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pdf2019 MCBS Community Questionnaire
Variable Name
MR Screen Name
ACQ - Access to Care
Question Type
Question Text/Description
Code List
Routing
ACCESS TO CARE QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C004, C005, C006, C007
SPALIVE=1
SEASON= WINTER
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after MPQ.
NOTES: As part of Content Management Cycle 1, it was decided that ACQ would move from the Fall round to the
Winter round. Therefore, ACQ was removed from R79 and will be fielded in R80.
ACINT
BOX AC1AA
routing
IF INTTYPE=7 AND VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1 AND (SP DID NOT HAVE ER
VISIT IN CURRENT ROUND AND AC6A NOT ALREADY ASKED), GO TO ACINTRO - ACINT.
ELSE IF (SP HAD AN ER VISIT IN THE CURRENT ROUND OR ANY OF THE 2 PREVIOUS ROUNDS) AND
(AC6A NOT ALREADY ASKED), GO TO AC6A - EWAITUNT.
ELSE GO TO BOX AC1C.
ACINTRO
no entry
The next questions are about health care services [you/(SP)] may have used since (REFERENCE DATE).
AC1 - ERVISIT
(01) YES
(02) NO
Since (REFERENCE DATE), did [you/(SP)] go to a hospital emergency room?
(-8) Don't Know
(-9) Refused
(00) DID NOT HAVE TO WAIT
(01) HOURS ONLY
Think about the most recent time [you/(SP)] went to the hospital emergency room. How long did [you/(SP)] have
(02) MINUTES ONLY
to wait during (your/his/her) visit before (you/he/she) saw a doctor or some other medical person? Please include
(03) HOURS AND MINUTES
the time spent in the waiting room and exam room.
(-8) Don't Know
(-9) Refused
(01) AC6A - EWAITUNT
(02) BOX AC1C
(-8) BOX AC1C
(-9) BOX AC1C
(00) BOX AC1C.
(01) AC6A - EWAITHRS
(02) AC6A - EWAITMIN
(03) AC6A - EWAITHRS
(-8) BOX AC1C
(-9) BOX AC1C
If AC6A - EWAITUNT = 3/HoursAndMinutes, go to AC6A
- EWAITMIN.
Else go to BOX AC1C.
BOX AC1C
ERVISIT
AC1
yes/no
EWAITUNT
AC6A
code one
EWAITHRS
AC6A
numeric
Think about the most recent time [you/(SP)] went to the hospital emergency room. How long did [you/(SP)] have
to wait during (your/his/her) visit before (you/he/she) saw a doctor or some other medical person? Please include (01) continuous answer
the time spent in the waiting room and exam room.
EWAITMIN
AC6A
numeric
Think about the most recent time [you/(SP)] went to the hospital emergency room. How long did [you/(SP)] have
to wait during (your/his/her) visit before (you/he/she) saw a doctor or some other medical person? Please include (01) continuous answer
the time spent in the waiting room and exam room.
routing
IF AC6A ASKED WHILE ADMINISTERING ER, GO TO BOX ER6.
ELSE IF INTTYPE=7 AND VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1 AND (SP DID NOT HAVE
OP VISIT IN CURRENT ROUND AND AC16A NOT ALREADY ASKED), GO TO AC8 - OPDVISIT.
ELSE IF (SP HAD AN OP VISIT IN THE CURRENT ROUND OR ANY OF THE 2 PREVIOUS ROUNDS) AND
(AC9-AC16A NOT ALREADY ASKED), GO TO AC9 - OPDREAS.
ELSE GO TO BOX AC1E.
yes/no
Since (REFERENCE DATE), did [you/(SP)] go to a hospital clinic or outpatient department?
DO NOT INCLUDE HOSPITAL INPATIENT STAYS.
BOX AC1C
OPDVISIT
AC8
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) AC9 - OPDREAS
(02) BOX AC1E
(-8) BOX AC1E
(-9) BOX AC1E
CHECK ALL THAT APPLY.
