MCAHPS Crosswalk

MCAHPS - Crosswalk 2023-1-26.pdf

Medicare Advantage, Medicare Part D, and Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey (CMS-R-246)

MCAHPS Crosswalk

OMB: 0938-0732

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0732 can be found here:

2024-06-25 - Revision of a currently approved collection

Document [pdf]

Download: pdf | pdf

FFS Survey

Existing Question (2023)
1. Some people who have Medicare also have other
insurance to help pay for some of the costs of their health
care. Do you have any other insurance that pays at least
some of the cost of your health care?
2. Please mark the box below for each type of health
insurance that you have.
2a. Medigap, which may be identified on the front of your
policy as “Medicare Supplemental Insurance”
2b. Employer, Union, or Retiree Health Coverage
(insurance)
2c. Veteran’s Benefits, also known as VA benefits
2d. Military Retiree Benefits, also known as Tricare
2e. Medicaid, also known as State medical assistance,
which is for some persons with limited income and
resources
2f. Any Prescription Drug Plan
2g. Other (Please write the name of the other health
insurance you currently have on the line below.)
2h. I don’t have health insurance other than Medicare.
3. In the last 6 months, did you have an illness, injury, or
condition that needed care right away in a clinic,
emergency room, or doctor’s office?

Proposed Question (2024)
Type of Change
1. Some people who have Medicare also have other
insurance to help pay for some of the costs of their health
care. Do you have any other insurance that pays at least
some of the cost of your health care?
2. Please mark the box below for each type of health
insurance that you have.
2a. Medigap, which may be identified on the front of your
policy as “Medicare Supplemental Insurance”
2b. Employer, Union, or Retiree Health Coverage (insurance)
2c. Veteran’s Benefits, also known as VA benefits
2d. Military Retiree Benefits, also known as Tricare
2e. Medicaid, also known as State medical assistance, which
is for some persons with limited income and resources
2f. Any Prescription Drug Plan
2g. Other (Please write the name of the other health
insurance you currently have on the line below.)
2h. I don’t have health insurance other than Medicare.

4. In the last 6 months, when you needed care right away,
how often did you get care as soon as you needed?

5. In the last 6 months, did you make any appointments for
a check-up or routine care at a doctor’s office or clinic?
6. In the last 6 months, how often did you get an
appointment for a check-up or routine care as soon as you
needed?

5. In the last 6 months, did you make any in-person, phone,
or video appointments for a check-up or routine care?
Change in wording
6. In the last 6 months, how often did you get an
appointment for a check-up or routine care as soon as you
needed?
-

7. In the last 6 months, not counting the times you went to
an emergency room, how many times did you go to a
doctor’s office or clinic to get health care for yourself?
8. Wait time includes time spent in the waiting room and
exam room. In the last 6 months, how often did you see the
person you came to see within 15 minutes of your
appointment time?
9. Using any number from 0 to 10, where 0 is the worst
health care possible and 10 is the best health care possible,
what number would you use to rate all your health care in
the last 6 months?
10. In the last 6 months, how often was it easy to get the
care, tests, or treatment you needed?
11. A personal doctor is the one you would see if you need
a check-up, want advice about a health problem, or get sick
or hurt. Do you have a personal doctor?

7. In the last 6 months, not counting the times you went to
an emergency room, how many times did you get health
care for yourself in person, by phone, or by video?
8. Wait time includes time spent in the waiting room and
exam room. In the last 6 months, how often did you see the
person you came to see within 15 minutes of your
appointment time?
9. Using any number from 0 to 10, where 0 is the worst
health care possible and 10 is the best health care possible,
what number would you use to rate all your health care in
the last 6 months?
10. In the last 6 months, how often was it easy to get the
care, tests, or treatment you needed?
11. A personal doctor is the one you would talk to if you
need a check-up, want advice about a health problem, or
get sick or hurt. Do you have a personal doctor?

Reason for Change

Burden Change

3. In the last 6 months, did you have an illness, injury, or
condition that needed care right away?

Change in wording

AHRQ 5.1 wording change to clarify inclusion of telehealth

Change in wording

FFS Survey
12. In the last 6 months, how many times did you have an in12. In the last 6 months, how many times did you visit your person, phone, or video visit with your personal doctor
personal doctor to get care for yourself?
about your health?
Change in wording
13. In the last 6 months, how often did your personal
doctor explain things in a way that was easy to understand?
14. In the last 6 months, how often did your personal
doctor listen carefully to you?
15. In the last 6 months, how often did your personal
doctor show respect for what you had to say?
16. In the last 6 months, how often did your personal
doctor spend enough time with you?
17. Using any number from 0 to 10, where 0 is the worst
personal doctor possible and 10 is the best personal doctor
possible, what number would you use to rate your personal
doctor?
18. In the last 6 months, when you visited your personal
doctor for a scheduled appointment, how often did he or
she have your medical records or other information about
your care?
19. In the last 6 months, did your personal doctor order a
blood test, x-ray or other test for you?
20. In the last 6 months, when your personal doctor
ordered a blood test, x-ray or other test for you, how often
did someone from your personal doctor’s office follow up
to give you those results?

13. In the last 6 months, how often did your personal doctor
explain things in a way that was easy to understand?
14. In the last 6 months, how often did your personal doctor
listen carefully to you?
15. In the last 6 months, how often did your personal doctor
show respect for what you had to say?
16. In the last 6 months, how often did your personal doctor
spend enough time with you?
17. Using any number from 0 to 10, where 0 is the worst
personal doctor possible and 10 is the best personal doctor
possible, what number would you use to rate your personal
doctor?
18. In the last 6 months, when you talked with your personal
doctor during a scheduled appointment, how often did he or
she have your medical records or other information about
your care?
19. In the last 6 months, did your personal doctor order a
blood test, x-ray or other test for you?
20. In the last 6 months, when your personal doctor ordered
a blood test, x-ray or other test for you, how often did
someone from your personal doctor’s office follow up to
give you those results?

