Medical Expenditure Panel Survey (MEPS) COVID-19 Changes

Forms and Documents

Document	Type	Status	Availability
Form Attachment 29 MEPS-HC Core Interview	Form and Instruction	Unchanged	Repair queued
Form 1 COVID-19 Questions	Form and Instruction	New	Repair queued
Form Attachment A – COV COVID-19 and Telehealth (telemedicine) questions included in the MEPS questionnaire	Form and Instruction	Unchanged	Repair queued
Form Attachment C Attachment C – Social and Health Experiences Self-Administered Questionnaire	Form and Instruction	Unchanged	Repair queued
Form 106a HC Adult SAQ that includes Mental Health Questions	Form and Instruction	Unchanged	Repair queued
Form 107a Health Insurance Cost Sharing Collection- 2020	Form and Instruction	Unchanged	Repair queued
Form 108 Pilot Test on Sampling NHIS Nonrespondents – 2020, R1 only of MEPS Core	Form and Instruction	Unchanged	Repair queued
Form Attachment 19 Attachment 19 – HC Adult SAQ – Male	Form and Instruction	Unchanged	Repair queued
Form Attachment 20 Attachment 20 HC Adult SAQ Female	Form and Instruction	Unchanged	Repair queued
Form Attachment 72 MPC Contact Guide/Screening Call	Form and Instruction	Unchanged	Repair queued
Form Attachment 26 MEPS-HC Validation Interview	Form and Instruction	Unchanged	Repair queued
Form Attachment 24 Authorization form for the MEPS-MPC Pharmacy Survey	Form and Instruction	Unchanged	Repair queued
Form Attachment 25 Authorization form for the MEPS-MPC Provider Survey	Form and Instruction	Unchanged	Repair queued
Form Attachment 98 Pharmacies questionnaire	Form and Instruction	Unchanged	Repair queued
Form Attachment 96 Institutions (non-hospital) questionnaire	Form and Instruction	Unchanged	Repair queued
Form Attachment 91 Hospitals questionnaire	Form and Instruction	Unchanged	Repair queued
Form Attachment 87 Separately billing doctors questionnaire	Form and Instruction	Unchanged	Repair queued
Form Attachment 83 Office based providers questionnaire	Form and Instruction	Unchanged	Repair queued
Form Attachment 82 Home care for non health care providers questionnaire	Form and Instruction	Unchanged	Repair queued
Form Attachment 78 Home care for health care providers questionnaire	Form and Instruction	Unchanged	Repair queued
Form Attachment 22 Diabetes Care SAQ	Form and Instruction	Unchanged	Repair queued
BEA Letter of Support.pdf	Supplementary Document	Uploaded 2022-09-27	Repair queued
Attachment D - MEPS New Social Determinates of Care SAQ Items Crosswalk v2.docx	Supplementary Document	Uploaded 2020-11-17	Repair queued
Attachment A1 - MEPS New COVID-19 Delays in Receiving Care Items Corsswalk.docx	Supplementary Document	Uploaded 2020-11-17	Repair queued
response Nurse Pract FRN Comment.msg	Supplementary Document	Uploaded 2019-07-15	Repair queued
Attachment 104 – MPC Veterans Affairs Authorization Form Package.docx	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 103 – MPC Pharmacy Provider Letters., Email Templates, and Other Documents.doc	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 102 – MPC Durable Medical Equipment Provider Authorization Form Package.docx	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 101 – MPC Pharmacy Provider Overflow Patient List.docx	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 100 – MPC Pharmacy Provider Authorization Form Package, Phone Data Collection Anticipated.doc	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 99 – MPC Pharmacy Provider Authorization Form Package, Records to be Provided via Fax Anticipated.doc	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 97 – MPC Letters, Emal Templates, and Other Documents.docx	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 95 – MPC Hospital Provider Overflow Patient List.docx	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 94 – MPC Hospital Provider Authorization Form Package, Point of Contact for Patient Account Records.doc	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 93 – MPC Hospital Provider Authorization Form Package, Point of Contact for Medical Records.doc	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 92 – MPC Institution Provider Questionnaire.docx	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 90 – MPC Separately Billing Doctor Provider Overflow Patient List.docx	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 89 – MPC Separately Billing Doctor Provider Authorization Form Package, Phone Data Collection Anticipated.doc	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 88 – MPC Hospital Provider Authorization Form Package,.doc	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 86 – MPC Office-Based Doctor Provider Overflow Patient List.docx	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 85 – MPC Separately Billing Doctor Provider Authorization Form Package, Phone Data Collection Anticipated.doc	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 84 – MPC Office-Based