(01) MEDICAL CONDITION NAMED
(02) TESTS
(03) FOLLOW-UP
(04) CHECKUP
(05) REFERRAL
(06) SURGERY
(07) PREVENTIVE SHOT
(08) TREATMENT SHOT
(09) TO GET OR REFILL PRESCRIPTION
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) BOX AC1D
(02) BOX AC1D
(03) BOX AC1D
(04) BOX AC1D
(05) BOX AC1D
(06) BOX AC1D
(07) BOX AC1D
(08) BOX AC1D
(09) BOX AC1D
(91) AC9 - OPDOTHOS
(-8) BOX AC1D
(-9) BOX AC1D
verbatim text
OTHER (SPECIFY)
(01) continuous answer
BOX AC1D
routing
IF (INTTYPE=7 AND VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1 AND SP DID NOT REPORT
OUTPATIENT DEPARTMENT VISIT AT OP4) AND (RESPONSE TO AC9 - OPDREAS INCLUDES
1/MedCondNamed OR 6/Surgery), GO TO AC12 - OPDAPPT.
ELSE IF INTTYPE=7 AND VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1 AND SP DID NOT REPORT
OUTPATIENT DEPARTMENT VISIT AT OP4) AND (RESPONSE TO AC9 - OPDREAS DOES NOT INCLUDE
1/MedCondNamed AND DOES NOT INCLUDE 6/Surgery), GO TO AC10 - OPDSCOND.
ELSE GO TO AC12 - OPDAPPT.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
AC12 - OPDAPPT
[I have a few more questions about visits that [you/(SP)] had in the past.]
OPDREAS
AC9
code all
Think about the most recent time [you/(SP)] went to a hospital clinic or outpatient department. What was the
reason [you/(SP)] went to the hospital clinic or outpatient department?
[PROBE FOR THE MOST RECENT VISIT IF RESPONDENT MENTIONS MORE THAN ONE. IF NEEDED,
PROBE WITH ‘What did you have done during your most recent visit to the hospital clinic or outpatient
department?’ SELECT ALL THAT APPLY.]
[PROBE: Any other reason?]
THE MOST RECENT VISIT CAN BE OUTSIDE OF THE REFERENCE PERIOD USED IN OTHER SECTIONS
OPDOTHOS
AC9
BOX AC1D
OPDSCOND
AC10
yes/no
Was that for a specific condition?
Page 1 of 5
2019 MCBS Community Questionnaire
Variable Name
OPDAPPT
OPDDRTEL
MR Screen Name
AC12
AC13
ACQ - Access to Care
Question Type
Question Text/Description
code one
Did [you/(SP)] have an appointment for this visit to the hospital clinic or outpatient department, or did (you/he/she)
just walk in?
code one
We are interested in knowing how the appointment was made for the visit to the hospital clinic or outpatient
department you just told me about.
Did someone make this appointment during an earlier visit, or did [you/(SP)] contact the hospital clinic or
outpatient department to set up the appointment ?
How long did [you/(SP)] have to wait for the appointment -- about how many days, weeks, or months?
OPDAWUNT
AC14
code one
OPDAWDAY
OPDAWWKS
OPDAWMOS
AC14
AC14
AC14
numeric
numeric
numeric
WE ARE ASKING HOW MUCH TIME PASSED BETWEEN THE FIRST CONTACT FOR SETTING THE
APPOINTMENT AND THE ACTUAL DATE OF THE APPOINTMENT
How long did [you/(SP)] have to wait for the appointment -- about how many days, weeks, or months?
How long did [you/(SP)] have to wait for the appointment -- about how many days, weeks, or months?
How long did [you/(SP)] have to wait for the appointment -- about how many days, weeks, or months?
[Think about the most recent time [you/(SP)] went to a hospital clinic or outpatient department.]
OWAITUNT
AC16A
code one
How long did [you/(SP)] have to wait during (your/his/her) most recent visit before (you/he/she) saw a doctor or
some other medical person? Please include the time spent in the waiting room and exam room.
Code List
Routing
(01) APPOINTMENT
(02) WALKED IN
(-8) Don't Know
(-9) Refused
(01) SOMEONE MADE APPOINTMENT DURING
EARLIER VISIT
(02) SP CONTACTED OFFICE TO SET UP
APPOINTMENT
(03) DOCTOR'S OFFICE CONTACTED SP TO SET UP
APPOINTMENT
(-8) Don't Know
(-9) Refused
(00) DID NOT HAVE TO WAIT
(01) DAYS
(02) WEEKS
(03) MONTHS
(-8) Don't Know
(-9) Refused
(01) continuous answer
(01) continuous answer
(01) continuous answer
(00) DID NOT HAVE TO WAIT
(01) HOURS ONLY
(02) MINUTES ONLY
(03) HOURS AND MINUTES
(-8) Don't Know
(-9) Refused
(01) AC13 - OPDDRTEL
(02) AC16A - OWAITUNT
(-8) AC16A - OWAITUNT
(-9) AC16A - OWAITUNT
[Think about the most recent time [you/(SP)] went to a hospital clinic or outpatient department.]