21. In the last 6 months, when your personal doctor
ordered a blood test, x-ray or other test for you, how often
did you get those results as soon as you needed them?
22. In the last 6 months, did you take any prescription
medicine?
23. In the last 6 months, how often did you and your
personal doctor talk about all the prescription medicines
you were taking?
24. In the last 6 months, did you get care from more than
one kind of health care provider or use more than one kind
of health care service?
25. In the last 6 months, did you need help from anyone in
your personal doctor’s office to manage your care among
these different providers and services?

21. In the last 6 months, when your personal doctor ordered
a blood test, x-ray or other test for you, how often did you
get those results as soon as you needed them?
22. In the last 6 months, did you take any prescription
medicine?
23. In the last 6 months, how often did you and your
personal doctor talk about all the prescription medicines
you were taking?
24. In the last 6 months, did you get care from more than
one kind of health care provider or use more than one kind
of health care service?
25. In the last 6 months, did you need help from anyone in
your personal doctor’s office to manage your care among
these different providers and services?

AHRQ 5.1 wording change to clarify inclusion of telehealth

Change in wording
-

FFS Survey
29. In the last 6 months, how often did you get an
appointment to see a specialist as soon as you needed?
30. How many specialists have you seen in the last 6
months?
31. We want to know your rating of the specialist you saw
most often in the last 6 months. Using any number from 0
to 10, where 0 is the worst specialist possible and 10 is the
best specialist possible, what number would you use to rate
that specialist?
32. In the last 6 months, how often did your personal
doctor seem informed and up-to-date about the care you
got from specialists?
33. How likely are you to change doctors if you are
dissatisfied with the way you and your doctor
communicate?
34. How likely are you to tell your doctor when you
disagree with him or her?
35. In the last 6 months, how often did you leave your
doctor’s office feeling that all of your concerns or questions
were fully answered?

29. In the last 6 months, how often did you get an
appointment with a specialist as soon as you needed?
30. How many specialists have you talked to in the last 6
months?
31. We want to know your rating of the specialist you talked
to most often in the last 6 months. Using any number from 0
to 10, where 0 is the worst specialist possible and 10 is the
best specialist possible, what number would you use to rate
that specialist?
32. In the last 6 months, how often did your personal doctor
seem informed and up-to-date about the care you got from
specialists?
33. How likely are you to change doctors if you are
dissatisfied with the way you and your doctor
communicate?
34. How likely are you to tell your doctor when you disagree
with him or her?
35. In the last 6 months, how often did you leave your
doctor’s office feeling that all of your concerns or questions
were fully answered?

36. In the last 6 months, how often did you make sure you
understood the results of any medical test or procedure
such as x-ray, blood test, or EKG for heart conditions?
37. In the last 6 months, did you get information or help
from Medicare’s customer service?
38. In the last 6 months, how often did Medicare’s
customer service give you the information or help you
needed?

39. In the last 6 months, how often did Medicare’s
customer service staff treat you with courtesy and respect?
40. In the last 6 months, did Medicare give you any forms
to fill out?
41. In the last 6 months, how often were the forms from
Medicare easy to fill out?

39. In the last 6 months, how often did Medicare’s customer
service staff treat you with courtesy and respect?
40. In the last 6 months, did Medicare give you any forms to
fill out?
41. In the last 6 months, how often were the forms from
Medicare easy to fill out?
-

42. Using any number from 0 to 10, where 0 is the worst
health plan possible and 10 is the best health plan possible,
what number would you use to rate Medicare?
43. In general, how would you rate your overall health?
44. In general, how would you rate your overall mental or
emotional health?

45. In the last 6 months, did you spend one or more nights
in a hospital?
46. In the last 6 months, how often was it easy to get the
medicines your doctor prescribed?
47. Do you have insurance that pays part or all of the cost
of your prescription medicines?

45. What language do you mainly speak at home?
46. In the last 6 months, did you spend one or more nights
in a hospital?
47. In the last 6 months, how often was it easy to get the
medicines your doctor prescribed?
48. Do you have insurance that pays part or all of the cost of
your prescription medicines?