Doctor Provider Authorization Form Package, Phone Data Collection Anticipated.doc	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 82 – MPC Home Care Provider Questionnaire for Non-Health Care Providers.docx	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 81 – MPC Home Care Provider Overflow Patient List.docx	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 80 – MPC Home Care Provider Authorization Form Package, Records to be Provided via Fax Anticipated.doc	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 79 – MPC Home Care Provider Authorization Form Package, Phone Data Collection Anticipated.doc	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 28 HC Tips for Making Your MEPS Interview Easier.pdf	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 27 HC MEPS Tip Sheet.pdf	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 17 HC Who Uses MEPS Data.pdf	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 16 HC Certificate of Appreciation.pdf	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 15 HC Validation Letter.pdf	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 14 HC Showcards.pdf	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 13 HC MEPS Record Keeper.pdf	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 12 HC MEPS Monthly Planner.pdf	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 11 HC MEPS FAQs Brochure.pdf	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 10 HC Respondent Letters, Postcards and Notes.docx	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 9 HC Data Example and FAQs.docx	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 8 HC Important Information About Your Participation in MEPS.pdf	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 7 HC Respondent Recruitment Video Transcript.pdf	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 6 HC Data Protection is word ONE with MEPS.pdf	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 5 HC About the MEPS MPC Authorization form.pdf	Supplementary Document	Uploaded 2018-09-12	Missing upstream
Attachment 4 HC What MEPS tells us about Charts.docx	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 3 HC MEPS A Survey of Health Care Use and Spending.pdf	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 2 HC Why is Participation in MEPS so Important.pdf	Supplementary Document	Uploaded 2018-09-12	Repair queued
Attachment 1 final draft.09052018..docx	Supplementary Document	Uploaded 2018-09-12	Repair queued
Supporting Statement Part B -- MEPS Covid Condition.docx	Supporting Statement B	Uploaded 2022-09-27	Repair queued
Supporting Statement Part A -- MEPS Covid Condition (002).docx	Supporting Statement A	Uploaded 2022-10-05	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
37877	MEPS-HC Core Interview	Form and Instruction	Unchanged
256163	COVID-19 Questions	Form and Instruction	New
242880	COVID-19 and Telehealth (telemedicine) questions included in the MEPS questionnaire	Form and Instruction	Unchanged
242879	Attachment C – Social and Health Experiences Self-Administered Questionnaire	Form and Instruction	Unchanged
236894	HC Adult SAQ that includes Mental Health Questions	Form and Instruction	Unchanged
236893	Health Insurance Cost Sharing Collection- 2020	Form and Instruction	Unchanged
236883	Pilot Test on Sampling NHIS Nonrespondents – 2020, R1 only of MEPS Core	Form and Instruction	Unchanged
230227	Attachment 19 – HC Adult SAQ – Male	Form and Instruction	Unchanged
230226	Attachment 20 HC Adult SAQ Female	Form and Instruction	Unchanged
204200	MPC Contact Guide/Screening Call	Form and Instruction	Unchanged
204199	MEPS-HC Validation Interview	Form and Instruction	Unchanged
204198	Authorization form for the MEPS-MPC Pharmacy Survey	Form and Instruction	Unchanged
204197	Authorization form for the MEPS-MPC Provider Survey	Form and Instruction	Unchanged
191107	Pharmacies questionnaire	Form and Instruction	Unchanged
191106	Institutions (non-hospital) questionnaire	Form and Instruction	Unchanged
191105	Hospitals questionnaire	Form and Instruction	Unchanged
191104	Separately billing doctors questionnaire	Form and Instruction	Unchanged
191103	Office based providers questionnaire	Form and Instruction	Unchanged
191102	Home care for non health care providers questionnaire	Form and Instruction	Unchanged
191101	Home care for health care providers questionnaire	Form and Instruction	Unchanged
191099	Diabetes Care SAQ	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0935-0118	ICR Reference No: 202209-0935-003
Status: Received in OIRA	Previous ICR Reference No: 202007-0935-001
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Medical Expenditure Panel Survey (MEPS) COVID-19 Changes
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/05/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	11/30/2023
Responses	392,715	379,377
Time Burden (Hours)	88,531	88,309
Cost Burden (Dollars)	0	0