OWAITHRS
AC16A
numeric
How long did [you/(SP)] have to wait during (your/his/her) most recent visit before (you/he/she) saw a doctor or
some other medical person? Please include the time spent in the waiting room and exam room.
(01) AC14 - OPDAWUNT
(02) AC14 - OPDAWUNT
(03) AC14 - OPDAWUNT
(-8) AC16A - OWAITUNT
(-9) AC16A - OWAITUNT
(00) AC16A - OWAITUNT
(01) AC14 - OPDAWDAY
(02) AC14 - OPDAWWKS
(03) AC14 - OPDAWMOS
(-8) AC16A - OWAITUNT
(-9) AC16A - OWAITUNT
AC16A - OWAITUNT
AC16A - OWAITUNT
AC16A - OWAITUNT
(00) BOX AC1E
(01) AC16A - OWAITHRS
(02) AC16A - OWAITMIN
(03) AC16A - OWAITHRS
(-8) BOX AC1E
(-9) BOX AC1E
(01) continuous answer
If AC16A - OWAITUNT = 3/HoursAndMinutes, go to
AC16A - OWAITMIN.
Else go to BOX AC1E.
(01) continuous answer
BOX AC1E
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) AC20 - MDSPCLTY
(02) BOX AC1G
(-8) BOX AC1G
(-9) BOX AC1G
[Think about the most recent time [you/(SP)] went to a hospital clinic or outpatient department.]
OWAITMIN
AC16A
BOX AC1E
numeric
routing
How long did [you/(SP)] have to wait during (your/his/her) most recent visit before (you/he/she) saw a doctor or
some other medical person? Please include the time spent in the waiting room and exam room.
IF AC9-AC16A ASKED WHILE ADMINISTERING OP, GO TO BOX OP7.
ELSE IF BENEFICIARY IS IN THE SECOND ROUND BASELINE INTERVIEW (INTTYPE=7) AND IS NONNEWLY ELIGIBLE (VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1) AND [(SP DID NOT REPORT A
MEDICAL PROVIDER VISIT OR REPORTED ONLY MEDICAL PROVIDER VISITS THAT WERE ALSO SD
EVENTS (THE EVNT LOOP CONTAINS NO ENTRIES WHERE EVNTTYPE=MP AND
EVNTRNDC=CURROUND)) OR REPORTED ONLY MEDICAL PROVIDER VISITS THAT ARE FLAGGED AS
ERRORS OR DELETIONS (THE ONLY ENTRIES IN THE EVNT LOOP WHERE EVNTTYPE=MP AND
EVNTRNDC=CURROUND ARE FLAGGED WITH EVERRFLG=1 OR EVNTDFLG=1) AND (AC20-AC28A1 NOT
ALREADY ASKED), GO TO AC19-MDVISIT.
ELSE IF (SP HAD AN MP VISIT IN THE CURRENT ROUND OR ANY OF THE 2 PREVIOUS ROUNDS) AND
(AC20-AC28A1 NOT ALREADY ASKED), GO TO AC20 - MDSPCLTY.
ELSE GO TO BOX AC1G
MDVISIT
AC19
yes/no
Next, I want to ask about [your/(SP)’s] visits to doctors since (REFERENCE DATE). [Have you/Has (SP)] seen a
medical doctor since (REFERENCE DATE)? Please do not include a doctor seen at home, at an emergency
room or outpatient department, or while an inpatient at a hospital.
[IF NECESSARY, SAY, ‘Please look at show card AC1 for examples of types of medical doctors.’]