Change in wording

AHRQ 5.1 wording change to clarify inclusion of telehealth

Change in wording

AHRQ 5.1 wording change to clarify inclusion of telehealth

Change in wording

AHRQ 5.1 wording change to clarify inclusion of telehealth

38. In the last 6 months, how often did Medicare’s customer
service give you the information or help you needed?
-

New item
-

New item to promote CMS goal of measuring health inequity Yes - increase

FFS Survey
48. In the last 6 months, did you delay or not fill a
49. In the last 6 months, did you delay or not fill a
prescription because you felt you could not afford it?
prescription because you felt you could not afford it?
49. Are you currently enrolled in a Medicare Part D plan
(prescription drug plan)?
50. Are you enrolled in a Medicare Part D Medication
Therapy Management program?
51. Did a health care provider, such as a pharmacist, call or
meet with you to review your medications and answer your
questions about your medications?
52. Did the review increase your understanding of your
medications and how to use them?
53. A printed summary of the review includes a letter, a
medication action plan, and a personal medication list. Did
you receive a printed summary of the review?
54. How satisfied were you with the information in the
printed summary of the review?
55. Overall, how satisfied are you with the Medication
Therapy Management program provided by your Medicare
Part D plan?
50. In the last 6 months, did anyone from a clinic,
emergency room, or doctor’s office where you got care treat
you in an unfair or insensitive way because of any of the
following things about you?
50a. Health condition
50b. Disability
50c. Age
50d. Culture or religion
50e. Language or accent
50f. Race or ethnicity
50g. Sex (female or male)
50h. Sexual orientation
50i. Gender or gender identity
50j. Income"
56. Has a doctor ever told you that you had any of the
51. Has a doctor ever told you that you had any of the
following conditions?
following conditions?
56a. A heart attack?
51a. A heart attack?
56b. Angina or coronary heart disease?
51b. Angina or coronary heart disease?
56c. Hypertension or high blood pressure?
51c. Hypertension or high blood pressure?
56d. Cancer, other than skin cancer?
51d. Cancer, other than skin cancer?
56e. Emphysema, asthma or COPD (chronic obstructive
51e. Emphysema, asthma or COPD (chronic obstructive
pulmonary disease)?
pulmonary disease)?
56f. Any kind of diabetes or high blood sugar?
51f. Any kind of diabetes or high blood sugar?
57. Have you had a flu shot since July 1, 2022?
52. Have you had a flu shot since July 1, 2023?
58. Have you ever had one or more pneumonia shots? Two 53. Have you ever had one or more pneumonia shots? Two
shots are usually given in a person’s lifetime and these are shots are usually given in a person’s lifetime and these are
different from a flu shot. It is also called the pneumococcal different from a flu shot. It is also called the pneumococcal
vaccine.
vaccine.
59. Do you now smoke cigarettes or use tobacco every day, 54. Do you now smoke cigarettes or use tobacco every day,
some days, or not at all?
some days, or not at all?

Item removed
Item removed

Removing since the measure has become unreliable as only
relevant for a small number of enrollees.
Removing since the measure has become unreliable as only
relevant for a small number of enrollees.
Removing since the measure has become unreliable as only
relevant for a small number of enrollees.
Removing since the measure has become unreliable as only
relevant for a small number of enrollees.

Yes - decrease
Yes - decrease

Item removed

Removing since the measure has become unreliable as only
relevant for a small number of enrollees.
Removing since the measure has become unreliable as only
relevant for a small number of enrollees.

Item removed

Removing since the measure has become unreliable as only
relevant for a small number of enrollees.

New item

New item to promote CMS goal of measuring health inequity Yes - increase

Item removed

Yes - decrease
Yes - decrease

Yes - decrease

FFS Survey
60. In the last 6 months, how often were you advised to
quit smoking or using tobacco by a doctor or other health
provider?
61. What is the highest grade or level of school that you
have completed?
62. Are you of Hispanic or Latino origin or descent?
63. What is your race? Please mark one or more.

55. In the last 6 months, how often were you advised to quit
smoking or using tobacco by a doctor or other health
provider?
56. What is the highest grade or level of school that you
have completed?
57. Are you of Hispanic or Latino origin or descent?
58. What is your race? Please mark one or more.
59. What sex were you assigned at birth, on your birth
certificate?

60. What is your current gender?
61. Which of the following best represents how you think
about yourself?
64. How many people live in your household now, including 62. How many people live in your household now, including
yourself?
yourself?
65. Because of a health or physical problem are you unable 63. Because of a health or physical problem are you unable
to do or have any difficulty doing the following activities? to do or have any difficulty doing the following activities?
(Please mark one response for each activity.)
(Please mark one response for each activity.)
65a. Bathing
63a. Bathing
65b. Dressing
63b. Dressing
65c. Eating
63c. Eating
65d. Getting in or out of chairs
63d. Getting in or out of chairs
65e. Walking
63e. Walking
63f. Using the toilet
65f. Using the toilet
66. Because of a physical, mental or emotional condition, 64. Because of a physical, mental or emotional condition, do
do you have difficulty doing errands alone such as visiting a you have difficulty doing errands alone such as visiting a
doctor’s office or shopping?
doctor’s office or shopping?
67. Do you ever use the internet at home?
65. Do you ever use the internet at home?
68. May the Medicare Program follow up with you to learn
more about your health care, or to invite you to a group
discussion or interview on topics related to health care?
69. Did someone help you complete this survey?
70. How did that person help you? Please mark one or
more.
70a. Read the questions to me
70b. Wrote down the answers I gave
70c. Answered the questions for me
70d. Translated the questions into my language
70e. Helped in some other way

66. May the Medicare Program follow up with you to learn
more about your health care, or to invite you to a group
discussion or interview on topics related to health care?
67. Did someone help you complete this survey?

New item

New item to promote CMS goal of measuring health inequity Yes - increase

New item

New item to promote CMS goal of measuring health inequity Yes - increase

New item

New item to promote CMS goal of measuring health inequity Yes - increase

68. How did that person help you? Please mark one or more.
68a. Read the questions to me
68b. Wrote down the answers I gave
68c. Answered the questions for me
68d. Translated the questions into my language
68e. Helped in some other way
-

MA-PD Survey
Existing Question (2023)
1. Our records show that in 2022 your
health services were covered by the plan
named on the back page. Is that right?
2. Please write below the name of the
health plan you had in 2022 and complete
the rest of the survey based on the
experiences you had with that plan. (Please
print)
3. In the last 6 months, did you have an
illness, injury, or condition that needed care
right away in a clinic, emergency room, or
doctor’s office?
4. In the last 6 months, when you needed
care right away, how often did you get care
as soon as you needed?