---

Abstract: The questions will be asked of all MEPS sample members with a single household respondent reporting for the household. The first two questions serve as gate questions and only respondents who report having a COVID-19 diagnosis in the relevant time period will receive follow-up questions about the timing of their most recent infection. These questions will be administered in the existing Priority Conditions Enumeration section of MEPS, which includes a similar series of questions about whether household members have ever been diagnosed with certain medical conditions. Historically, MEPS has been conducted using Computer Assisted Personal Interviewing (CAPI) where field interviews conduct interviews with household respondents in person. However, MEPS is currently being conducted via multiple modes, including face-to-face, phone, and virtual interviewing, due to the ongoing COVID-19 pandemic. The information collected on COVID-19 diagnoses will undergo editing and be reviewed for data quality, including consistency with publicly available sources of data on COVID-19 infections. Additionally, the resulting variables will be included on the annual MEPS full-year consolidated public use data files after being assessed for any potential disclosure concerns. The new CAPI questions collecting information about COVID-19 will be folded into the regular processing stream of MEPS data to produce estimates of health care utilization and expenditures. The information collected on COVID-19 diagnoses will be used to compare healthcare utilization and expenditures between those who have had confirmed COVID-19 and those who have not. Additionally, the information collected on the timing of recent infections can be used to either include or exclude recent infections from calendar year or round-specific estimates of healthcare utilization and expenditures. This allows researchers to examine both shorter-term and longer-term impacts of a COVID-19 diagnosis on healthcare utilization and expenditures.

---

Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Agency for Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 41126	07/11/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 60402	10/05/2022
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 21