Page 2 of 5
2019 MCBS Community Questionnaire
Variable Name
MR Screen Name
ACQ - Access to Care
Question Type
Question Text/Description
Code List
(01) AC21 - MDREAS
(02) AC21 - MDREAS
(03) AC21 - MDREAS
(05) AC21 - MDREAS
(07) AC21 - MDREAS
(08) AC21 - MDREAS
(09) AC21 - MDREAS
(10) AC21 - MDREAS
(11) AC21 - MDREAS
(12) AC21 - MDREAS
(13) AC21 - MDREAS
(14) AC21 - MDREAS
(15) AC21 - MDREAS
(16) AC21 - MDREAS
(17) AC21 - MDREAS
(18) AC21 - MDREAS
(19) AC21 - MDREAS
(20) AC21 - MDREAS
(21) AC21 - MDREAS
(22) AC21 - MDREAS
(24) AC21 - MDREAS
(25) AC21 - MDREAS
(36) AC21 - MDREAS
(26) AC21 - MDREAS
(27) AC21 - MDREAS
(37) AC21 - MDREAS
(28) AC21 - MDREAS
(38) AC21 - MDREAS
(29) AC21 - MDREAS
(30) AC21 - MDREAS
(31) AC21 - MDREAS
(01) continuous answer
AC21 - MDREAS
(01) MEDICAL CONDITION NAMED
(02) TESTS
(03) FOLLOW-UP
(04) CHECKUP
(05) REFERRAL
(06) SURGERY
(07) PREVENTIVE SHOT
(08) TREATMENT SHOT
(09) TO GET OR REFILL PRESCRIPTION
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) BOX AC1F
(02) BOX AC1F
(03) BOX AC1F
(04) BOX AC1F
(05) BOX AC1F
(06) BOX AC1F
(07) BOX AC1F
(08) BOX AC1F
(09) BOX AC1F
(91) AC21 - MDOTHOS
(-8) BOX AC1F
(-9) BOX AC1F
(01) continuous answer
BOX AC1F
MDSPCLTY
AC20
code one
(01) ALLERGY/IMMUNOLOGY
(02) ANESTHESIOLOGY
(03) CARDIOLOGY (HEART)
(05) DERMATOLOGY (SKIN)
(07) ENDOCRINOLOGY/METABOLISM
(DIABETES,THYROID)
(08) FAMILY PRACTICE
(09) GASTROENTEROLOGY
(10) GENERAL PRACTICE
(11) GENERAL SURGERY
SHOW CARD AC1
(12) GERIATRICS (ELDERLY)
(13) GYNECOLOGY - OBSTETRICS
[I have a few more questions about visits that [you/(SP)] had in the past.]
(14) HEMATOLOGY (BLOOD)
(15) HOSPITAL RESIDENCE
Think about the most recent time [you/(SP)] saw a medical doctor somewhere other than at home or at a hospital.
(16) INTERNAL MEDICINE (INTERNIST)
What was the doctor’s specialty?
(17) NEPHROLOGY (KIDNEYS)
(18) NEUROLOGY
[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF THEY MENTION A 'GENERIC'
(19) NUCLEAR MEDICINE
SPECIALITY LIKE ‘HEART DOCTOR.’ IF RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY AND THE
(20) ONCOLOGY (TUMORS, CANCER)
GENERIC WORD IS SHOWN IN PARENTHESES FOLLOWING ONE OF THE RESPONSES, SELECT THE
(21) OPHTHALMOLOGY (EYES)
RESPONSE CATEGORY FOR THAT SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE SELECT 'OTHER DR
(22) ORTHOPEDICS
SPECIALTY'.]
(24) OSTEOPATHY (DO)
(25) OTORHINOLARYNGOLOGY (EAR, NOSE,
THROAT)
(36) PAIN MANAGEMENT SPECIALIST
(26) PATHOLOGY
(27) PHYS MED/REHAB
(37) PHYSICIAN’S ASSISTANT
(28) PLASTIC SURGERY
(38) PODIATRIST
(29) PROCTOLOGY
MDSPCLOS
AC20
verbatim text
OTHER DR SPECIALTY (SPECIFY)
What was the reason [you/(SP)] saw the doctor?
MDREAS
AC21
code all
[PROBE: ‘What did you have done during the visit?’ IF RESPONDENT DOES NOT UNDERSTAND WHAT IS
BEING ASKED. PROBE: ‘Any other reason?’ TO OBTAIN ALL REASONS.]
CHECK ALL THAT APPLY.