Proposed Question (2024)
1. Our records show that in 2023 your
health services were covered by the plan
named on the back page. Is that right?
2. Please write below the name of the
health plan you had in 2023 and complete
the rest of the survey based on the
experiences you had with that plan. (Please
print)
-

3. In the last 6 months, did you have an
illness, injury, or condition that needed care
right away?
4. In the last 6 months, when you needed
care right away, how often did you get care
as soon as you needed?
5. In the last 6 months, did you make
5. In the last 6 months, did you make any
any in-person, phone, or video
appointments for a check-up or routine
appointments for a check-up or routine
care at a doctor’s office or clinic?
care?
6. In the last 6 months, how often did you 6. In the last 6 months, how often did you
get an appointment for a check-up or
get an appointment for a check-up or
routine care as soon as you needed?
routine care as soon as you needed?
7. In the last 6 months, not counting the
7. In the last 6 months, not counting the
times you went to an emergency room, how
times you went to an emergency room, how many times did you get health care for
many times did you go to a doctor’s office yourself in person, by phone, or by
or clinic to get health care for yourself?
video?
8. Wait time includes time spent in the
8. Wait time includes time spent in the
waiting room and exam room. In the last 6 waiting room and exam room. In the last 6
months, how often did you see the person months, how often did you see the person
you came to see within 15 minutes of your you came to see within 15 minutes of your
appointment time?
appointment time?

Type of
Change

Change in
wording

Reason for Change

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

Change in
wording

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

Change in
wording

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

Burden
Change

MA-PD Survey
9. Using any number from 0 to 10, where 0
is the worst health care possible and 10 is
the best health care possible, what number
would you use to rate all your health care in
the last 6 months?
10. In the last 6 months, how often was it
easy to get the care, tests or treatment you
needed?

9. Using any number from 0 to 10, where 0
is the worst health care possible and 10 is
the best health care possible, what number
would you use to rate all your health care in
the last 6 months?
10. In the last 6 months, how often was it
easy to get the care, tests or treatment you
needed?
-

11. A personal doctor is the one you would
see if you need a check-up, want advice
about a health problem, or get sick or hurt.
Do you have a personal doctor?

11. A personal doctor is the one you would
talk to if you need a check-up, want advice
about a health problem, or get sick or hurt.
Do you have a personal doctor?
12. In the last 6 months, how many times
12. In the last 6 months, how many times
did you have an in-person, phone, or video
did you visit your personal doctor to get
visit with your personal doctor about your
care for yourself?
health?
13. In the last 6 months, how often did your 13. In the last 6 months, how often did your
personal doctor explain things in a way that personal doctor explain things in a way that
was easy to understand?
was easy to understand?
14. In the last 6 months, how often did your
personal doctor listen carefully to you?
15. In the last 6 months, how often did your
personal doctor show respect for what you
had to say?
16. In the last 6 months, how often did your
personal doctor spend enough time with
you?
17. Using any number from 0 to 10, where 0
is the worst personal doctor possible and 10
is the best personal doctor possible, what
number would you use to rate your
personal doctor?

14. In the last 6 months, how often did your
personal doctor listen carefully to you?
15. In the last 6 months, how often did your
personal doctor show respect for what you
had to say?
16. In the last 6 months, how often did your
personal doctor spend enough time with
you?
17. Using any number from 0 to 10, where 0
is the worst personal doctor possible and 10
is the best personal doctor possible, what
number would you use to rate your
personal doctor?

Change in
wording

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

Change in
wording

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

MA-PD Survey
18. In the last 6 months, when you visited
your personal doctor for a scheduled
appointment, how often did he or she have
your medical records or other information
about your care?
19. In the last 6 months, did your personal
doctor order a blood test, x-ray or other
test for you?

18. In the last 6 months, when you talked
with your personal doctor during a
scheduled appointment, how often did
he or she have your medical records or Change in
other information about your care?
wording
19. In the last 6 months, did your personal
doctor order a blood test, x-ray or other
test for you?
-

20. In the last 6 months, when your
personal doctor ordered a blood test, x-ray
or other test for you, how often did
someone from your personal doctor’s office
follow up to give you those results?

20. In the last 6 months, when your
personal doctor ordered a blood test, x-ray
or other test for you, how often did
someone from your personal doctor’s office
follow up to give you those results?
-

23. In the last 6 months, how often did you
and your personal doctor talk about all the
prescription medicines you were taking?
24. In the last 6 months, did you get care
from more than one kind of health care
provider or use more than one kind of
health care service?

25. In the last 6 months, did you need help
from anyone in your personal doctor’s
office to manage your care among these
different providers and services?

25. In the last 6 months, did you need help
from anyone in your personal doctor’s
office to manage your care among these
different providers and services?
-

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

MA-PD Survey
26. In the last 6 months, did you get the
help you needed from your personal
doctor’s office to manage your care among
these different providers and services?
27. Specialists are doctors like surgeons,
heart doctors, allergy doctors, skin doctors,
and other doctors who specialize in one
area of health care. Is your personal doctor
a specialist?
28. In the last 6 months, did you make any
appointments to see a specialist?
29. In the last 6 months, how often did you
get an appointment to see a specialist as
soon as you needed?
30. How many specialists have you seen in
the last 6 months?
31. We want to know your rating of the
specialist you saw most often in the last 6
months. Using any number from 0 to 10,
where 0 is the worst specialist possible and
10 is the best specialist possible, what
number would you use to rate that
specialist?
32. In the last 6 months, how often did your
personal doctor seem informed and up-todate about the care you got from
specialists?
33. In the last 6 months, did you get
information or help from your health plan’s
customer service?
34. In the last 6 months, how often did your
health plan’s customer service give you the
information or help you needed?

