CMS-P-0015A Comm2017R79HHS

2017 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

HHS - Home Health Summary

Question Text/Description

Code List

Routing

HOME HEALTH SUMMARY SPECIFICATIONS
CRITERIA
INTTYPE=C001, C004, C009
SPALIVE=ALL
SEASON=ALL
SPPROXY=SP or PROXY
Other: R reported HH events in the previous round
PLACEMENT
Administer after IUQ.

PROFPROB

FRNDPROB

BOX HHS1

routing

IF SP RECEIVED CARE FROM AT LEAST ONE HOME HEALTH PROFESSIONAL DURING THE PREVIOUS
ROUND, GO TO BOX HHS1A.
ELSE GO TO BOX HHS2

BOX HHS1A

routing

CREATE CURRENT ROUND HERO RECORD FOR HH PROVIDER BEING ASKED ABOUT
GO TO HHS1 - PROFPROB.

HHS1

yes/no

We recorded that [you/(SP)] had been helped at home by (someone from) [READ PROVIDER BELOW] between
(01) YES
(SUMMUTIL) and (REFERENCE DATE). Has (anyone from) [READ PROVIDER BELOW] helped [you/(SP)] at
(02) NO
home [since (REFERENCE DATE/UTILDATE)/between (REFERENCE DATE) and (DATE OF DEATH)/ (DATE
(03) HOME HEALTH ENTERED IN ERROR IN
OF INSTITUTIONALIZATION/ENDUTILD)]?
PREVIOUS ROUND
(-8) Don't Know
[IF THE RESPONDENT SAYS "SOMEONE ELSE CAME," PROBE TO DETERMINE IF THE PERSON
(-9) Refused
WORKED FOR THE AGENCY SHOWN ON THE SCREEN.]

BOX HHS2

routing

IF SP RECEIVED HOME HEALTH CARE FROM AT LEAST ONE FRIEND OR RELATIVE DURING THE
PREVIOUS ROUND, GO TO BOX HHS2A.
ELSE GO TO BOX HHS6.

BOX HHS2A

routing

CREATE CURRENT ROUND HERO RECORD FOR HH PROVIDER BEING ASKED ABOUT
GO TO HHS2 - FRNDPROB.

HHS2

yes/no

We recorded that [you/(SP)] had received personal care or help with daily needs at home from (someone from)
[READ PROVIDER BELOW] between (SUMMUTIL) and (REFERENCE DATE). [Have you/Has (SP)] received
personal care or help with daily needs at home from (anyone from) [READ PROVIDER BELOW] [since
(REFERENCE DATE/UTILDATE)/between (REFERENCE DATE) and (DATE OF DEATH)/ (DATE OF
INSTITUTIONALIZATION/ENDUTILD]?
[IF THE RESPONDENT SAYS "SOMEONE ELSE CAME," PROBE TO DETERMINE IF THE PERSON
WORKED FOR THE AGENCY SHOWN ON THE SCREEN.]

routing

IF TYPE OF HOME HEALTH PROVIDER ORGANIZATION IS A MEAL PROGRAM, GO TO HHS3 - OTHMEALS.
ELSE GO TO BOX HH1BB

yes/no

(01) YES
Since (REFERENCE DATE/UTILDATE), has (PROVIDER NAME) provided any services to [you/(SP)] other than (02) NO
delivering meals?
(-8) Don't Know
(-9) Refused

BOX HHS5

routing

IF ASKING ABOUT HOME HEALTH PROFESSIONALS FROM THE PREVIOUS ROUND, THEN
IF SP RECEIVED CARE FROM ANOTHER HOME HEALTH PROFESSIONAL DURING THE PREVIOUS
ROUND, GO TO BOX HHS1A.
ELSE GO TO BOX HHS2.
ELSE IF ASKING ABOUT HOME HEALTH CARE FROM A FRIEND OR RELATIVE FROM THE PREVIOUS
ROUND, THEN IF SP RECEIVED HOME HEALTH CARE FROM ANOTHER FRIEND OR RELATIVE DURING
THE PREVIOUS ROUND, GO TO BOX HHS2A.
ELSE GO TO BOX HHS6.

BOX HHS6

routing

GO TO HHQ.

BOX HHS3

OTHMEALS

(01) YES
(02) NO
(03) HOME HEALTH ENTERED IN ERROR IN
PREVIOUS ROUND
(-8) Don't Know
(-9) Refused

HHS3

(01) BOX HHS3
(02) BOX HHS5
(03) BOX HHS5
(-8) BOX HHS5
(-9) BOX HHS5

BOX HHS3

(01) BOX HH1BB
(02) BOX HHS5
(-8) BOX HHS5
(-9) BOX HHS5

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