MDOTHOS
AC21
verbatim text
OTHER (SPECIFY)
BOX AC1F
routing
Routing
IF THE BENEFICIARY IS IN THE SECOND ROUND BASELINE INTERVIEW (INTTYPE=7) AND IS NON-NEWLY
ELIGIBLE (VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1) AND [((SP DID NOT REPORT A MEDICAL
PROVIDER VISIT OR REPORTED ONLY MEDICAL PROVIDER VISITS THAT WERE ALSO SD EVENTS ((THE
EVNT LOOP CONTAINS NO ENTRIES WHERE EVNTTYPE=MP AND EVNTRNDC=CURROUND)) OR
REPORTED ONLY MEDICAL PROVIDER VISITS THAT ARE FLAGGED AS ERRORS OR DELETIONS (THE
ONLY ENTRIES IN THE EVNT LOOP WHERE EVNTTYPE=MP AND EVNTRNDC=CURROUND ARE
FLAGGED WITH EVERRFLG=1 OR EVNTDFLG=1)) AND (RESPONSE TO AC21- MDREAS DOES NOT
INCLUDE 1/MedCondNamed AND DOES NOT INCLUDE 6/Surgery), GO TO AC22 - MDSCOND.
ELSE GO TO AC24 - MDAPPT.
MDSCOND
MDAPPT
MDDRTEL
AC22
AC24
AC25
yes/no
code one
code one
Was that for a specific condition?
Did [you/(SP)] have an appointment for this visit with the doctor, or did (you/he/she) just walk in?
We are interested in knowing how the appointment was made for the visit to the doctor’s office you just told me
about.
Did someone make this appointment during an earlier visit, or did [you/(SP)] contact the doctor’s office to set up
the appointment?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) APPOINTMENT
(02) WALKED IN
(-8) Don't Know
(-9) Refused
(01) SOMEONE MADE APPOINTMENT DURING
EARLIER VISIT
(02) SP CONTACTED OFFICE TO SET UP
APPOINTMENT
(03) DOCTOR'S OFFICE CONTACTED SP TO SET UP
APPOINTMENT
(04) STANDING APPOINTMENT
(-8) Don't Know
(-9) Refused
AC24 - MDAPPT
(01) AC25 - MDDRTEL
(02) AC28A1 - MWAITUNT
(-8) AC28A1 - MWAITUNT
(-9) AC28A1 - MWAITUNT
(01) AC26 - MDAWUNT
(02) AC26 - MDAWUNT
(03) AC26 - MDAWUNT
(04) AC28A1 - MWAITUNT
(-8) AC28A1 - MWAITUNT
(-9) AC28A1 - MWAITUNT
Page 3 of 5
2019 MCBS Community Questionnaire
Variable Name
MR Screen Name
ACQ - Access to Care
Question Type
Question Text/Description
Code List
Routing
(00) AC28A1 - MWAITUNT
(01) AC26 - MDAWDAY
(02) AC26 - MDAWWKS
(03) AC26 - MDAWMOS
(-8) AC28A1 - MWAITUNT
(-9) AC28A1 - MWAITUNT
MDAWUNT
AC26
code one
(00) DID NOT HAVE TO WAIT
How long did [you/(SP)] have to wait for the appointment with the medical doctor -- about how many days, weeks,
(01) DAYS
or months?
(02) WEEKS
(03) MONTHS
WE ARE ASKING HOW MUCH TIME PASSED BETWEEN THE FIRST CONTACT FOR SETTING THE
(-8) Don't Know
APPOINTMENT AND THE ACTUAL DATE OF THE APPOINTMENT
(-9) Refused
MDAWDAY
AC26
numeric
How long did [you/(SP)] have to wait for the appointment with the medical doctor -- about how many days, weeks,
(01) continuous answer
or months?
AC28A1 - MWAITUNT
MDAWWKS
AC26
numeric
How long did [you/(SP)] have to wait for the appointment with the medical doctor -- about how many days, weeks,
(01) continuous answer
or months?
AC28A1 - MWAITUNT
MDAWMOS
AC26
numeric
How long did [you/(SP)] have to wait for the appointment with the medical doctor -- about how many days, weeks,
(01) continuous answer
or months?