26. In the last 6 months, did you get the
help you needed from your personal
doctor’s office to manage your care among
these different providers and services?
27. Specialists are doctors like surgeons,
heart doctors, allergy doctors, skin doctors,
and other doctors who specialize in one
area of health care. Is your personal doctor
a specialist?
28. In the last 6 months, did you make any
appointments with a specialist?
29. In the last 6 months, how often did you
get an appointment with a specialist as soon
as you needed?
30. How many specialists have you talked
to in the last 6 months?
31. We want to know your rating of the
specialist you talked to most often in the
last 6 months. Using any number from 0 to
10, where 0 is the worst specialist possible
and 10 is the best specialist possible, what
number would you use to rate that
specialist?
32. In the last 6 months, how often did your
personal doctor seem informed and up-todate about the care you got from
specialists?
33. In the last 6 months, did you get
information or help from your health plan’s
customer service?
34. In the last 6 months, how often did your
health plan’s customer service give you the
information or help you needed?
35. In the last 6 months, how often did your
35. In the last 6 months, how often did your health plan’s customer service staff treat
you with courtesy
health plan’s customer service staff treat
you with courtesy and respect?
and respect?

Change in
wording

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

Change in
wording
Change in
wording

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No
AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

Change in
wording

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

MA-PD Survey
36. In the last 6 months, did your health
plan give you any forms to fill out?
37. In the last 6 months, how often were
the forms from your health plan easy to fill
out?

36. In the last 6 months, did your health
plan give you any forms to fill out?
37. In the last 6 months, how often were
the forms from your health plan easy to fill
out?
-

38. Using any number from 0 to 10, where 0
is the worst health plan possible and 10 is
the best health plan possible, what number
would you use to rate your health plan?

38. Using any number from 0 to 10, where 0
is the worst health plan possible and 10 is
the best health plan possible, what number
would you use to rate your health plan?
-

42. In the last 6 months, how often was it
easy to use your prescription drug plan to
get the medicines your doctor prescribed?
43. In the last 6 months, did you ever use
your prescription drug plan to fill a
prescription at your local pharmacy?

MA-PD Survey
44. In the last 6 months, how often was it
easy to use your prescription drug plan to
fill a prescription at your local pharmacy?
45. In the last 6 months, did you ever use
your prescription drug plan to fill a
prescription by mail?
46. In the last 6 months, how often was it
easy to use your prescription drug plan to
fill a prescription by mail?
47. Using any number from 0 to 10, where 0
is the worst prescription drug plan possible
and 10 is the best prescription drug plan
possible, what number would you use to
rate your prescription drug plan?
48. In general, how would you rate your
overall health?
49. In general, how would you rate your
overall mental or emotional health?

44. In the last 6 months, how often was it
easy to use your prescription drug plan to
fill a prescription at your local pharmacy?
45. In the last 6 months, did you ever use
your prescription drug plan to fill a
prescription by mail?
46. In the last 6 months, how often was it
easy to use your prescription drug plan to
fill a prescription by mail?

47. Using any number from 0 to 10, where 0
is the worst prescription drug plan possible
and 10 is the best prescription drug plan
possible, what number would you use to
rate your prescription drug plan?
48. In general, how would you rate your
overall health?
49. In general, how would you rate your
overall mental or emotional health?
50. What language do you mainly speak at
home?
50. In the last 6 months, did you spend one 51. In the last 6 months, did you spend one
or more nights in a hospital?
or more nights in a hospital?
51. In the last 6 months, did you delay or
52. In the last 6 months, did you delay or
not fill a prescription because you felt you not fill a prescription because you felt you
could not afford it?
could not afford it?
52. In the last 6 months, did you receive any
mail order medicines that you did not
request?

New item

New item to promote CMS goal of measuring
health inequity
Yes - increase

Removing since the measure has become
unreliable as only relevant for a small
Item removed number of enrollees.

Yes - decrease

MA-PD Survey
53. In the last 6 months, did anyone from a
clinic, emergency room, or doctor’s office
where you got care treat you in an unfair or
insensitive way because of any of the
following things about you?
53a. Health condition
53b. Disability
53c. Age
53d. Culture or religion
53e. Language or accent
53f. Race or ethnicity
53g. Sex (female or male)
53h. Sexual orientation
53i. Gender or gender identity
53j. Income
New item
53. Has a doctor ever told you that you had
any of the following conditions?
53a. A heart attack?
53b. Angina or coronary heart disease?
53c. Hypertension or high blood pressure?
53d. Cancer, other than skin cancer?
53e. Emphysema, asthma or COPD (chronic
obstructive pulmonary disease)?
53f. A
ny kind of diabetes or high blood
sugar?
54. Do you have serious difficulty walking or
climbing stairs?
55. Do you have difficulty dressing or
bathing?
56. Because of a physical, mental, or
emotional condition, do you have difficulty
doing errands alone such as visiting a
doctor’s office or shopping?
57. Have you had a flu shot since July 1,
2022?

54. Has a doctor ever told you that you had
any of the following conditions?
54a. A heart attack?
54b. Angina or coronary heart disease?
54c. Hypertension or high blood pressure?
54d. Cancer, other than skin cancer?
54e. Emphysema, asthma or COPD (chronic
obstructive pulmonary disease)?
54f. A
ny kind of diabetes or high blood
sugar?
55. Do you have serious difficulty walking or
climbing stairs?
56. Do you have difficulty dressing or
bathing?
57. Because of a physical, mental, or
emotional condition, do you have difficulty
doing errands alone such as visiting a
doctor’s office or shopping?
58. Have you had a flu shot since July 1,
2023?

New item to promote CMS goal of measuring
health inequity
Yes - increase

MA-PD Survey
58. Have you ever had one or more
pneumonia shots? Two shots are usually
given in a person’s lifetime and these are
different from a flu shot. It is also called the
pneumococcal vaccine.

59. Have you ever had one or more
pneumonia shots? Two shots are usually
given in a person’s lifetime and these are
different from a flu shot. It is also called the
pneumococcal vaccine.
-

59. Do you now smoke cigarettes or use
tobacco every day, some days, or not at all?
60. In the last 6 months, how often were
you advised to quit smoking or using
tobacco by a doctor or other health
provider?
61. What is the highest grade or level of
school that you have completed?
62. Are you of Hispanic or Latino origin or
descent?
63. What is your race? Please mark one or
more.
64. How many people live in your
household now, including yourself?

60. Do you now smoke cigarettes or use
tobacco every day, some days, or not at all?
61. In the last 6 months, how often were
you advised to quit smoking or using
tobacco by a doctor or other health
provider?
62. What is the highest grade or level of
school that you have completed?
63. Are you of Hispanic or Latino origin or
descent?
64. What is your race? Please mark one or
more.
65. How many people live in your
household now, including yourself?

65. Do you ever use the internet at home?
66. May the Medicare Program follow up
with you to learn more about your health
care, or to invite you to a group
discussion or interview on topics related
to health care?
67. Did someone help you complete this
survey?
68. How did that person help you? Please
mark one or more.
68a. Read the questions to me
68b. Wrote down the answers I gave
68c. Answered the questions for me
68d. Translated the questions into my
language
68e. Helped in some other way

66. Do you ever use the internet at home?
67. May the Medicare Program follow up
with you to learn more about your health
care, or to invite you to a group
discussion or interview on topics related
to health care?
68. Did someone help you complete this
survey?
69. How did that person help you? Please
mark one or more.
69a. Read the questions to me
69b. Wrote down the answers I gave
69c. Answered the questions for me
69d. Translated the questions into my
language
69e. Helped in some other way

MA-Only Survey
Existing Question (2023)
1. Our records show that in 2022 your
health services were covered by the plan
named on the back page. Is that right?
2. Please write below the name of the
health plan you had in 2022 and complete
the rest of the survey based on the
experiences you had with that plan. (Please
print)
3. In the last 6 months, did you have an
illness, injury, or condition that needed care
right away in a clinic, emergency room, or
doctor’s office?
4. In the last 6 months, when you needed
care right away, how often did you get care
as soon as you needed?

Type of
Change

Change in
wording

Reason for Change

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

Change in
wording

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

Change in
wording

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

Burden
Change

MA-Only Survey
9. Using any number from 0 to 10, where 0
is the worst health care possible and 10 is
the best health care possible, what number
would you use to rate all your health care in
the last 6 months?
10. In the last 6 months, how often was it
easy to get the care, tests or treatment you
needed?

11. A personal doctor is the one you would
see if you need a check-up, want advice
about a health problem, or get sick or hurt.
Do you have a personal doctor?

Change in
wording

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

Change in
wording

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

MA-Only Survey
18. In the last 6 months, when you visited
your personal doctor for a scheduled
appointment, how often did he or she have
your medical records or other information
about your care?
19. In the last 6 months, did your personal
doctor order a blood test, x-ray or other
test for you?

18. In the last 6 months, when you talked with
your personal doctor during a scheduled
appointment, how often did he or she have
Change in
your medical records or other information
about your care?
wording

19. In the last 6 months, did your personal
doctor order a blood test, x-ray or other
test for you?

20. In the last 6 months, when your
personal doctor ordered a blood test, x-ray
or other test for you, how often did
someone from your personal doctor’s office
follow up to give you those results?

25. In the last 6 months, did you need help
from anyone in your personal doctor’s
office to manage your care among these
different providers and services?

25. In the last 6 months, did you need help
from anyone in your personal doctor’s
office to manage your care among these
different providers and services?
-

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

MA-Only Survey
26. In the last 6 months, did you get the
help you needed from your personal
doctor’s office to manage your care among
these different providers and services?
27. Specialists are doctors like surgeons,
heart doctors, allergy doctors, skin doctors,
and other doctors who specialize in one
area of health care. Is your personal doctor
a specialist?
28. In the last 6 months, did you make any
appointments to see a specialist?
29. In the last 6 months, how often did you
get an appointment to see a specialist as
soon as you needed?
30. How many specialists have you seen in
the last 6 months?
31. We want to know your rating of the
specialist you saw most often in the last 6
months. Using any number from 0 to 10,
where 0 is the worst possible and 10 is the
best specialist possible, what number would
you use to rate that specialist?
32. In the last 6 months, how often did your
personal doctor seem informed and up-todate about the care you got from
specialists?
33. In the last 6 months, did you get
information or help from your health plan’s
customer service?
34. In the last 6 months, how often did your
health plan’s customer service give you the
information or help you needed?
35. In the last 6 months, how often did your
health plan’s customer service staff treat
you with courtesy
and respect?

26. In the last 6 months, did you get the
help you needed from your personal
doctor’s office to manage your care among
these different providers and services?
27. Specialists are doctors like surgeons,
heart doctors, allergy doctors, skin doctors,
and other doctors who specialize in one
area of health care. Is your personal doctor
a specialist?
28. In the last 6 months, did you make any
appointments with a specialist?
29. In the last 6 months, how often did you
get an appointment with a specialist as soon
as you needed?
30. How many specialists have you talked
to in the last 6 months?
31. We want to know your rating of the
specialist you talked to most often in the
last 6 months. Using any number from 0 to
10, where 0 is the worst specialist possible
and 10 is the best specialist possible, what
number would you use to rate that
specialist?
32. In the last 6 months, how often did your
personal doctor seem informed and up-todate about the care you got from
specialists?
33. In the last 6 months, did you get
information or help from your health plan’s
customer service?
34. In the last 6 months, how often did your
health plan’s customer service give you the
information or help you needed?
35. In the last 6 months, how often did your
health plan’s customer service staff treat
you with courtesy
and respect?

Change in
wording

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

Change in
wording
Change in
wording

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No
AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

Change in
wording

AHRQ 5.1 wording change to clarify inclusion
of telehealth
No

MA-Only Survey
36. In the last 6 months, did your health
plan give you any forms to fill out?
37. In the last 6 months, how often were
the forms from your health plan easy to fill
out?

36. In the last 6 months, did your health
plan give you any forms to fill out?
37. In the last 6 months, how often were
the forms from your health plan easy to fill
out?
-

38. Using any number from 0 to 10, where 0
is the worst health plan possible and 10 is
the best health plan possible, what number
would you use to rate your health plan?

38. Using any number from 0 to 10, where 0
is the worst health plan possible and 10 is
the best health plan possible, what number
would you use to rate your health plan?
-

39. A co-pay is the amount of money you
pay at the time of a visit to a doctor’s office
or clinic. In the last 6 months, did your
health plan offer to lower the amount of
your co-pay because you have a health
condition (like high blood pressure)?
40. Your health plan benefits are the types
of health care and services you can get
under the plan. In the last 6 months, did
your health plan offer you extra benefits
because you have a health condition (like
high blood pressure)?
41. In general, how would you rate your
overall health?
42. In general, how would you rate your
overall mental or emotional health?
43. What language do you mainly speak at
home?
43. In the last 6 months, did you spend one 44. In the last 6 months, did you spend one
or more nights in a hospital?
or more nights in a hospital?
44. In the last 6 months, how often was it 45. In the last 6 months, how often was it
easy to get the medicines your doctor
easy to get the medicines your doctor
prescribed?
prescribed?
45. Do you have insurance that pays part or 46. Do you have insurance that pays part or
all of the cost of your prescription
all of the cost of your prescription
medicines?
medicines?

New item
-

New item to promote CMS goal of measuring
health inequity
Yes - increase

MA-Only Survey
46. In the last 6 months, did you delay or
47. In the last 6 months, did you delay or
not fill a prescription because you felt you not fill a prescription because you felt you
could not afford it?
could not afford it?
47. In the last 6 months, did you receive any
mail order medicines that you did not
request?
Item removed
48. In the last 6 months, did anyone from a
clinic, emergency room, or doctor’s office
where you got care treat you in an unfair or
insensitive way because of any of the
following things about you?
48a. Health condition
48b. Disability
48c. Age
48d. Culture or religion
48e. Language or accent
48f. Race or ethnicity
48g. Sex (female or male)
48h. Sexual orientation
48i. Gender or gender identity
48j. Income
New item
48. Has a doctor ever told you that you had
any of the following conditions?
48a. A heart attack?
48b. Angina or coronary heart disease?
48c. Hypertension or high blood pressure?
48d. Cancer, other than skin cancer?
48e. Emphysema, asthma or COPD (chronic
obstructive pulmonary disease)?
48f. Any kind of diabetes or high blood
sugar?
49. Do you have serious difficulty walking or
climbing stairs?
50. Do you have difficulty dressing or
bathing?

49. Has a doctor ever told you that you had
any of the following conditions?
49a. A heart attack?
49b. Angina or coronary heart disease?
49c. Hypertension or high blood pressure?
49d. Cancer, other than skin cancer?
49e. Emphysema, asthma or COPD (chronic
obstructive pulmonary disease)?
49f. Any kind of diabetes or high blood
sugar?
50. Do you have serious difficulty walking or
climbing stairs?
51. Do you have difficulty dressing or
bathing?
-

Removing since the measure has become
unreliable as only relevant for a small
number of enrollees.

Yes - decrease

New item to promote CMS goal of measuring
health inequity
Yes - increase

MA-Only Survey
51. Because of a physical, mental, or
emotional condition, do you have difficulty
doing errands alone such as visiting a
doctor’s office or shopping?
52. Have you had a flu shot since July 1,
2022?
53. Have you ever had one or more
pneumonia shots? Two shots are usually
given in a person’s lifetime and these are
different from a flu shot. It is also called the
pneumococcal vaccine.

52. Because of a physical, mental, or
emotional condition, do you have difficulty
doing errands alone such as visiting a
doctor’s office or shopping?
53. Have you had a flu shot since July 1,
2023?
54. Have you ever had one or more
pneumonia shots? Two shots are usually
given in a person’s lifetime and these are
different from a flu shot. It is also called the
pneumococcal vaccine.
-

54. Do you now smoke cigarettes or use
tobacco every day, some days, or not at all?
55. In the last 6 months, how often were
you advised to quit smoking or using
tobacco by a doctor or other health
provider?
56. What is the highest grade or level of
school that you have completed?
57. Are you of Hispanic or Latino origin or
descent?
58. What is your race? Please mark one or
more.
59. How many people live in your
household now, including yourself?

55. Do you now smoke cigarettes or use
tobacco every day, some days, or not at all?
56. In the last 6 months, how often were
you advised to quit smoking or using
tobacco by a doctor or other health
provider?
57. What is the highest grade or level of
school that you have completed?
58. Are you of Hispanic or Latino origin or
descent?
59. What is your race? Please mark one or
more.
60. How many people live in your
household now, including yourself?

60. Do you ever use the internet at home?
61. May the Medicare Program follow up
with you to learn more about your health
care, or to invite you to a group discussion
or interview on topics related to health
care?
62. Did someone help you complete this
survey?

61. Do you ever use the internet at home?
62. May the Medicare Program follow up
with you to learn more about your health
care, or to invite you to a group discussion
or interview on topics related to health
care?
63. Did someone help you complete this
survey?

MA-Only Survey
63. How did that person help you? Please
mark one or more.
63a. Read the questions to me
63b. Wrote down the answers I gave
63c. Answered the questions for me
63d. Translated the questions into my
language
63e. Helped in some other way

64. How did that person help you? Please
mark one or more.
64a. Read the questions to me
64b. Wrote down the answers I gave
64c. Answered the questions for me
64d. Translated the questions into my
language
64e. Helped in some other way

PDP Survey
Existing Question (2023)
1. Our records show that in 2022 your
prescriptions were covered by the Medicare
prescription drug plan named on the back
page.
Is that right?
2. Please write below the name of the
Medicare prescription drug plan you had in
2022 and complete the rest of the survey
based on the experiences you had with that
plan. (Please print)
3. In the last 6 months, did anyone from a
doctor’s office, pharmacy or your
prescription drug plan contact you:
3a. To make sure you filled or refilled a
prescription?
3b. To make sure you were taking
medications as directed?

Proposed Question (2024)
1. Our records show that in 2023 your
prescriptions were covered by the Medicare
prescription drug plan named on the back
page.
Is that right?
2. Please write below the name of the
Medicare prescription drug plan you had in
2023 and complete the rest of the survey
based on the experiences you had with that
plan. (Please print)
3. In the last 6 months, did anyone from a
doctor’s office, pharmacy or your
prescription drug plan contact you:
3a. To make sure you filled or refilled a
prescription?
3b. To make sure you were taking
medications as directed?
-

4. In the last 6 months, how often was it
easy to use your prescription drug plan to
get the medicines your doctor prescribed?
5. In the last 6 months, did you ever use
your prescription drug plan to fill a
prescription at your local pharmacy?

6. In the last 6 months, how often was it
easy to use your prescription drug plan to
fill a prescription at your local pharmacy?
7. In the last 6 months, did you ever use
your prescription drug plan to fill a
prescription by mail?
8. In the last 6 months, how often was it
easy to use your prescription drug plan to
fill a prescription by mail?

Type of
Change

Reason for Change

Burden
Change

PDP Survey
9. Using any number from 0 to 10, where 0
is the worst prescription drug plan possible
and 10 is the best prescription drug plan
possible, what number would you use to
rate your prescription drug plan?
10. In general, how would you rate your
overall health?
11. In general, how would you rate your
overall mental or emotional health?

9. Using any number from 0 to 10, where 0
is the worst prescription drug plan possible
and 10 is the best prescription drug plan
possible, what number would you use to
rate your prescription drug plan?
10. In general, how would you rate your
overall health?
11. In general, how would you rate your
overall mental or emotional health?
12. What language do you mainly speak at
home?
12. In the last 6 months, did you spend one 13. In the last 6 months, did you spend one
or more nights in a hospital?
or more nights in a hospital?
13. In the last 6 months, did you delay or
14. In the last 6 months, did you delay or
not fill a prescription because you felt you not fill a prescription because you felt you
could not afford it?
could not afford it?
14. In the last 6 months, did you receive any
mail order medicines that you did not
request?
15. Has a doctor ever told you that you had
any of the following conditions?
15a. A heart attack?
15b. Angina or coronary heart disease?
15c. Hypertension or high blood pressure?
15d. Cancer, other than skin cancer?
15e. Emphysema, asthma or COPD (chronic
obstructive pulmonary disease)?
15f. Any kind of diabetes or high blood
sugar?
16. Do you have serious difficulty walking or
climbing stairs?
17. Do you have difficulty dressing or
bathing?

New item

New item to promote CMS goal of measuring
health inequity
Yes - increase

Removing since the measure has become
unreliable as only relevant for a small
Item removed number of enrollees.

15. Has a doctor ever told you that you had
any of the following conditions?
15a. A heart attack?
15b. Angina or coronary heart disease?
15c. Hypertension or high blood pressure?
15d. Cancer, other than skin cancer?
15e. Emphysema, asthma or COPD (chronic
obstructive pulmonary disease)?
15f. Any kind of diabetes or high blood
sugar?
16. Do you have serious difficulty walking or
climbing stairs?
17. Do you have difficulty dressing or
bathing?
-

Yes - decrease

PDP Survey
18. Because of a physical, mental, or
emotional condition, do you have difficulty
doing errands alone such as visiting a
doctor’s office or shopping?
19. What is the highest grade or level of
school that you have completed?
20. Are you of Hispanic or Latino origin or
descent?
21. What is your race? Please mark one or
more.
22. How many people live in your
household now, including yourself?

18. Because of a physical, mental, or
emotional condition, do you have difficulty
doing errands alone such as visiting a
doctor’s office or shopping?
19. What is the highest grade or level of
school that you have completed?
20. Are you of Hispanic or Latino origin or
descent?
21. What is your race? Please mark one or
more.
22. How many people live in your
household now, including yourself?

23. Do you ever use the internet at home?
24. May the Medicare Program follow up
with you to learn more about your health
care, or to invite you to a group discussion
or interview on topics related to health
care?
25. Did someone help you complete this
survey?
26. How did that person help you? Please
mark one or more.
26a. Read the questions to me
26b. Wrote down the answers I gave
26c. Answered the questions for me
26d. Translated the questions into my
language
26e. Helped in some other way

File Type	application/pdf
File Title	MCAHPS - Crosswalk 2023-1-26
Author	Lila Malin
File Modified	2023-02-01
File Created	2023-01-31