IC Title	Form No.	Form Name
Attachment 20 HC Adult SAQ Female	Attachment 20 , Attachment 19	Attachment 20 HC Adult SAQ Female ,   Attachment 19 HC Adult SAQ Male
COVID-19 Questions	1	PE COVID-19
Attachment 19 – HC Adult SAQ – Male	Attachment 19 , Attachment 18	Attachment 19 – HC Adult SAQ – Male ,   Attachment 18 HC Adult SAQ
Attachment C – Social and Health Experiences Self-Administered Questionnaire	Attachment C	Attachment C
Authorization form for the MEPS-MPC Pharmacy Survey	Attachment 24	Attachment 24 HC Authorization Form for the MEPS MPC Pharmacy
Authorization form for the MEPS-MPC Provider Survey	Attachment 25	Attachment 25 HC Authorization Form for the MEPS MPC Provider
COVID-19 and Telehealth (telemedicine) questions included in the MEPS questionnaire	Attachment B, Attachment A – COVID-19 Questions	Attachment A – COVID-19 Questions ,   Attachment B
Diabetes Care SAQ	Attachment 22, Attachment 23	Attachment 22 -- HC Diabetes SAQ - Proxy ,   Attachment 23 -- HC Diabetes SAQ - Self
HC Adult SAQ that includes Mental Health Questions	106a, 106b	Attachment 106a.REV_Female PSAQ with Mental Health Content ,   Attachment106b.REV_Male PSAQ with Mental Health Content
Health Insurance Cost Sharing Collection- 2020	107b, 107a, 107c, 107d	Attachment 107a.Protocol A (Medicare) ,   Attachment 107b.Protocol B (Employer) ,   Attachment 107c.Protocol C (Private with Medicare)_ ,   Attachment 107d.Protocol D (Other)
Home care for health care providers questionnaire	Attachment 78	Attachment 78 – MPC Home Care Provider Questionnaire for Health Care Providers
Home care for non health care providers questionnaire	Attachment 82	Attachment 82 – MPC Home Care Provider Questionnaire for Non-Health Care Providers
Hospitals questionnaire	Attachment 91	Attachment 91 – MPC Hospital Provider Questionnaire
Institutions (non-hospital) questionnaire	Attachment 96	Attachment 96 – MPC Institution Provider Questionnaire
MEPS-HC Core Interview	Attachment 29, Attachment 30 , Attachment 31 , Attachment 32 , Attachment 33 , Attachment 34, Attachment 35 , Attachment 36 , Attachment 37 , Attachment 39 , Attachment 40 , Attachment 41 , Attachment 42 , Attachment 43 , Attachment 44 , Attachment 46 , Attachment 47 , Attachment 48 , Attachment 49 , Attachment 50 , Attachment 51 , Attachment 53 , Attachment 52 HC, Attachment 54 , Attachment 55 , Attachment 56 , Attachment 57 , Attachment 58 , Attachment 59 , Attachment 60 , Attachment 62 , Attachment 63 , Attachment 64 , Attachment 65 , Attachment 66 , Attachment 67 , Attachment 68 , Attachment 69 , Attachment 70 , Attachment 71 , Attachment 38 , Attachment 45 , Attachment 61	Attachment 29 –HC Access to Care Section ,   Attachment 30 – HC Condition Enumeration Section ,   Attachment 31 – Attachment 31 HC Assets Section. ,   Attachment 32 – Attachment 32 HC Calendar Section ,   Attachment 33 Additional healthcare Section ,   Attachment 34 HC Closing Section ,   Attachment 35 HC Start_Restart ,   Attachment 36 HC Charge Payment Section ,   Attachment 37 HC Flat Fee Section ,   Attachment 38 – HC Child Preventive Health Supplement Section ,   Attachment 39 – HC Institutional Care Section ,   Attachment 40 – HC Dental Care Section ,   Attachment 41 – HC Event Driver Section ,   Attachment 42 – HC Employment (EM) Section ,   Attachment 43 – HC Review of Employment Information (RJ) Section ,   Attachment 44 – HC Employment Driver (OE) Section ,   Attachment 45 – HC Employment Wage (EW) Section ,   Attachment 46 – HC Emergency Room Section ,   Attachment 47 Event Roster Section ,   Attachment 48 Health Status Section ,   Attachment 49 HC Help Text ,   Attachment 50 Home Health Section ,   Attachment 51 Health Insurance (HX) Section ,   Attachment 52 HC Private Health Insurance Detail (HP) Section ,   Attachment 53 HC Time Covered Detail (HQ) Section ,   Attachment 54 HC Managed Care (MC) Section ,   Attachment 55 HC Old Employment Health Insurance (OE) Section ,   Attachment 56 HC Old Public Related Insurance (PR) Section ,   Attachment 57 HC Hospital Stay Section ,   Attachment 58 HC Income Section ,   Attachment 59 HC Medical Provider Section ,   Attachment 60 HC Other Medical Expense Section ,   Attachment 61 HC Outpatient Department Section ,   Attachment 62 HC Quality Supplement Section ,   Attachment 63 HC Respondent Forms Section ,   Attachment 64 HC Priority Conditions Enumeration Section ,   Attachment 65 HC Prescribed Medicines Section ,   Attachment 66 HC Provider Probes Section ,   Attachment 67 HC Provider Roster Section ,   Attachment 68 HC Reenumeration Subsection ,   Attachment 69 HC Reenumeration Subsection B ,   Attachment 70 HC RU Information Screener ,   Attachment 71 HC Event Follow Up Section
MEPS-HC Validation Interview	Attachment 26	Attachment 26 HC MEPS Validation Interview
MPC Contact Guide/Screening Call	Attachment 72 , Attachment 73 , Attachment 74 , Attachment 75 , Attachment 76 , Attachment 77	Attachment 72 – MPC Hospital Contact Guide ,   Attachment 73 – MPC Office-Based Doctor Contact Guide ,   Attachment 74 – MPC Home Care Contact ,   Attachment 75 – MPC Institution Contact Guide ,   Attachment 76 – MPC Pharmacy Contact Guide ,   Attachment 77 – MPC Separate Billing Doctor Contact Guide
Office based providers questionnaire	Attachment 83	Attachment 83 – MPC Office-Based Doctor Provider Questionnaire
Pharmacies questionnaire	Attachment 98	Attachment 98 – MPC Pharmacy Provider Questionnaire
Pilot Test on Sampling NHIS Nonrespondents – 2020, R1 only of MEPS Core	108	Attachment 108 - Household Component Core Instrument Link
Separately billing doctors questionnaire	Attachment 87	Attachment 87 – MPC Separately Billing Doctor Provider Questionnaire

---

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	392,715	379,377	0	13,338	0	0
Annual Time Burden (Hours)	88,531	88,309	0	222	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The total estimated annual burden hours for the MEPS have increased from 88,309 hours in the previous clearance to 88,531 hours in this clearance request, an increase of 222 hours due to the addition of the COVID-19 related questions.

---

Annual Cost to Federal Government: $70,500

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/05/2022

---