AC28A1 - MWAITUNT
MWAITUNT
MWAITHRS
MWAITMIN
(00) BOX AC1G
(01) AC28A1 - MWAITHRS
(02) AC28A1 - MWAITMIN
(03) AC28A1 - MWAITHRS
(-8) BOX AC1G
(-9) BOX AC1G
code one
[Think about the most recent time [you/(SP)] saw a medical doctor somewhere other than at home or at a
hospital.] How long did [you/(SP)] have to wait during (your/his/her) most recent visit before (you/he/she) saw a
doctor or some other medical person? Please include the time spent in the waiting room and exam room.
numeric
[Think about the most recent time [you/(SP)] saw a medical doctor somewhere other than at home or at a
hospital.] How long did [you/(SP)] have to wait during (your/his/her) most recent visit before (you/he/she) saw a
doctor or some other medical person? Please include the time spent in the waiting room and exam room.
(01) continuous answer
If AC28A1 - MWAITUNT = 3/HoursAndMinutes, go to
AC28A1 - MWAITMIN.
Else go to BOX AC1G.
AC28A1
numeric
[Think about the most recent time [you/(SP)] saw a medical doctor somewhere other than at home or at a
hospital.] How long did [you/(SP)] have to wait during (your/his/her) most recent visit before (you/he/she) saw a
doctor or some other medical person? Please include the time spent in the waiting room and exam room.
(01) continuous answer
BOX AC1G
BOX AC1G
routing
IF AC20-AC28A1 ASKED WHILE ADMINISTERING MP, GO TO MP18 - MPPRPRAC.
ELSE IF SP HAS A CURRENT MEDICARE MANAGED CARE PLAN, GO TO AC33 - MHREFDIF.
ELSE GO TO BOX AC3.
AC28A1
AC28A1
The following questions are about health care that [you/(SP)] received through (CURRENT MEDICARE
MANAGED CARE PLAN NAME).
MHREFDIF
(00) DID NOT HAVE TO WAIT
(01) HOURS ONLY
(02) MINUTES ONLY
(03) HOURS AND MINUTES
(-8) Don't Know
(-9) Refused
AC33
code one
(01) YES
While a member of (CURRENT MEDICARE MANAGED CARE PLAN NAME), [have you/has (SP)] had difficulty in (02) NO
obtaining referrals for the services of a specialist or other medical person within (CURRENT MEDICARE
(03) N/A, HAVEN'T TRIED TO OBTAIN REFERRAL
MANAGED CARE PLAN NAME) that [you/(SP)] thought were necessary?
(-8) Don't Know
[IF NECESSARY, SAY: ‘The referral must have been for services provided by a specialist or medical provider who (-9) Refused
is associated with your Medicare Managed Care plan, not a specialist or medical provider who is "outside" of the
plan.’]
(01) AC34A - MHSPCLTY
(02) AC36 - MHREFPAY
(03) AC36 - MHREFPAY
(-8) AC36 - MHREFPAY
(-9) AC36 - MHREFPAY
Page 4 of 5
2019 MCBS Community Questionnaire
Variable Name
MR Screen Name
MHSPCLTY
MHSPCLOS
ACQ - Access to Care
Question Type
AC34A
AC34A
code one
verbatim text
Question Text/Description
Code List
(01) ALLERGY/IMMUNOLOGY
(03) CARDIOLOGY (HEART)
(05) DERMATOLOGY (SKIN)
(07) ENDOCRINOLOGY/METABOLISM
(DIABETES,THYROID)
(09) GASTROENTEROLOGY
(11) GENERAL SURGERY
(12) GERIATRICS (ELDERLY)
(13) GYNECOLOGY - OBSTETRICS
(14) HEMATOLOGY (BLOOD)
(16) INTERNAL MEDICINE (INTERNIST)
(17) NEPHROLOGY (KIDNEYS)
(18) NEUROLOGY
(20) ONCOLOGY (TUMORS, CANCER)
(21) OPHTHALMOLOGY (EYES)
SHOW CARD AC2
(22) ORTHOPEDICS
What kind of specialist or medical person was this?
(24) OSTEOPATHY (DO)
[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF THEY MENTION A 'GENERIC'
(25) OTORHINOLARYNGOLOGY (EAR, NOSE,
SPECIALITY LIKE ‘HEART DOCTOR.’ IF RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY AND THE
THROAT)
GENERIC WORD IS SHOWN IN PARENTHESES FOLLOWING ONE OF THE RESPONSES, SELECT THE
(26) PATHOLOGY
RESPONSE CATEGORY FOR THAT SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE SELECT 'OTHER DR
(27) PHYS MED/REHAB
SPECIALTY'.]
(28) PLASTIC SURGERY
(29) PROCTOLOGY
(30) PSYCHIATRY/PSYCHIATRIST
(31) PULMONARY (LUNGS)
(33) RHEUMATOLOGY (ARTHRITIS)
(35) UROLOGY
(36) AUDIOLOGIST
(37) CHIROPRACTOR
(38) DENTIST
(39) OPTOMETRIST
(40) PHYSICAL THERAPIST
(41) PSYCHOLOGIST
(91) OTHER DR SPECIALTY
(-8) Don't Know
(-9) Refused
OTHER (SPECIFY)
What kind of difficulty did [you/(SP)] have?
Routing
(01) AC35 - MHDIFCLT
(03) AC35 - MHDIFCLT
(05) AC35 - MHDIFCLT
(07) AC35 - MHDIFCLT
(09) AC35 - MHDIFCLT
(11) AC35 - MHDIFCLT
(12) AC35 - MHDIFCLT
(13) AC35 - MHDIFCLT
(14) AC35 - MHDIFCLT
(16) AC35 - MHDIFCLT
(17) AC35 - MHDIFCLT
(18) AC35 - MHDIFCLT
(20) AC35 - MHDIFCLT
(21) AC35 - MHDIFCLT
(22) AC35 - MHDIFCLT
(24) AC35 - MHDIFCLT
(25) AC35 - MHDIFCLT
(26) AC35 - MHDIFCLT
(27) AC35 - MHDIFCLT
(28) AC35 - MHDIFCLT
(29) AC35 - MHDIFCLT
(30) AC35 - MHDIFCLT
(31) AC35 - MHDIFCLT
(33) AC35 - MHDIFCLT
(35) AC35 - MHDIFCLT
(36) AC35 - MHDIFCLT
(37) AC35 - MHDIFCLT
(38) AC35 - MHDIFCLT
(39) AC35 - MHDIFCLT
(40) AC35 - MHDIFCLT
(41) AC35 - MHDIFCLT
(91) AC34A - MHSPCLOS
(-8) AC35 - MHDIFCLT
(-9) AC35 - MHDIFCLT
(01) continuous answer
AC35 - MHDIFCLT
(01) PLAN WOULDN’T AUTHORIZE SERVICE
(02) THE WAIT FOR APPOINTMENT WAS TOO LONG
(03) PROVIDER’S LOCATION WAS NOT
CONVENIENT
(04) DOCTOR/PLAN WOULDN'T GIVE SP REFERRAL
TO SEE PROVIDER SP WANTED TO SEE
(05) SP DIDN'T LIKE/NOT CONFIDENT IN PROVIDER
PLAN REFERRED SP TO
(06) PROVIDER’S OFFICE HOURS WERE NOT
CONVENIENT
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) AC36 - MHREFPAY
(02) AC36 - MHREFPAY
(03) AC36 - MHREFPAY
(04) AC36 - MHREFPAY
(05) AC36 - MHREFPAY
(06) AC36 - MHREFPAY
(91) AC35 - MHOTHOS
(-8) AC36 - MHREFPAY
(-9) AC36 - MHREFPAY
MHDIFCLT
AC35
code all
MHOTHOS
AC35
verbatim text
OTHER (SPECIFY)
(01) continuous answer
AC36 - MHREFPAY
AC36
code one
Has (CURRENT MEDICARE MANAGED CARE PLAN NAME) ever refused to pay for emergency treatment that
[you/(SP)] felt was necessary?
[‘EMERGENCY TREATMENT’ REFERS TO URGENTLY NEEDED MEDICAL CARE THAT IS REQUIRED WHEN
THE BENEFICIARY IS OUTSIDE OF THE PLAN'S SERVICE AREA OR WHEN THE CARE IS REQUIRED
DURING A TIME THAT IS OUTSIDE THE PLAN'S NORMAL OPERATING HOURS.]
(01) YES
(02) NO
(03) N/A, HAVEN'T NEEDED EMERGENCY
TREATMENT
(-8) Don't Know
(-9) Refused
BOX AC3
BOX AC3
routing
IF 11TH ROUND INTERVIEW AND (INTTYPE IN C001) AND (MREFDATE) IS AFTER (JANUARY 1 (CURRENT
YEAR)) GO TO STQ.
ELSE GO TO PMQ.
MHREFPAY
[PROBE: Any other difficulty?]
CHECK ALL THAT APPLY.
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| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |