASELINE INTERVIEW AND MEDICAID COLLECTED AND INMCDFLG = 0/NotIndicated, GO TO IN5A - MCAIDHMO.
ELSE IF THIS IS NOT A BASELINE INTERVIEW AND MEDICAID NOT COLLECTED OR INMCDFLG = 1/Indicated, GO TO IN1A - ICAIDNOW.
ELSE GO TO IN18 - IGAPCOV.
Question Text
Has (SP) ever been covered by [READ NAME(S) FROM ABOVE]?
Field 1: ICAIDECO
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
IN13A - ICAREPTD |
1 |
YES |
IN2 - ICAIDDOC |
2 |
PENDING |
IN13A - ICAREPTD |
|
Don't Know |
IN13A - ICAREPTD |
|
Refused |
IN13A - ICAREPTD |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
INCAID |
PERS.INCAID = IN1 - ICAIDECO |
CAIDECO |
PERS.CAIDECO = IN1 - ICAIDECO |
INMCDFLG |
INMCDFLG = 1/Indicated |
Question Text
(The last time we asked about (SP's) health insurance, (he/she) was not covered by [READ NAME(S) FROM ABOVE].) Is (SP) now covered by [READ NAME(S) FROM ABOVE]?
Field 1: ICAIDNOW
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
IN18 - IGAPCOV |
1 |
YES |
IN2 - ICAIDDOC |
2 |
PENDING |
IN18 - IGAPCOV |
|
Don't Know |
IN18 - IGAPCOV |
|
Refused |
IN18 - IGAPCOV |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
INCAID |
PERS.INCAID = IN1A - ICAIDNOW |
XCAIDFLG |
PERS.XCAIDFLG = 0/No |
INMCDFLG |
INMCDFLG = 1/Indicated |
Question Text
Do you have a document that shows (SP's) most current [READ NAME(S) FROM ABOVE] ID number?
Field 1: ICAIDDOC
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
IN3 - ICAIDNUM |
1 |
YES |
IN3 - ICAIDNUM |
|
Don't Know |
IN3 - ICAIDNUM |
|
Refused |
IN3 - ICAIDNUM |
Question Text
[Please read me (SP's) [READ NAME(S) FROM ABOVE] ID number from the document/Please tell me (SP's) [READ NAME(S) FROM ABOVE] ID number.]
Field 1: ICAIDNUM
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
IN4 - ICAIDVER |
|
Don't Know |
IN5A - MCAIDHMO |
|
Refused |
IN5A - MCAIDHMO |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
ICAIDNM |
PERS.ICAIDNM = IN3 - ICAIDNUM |
MCAIDFLG |
If IN3 - ICAIDNUM
= RF, then PERS.MCAIDFLG = 1/RForNWK |
Question Text
I'd like to verify the [READ NAME(S) FROM ABOVE] ID number that I have recorded. I have entered (MEDICAID ID NUMBER). Is this correct?
Field 1: ICAIDVER
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
IN3 - ICAIDNUM |
1 |
YES |
IN5A - MCAIDHMO |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
MCAIDFLG |
If IN4 - ICAIDVER = 1/Yes, then PERS.MCAIDFLG = 3/ValidNumber |
Question Text
Some states now use HMOs (health maintenance organizations) to provide some or all health care for Medicaid beneficiaries. (Is/Was) (SP) enrolled in a [READ NAME(S) FROM ABOVE] HMO?
Field 1: MCAIDHMO
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX IN3A |
1 |
YES |
BOX IN3A |
|
Don't Know |
BOX IN3A |
|
Refused |
BOX IN3A |
Box Instructions
IF THIS IS A BASELINE INTERVIEW, GO TO IN6 - ICDCRCOV.
ELSE GO TO IN18 - IGAPCOV.
Question Text
Was (SP) covered by [READ NAME(S) FROM ABOVE] [on September 1, (CURRENT YEAR)?/when (he/she) was admitted on (FAD/RAD)?]
Field 1: ICDCRCOV
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
IN13A - ICAREPTD |
1 |
YES |
IN13A - ICAREPTD |
|
Don't Know |
IN13A - ICAREPTD |
|
Refused |
IN13A - ICAREPTD |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
XCAIDFLG |
If IN6-ICDCRCOV <> 1/Yes, then PERS.XCAIDFLG = 1/Yes |
Question Text
Our
records show that (SP) is covered by Medicare. I'd like to ask some
questions about (his/her) Medicare coverage.
Was (SP)
covered by Part D of Medicare on [September 1, (CURRENT
YEAR)/(FAD/RAD)]?
PRESS F1 FOR PART D DEFINITIONS.
Field 1: ICAREPTD
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
IN18 - IGAPCOV |
1 |
YES |
IN18 - IGAPCOV |
|
Don't Know |
IN18 - IGAPCOV |
|
Refused |
IN18 - IGAPCOV |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
CAREPTD |
PERS.CAREPTD=IN13A-ICAREPTD |
Question Text
On [September 1, (CURRENT YEAR)/(FAD/RAD)], was (SP) covered by private health insurance that pays for some or all charges for inpatient and outpatient hospital and physician services and/or supplements Medicare (Medigap policy)?
Field 1: IGAPCOV
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
IN20 - ILTCCOV |
1 |
YES |
IN19 - IGAPNAME |
|
Don't Know |
IN20 - ILTCCOV |
|
Refused |
IN20 - ILTCCOV |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
GAPCOV |
PERS.GAPCOV = IN18-IGAPCOV |
Question Text
What
is the name of the insurance company?
[PROBE: Any
others?]
IF NO MORE INSURANCE COMPANY NAMES, PRESS ENTER TO CONTINUE.
Field 1: IGAPNAME
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
IN19 - IGAPNAM2 |
Field 2: IGAPNAM2
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
IN19 - IGAPNAM3 |
Field 3: IGAPNAM3
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
IN19 - IGAPNAM4 |
Field 4: IGAPNAM4
Field 4 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
IN19 - IGAPNAM5 |
Field 5: IGAPNAM5
Field 5 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
IN20 - ILTCCOV |
Question Text
On [September 1, (CURRENT YEAR)/(FAD/RAD)], was (SP) covered by private health insurance that pays for some or all charges for more than 100 days of nursing home care, that is, a long-term care policy?
Field 1: ILTCCOV
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
IN22 - ICHACOV |
1 |
YES |
IN21 - ILTCNAME |
|
Don't Know |
IN22 - ICHACOV |
|
Refused |
IN22 - ICHACOV |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
LTCCOV |
PERS.LTCCOV = IN20 - ILTCCOV |
LTCNAME |
If IN20-ILTCCOV <> 1/Yes, then PERS.LTCNAME = EMPTY |
Question Text
What
is the name of the insurance company?
[PROBE: Any
others?]
Field 1: ILTCNAME
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
IN21 - ILTCNAM2 |
Field 2: ILTCNAM2
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
IN21 - ILTCNAM3 |
Field 3: ILTCNAM3
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
IN21 - ILTCNAM4 |
Field 4: ILTCNAM4
Field 4 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
IN21 - ILTCNAM5 |
Field 5: ILTCNAM5
Field 5 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
IN22 - ICHACOV |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
LTCNAME |
PERS.LTCNAME = IN21-ILTCNAME |
Question Text
Was (SP) covered by either TRICARE or CHAMPVA for hospital or physician care on [September 1, (CURRENT YEAR)/(FAD/RAD)]?
PRESS F1 FOR EXPLANATION OF TRICARE AND CHAMPVA.
Field 1: ICHACOV
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
IN23 - IDVACOV |
1 |
YES |
IN23 - IDVACOV |
|
Don't Know |
IN23 - IDVACOV |
|
Refused |
IN23 - IDVACOV |
Question Text
Was (SP) covered by any other Department of Veterans Affairs (VA) program or contract on [September 1, (CURRENT YEAR)/(FAD/RAD)]?
Field 1: IDVACOV
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
IN24 - IPUBCOV |
1 |
YES |
IN24 - IPUBCOV |
|
Don't Know |
IN24 - IPUBCOV |
|
Refused |
IN24 - IPUBCOV |
Question Text
(Besides [READ NAME(S) FROM ABOVE], was/Was) (SP) covered by any other public assistance health insurance program on [September 1, (CURRENT YEAR)/(FAD/RAD)]?
Field 1: IPUBCOV
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX IN9 |
1 |
YES |
IN25 - IPUBNAME |
|
Don't Know |
BOX IN9 |
|
Refused |
BOX IN9 |
Question Text
What (is/was) the name of the public assistance health insurance program?
Field 1: IPUBNAME
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX IN9 |
Box Instructions
IF SP ALIVE, AND A CFR, FFC, OR FCF, AND IS A FALL ROUND, GO TO INBQ13A - IMARSTAT.
ELSE GO TO INEND - INENDCT.
Question Text
Is (SP) currently married, widowed, divorced, separated, or never married?
Field 1: IMARSTAT
Field 1 Routing
Value |
Label |
Route |
1 |
MARRIED |
INEND - INENDCT |
2 |
WIDOWED |
INEND - INENDCT |
3 |
DIVORCED |
INEND - INENDCT |
4 |
SEPARATED |
INEND - INENDCT |
5 |
NEVER MARRIED |
INEND - INENDCT |
|
Don't Know |
INEND - INENDCT |
|
Refused |
INEND - INENDCT |
Question Text
(YOU HAVE COMPLETED THE HEALTH INSURANCE SECTION FOR THIS SP.)
PRESS "1" TO RETURN TO NAVIGATION SCREEN.
Field 1: INENDCT
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX INEND |
Other Programming Instructions
Background Variable Assignments
INDISP:
If
IN1PRE2-IN1PR2CT = 2/ConsentRequired, INDISP =
1/ConsentRequired.
Else if IN1PRE2-IN1PR2CT = 3/InitialRefusal,
INDISP = 4/InitialRefusal.
Else if INCONREF-CONREFFN =
2/FinalConsentDenied, INDISP = 11/FinalConsentDenied.
Else if
INCONREF-CONREFFN = 4/FinalRefusal, INDISP = 12/FinalRefusal.
Else
INDISP = 96/Complete.
Box Instructions
GO TO NAVIGATOR
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Ryan Hubbard |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |