Crosswalk

CMS-10816 CY 2023 MEDICARE ADVANTAGE AND MEDICARE PRECRIPTION DRUG PLAN INTERVIEW GUIDE CROSSWALK

Current Cognitive Interview Guide Language	Location on current interview guide	Revised Cognitive Interview Guide Language	Type of Change	Reason for Change	Location on updated interview guide
 American Indian or Alaska Native Asian  Asian Indian Chinese Filipino Guamanian or Chamorro Japanese Korean Vietnamese  Other Asian  Black or African American Native Hawaiian and Pacific IslanderNative Hawaiian Other Pacific Islander Samoan White  I choose not to answer.	Pages 2-4	0 American Indian or Alaska Native Asian: 0 Asian Indian 0 Chinese 0 Filipino 0 Japanese 0 Korean 0 Vietnamese 0 Other Asian 0 Black or African American Native Hawaiian and Pacific Islander: 0 Guamanian or Chamorro 0 Native Hawaiian 0 Samoan 0 Other Pacific Islander 0 White 0 I choose not to answer.	Rev	OMB’s terms of clearance for the approved information collection, Medicare Part C and Medicare Part D Enrollment Form Interviews (CMS-10816, OMB 0938-1440), required that CMS submit non-substantial change requests to revise its new race question to ensure appropriate and tested alphabetization of race categories with nested sub-categories of race rather than alphabetization of all sub-categories together. This revision clarifies the listings of those categories.	Pages 2-4
The first question was: Are you Hispanic, Latino/a, or Spanish origin? Select all that apply. And, the response options were: £No, not of Hispanic, Latino/a, or Spanish origin £ Yes, Mexican, Mexican American, Chicano/a £Yes, Puerto Rican £Yes, Cuban £Yes, another Hispanic, Latino/a, or Spanish origin £ I choose not to answer.	Page 3	The first question was: Are you Hispanic, Latino/a, or Spanish origin? Select all that apply. Do you remember seeing the question about your ethnicity? Now I would like to read the response options to you and see what you think about them? The response options to the ethnicity question were as follows and you could select all that apply: £ No, not of Hispanic, Latino/a, or Spanish origin £ Yes, Mexican, Mexican American, Chicano/a £ Yes, Puerto Rican £ Yes, Cuban £ Yes, another Hispanic, Latino/a, or Spanish origin £ I choose not to answer.	Rev	Based on the results from the Wave 1 cognitive interviews conducted in April-July 2023, CMS is requesting the addition of prompts to the interview protocol to aid in CMS’ understanding of participant recall of the race and ethnicity questions on the enrollment form.	Page 3
The second question was: What’s your race? Select all that apply. And the response options were: £ American Indian or Alaska Native £Asian £ Asian Indian £Chinese £Filipino £Guamanian or Chamorro £Japanese £Korean £Vietnamese £ Other Asian £ Black or African American £Native Hawaiian and Pacific Islander £Native Hawaiian £Other Pacific Islander £Samoan £White £ I choose not to answer.	Page 3-4	The second question was: What’s your race? Select all that apply. Do you remember seeing the question about your race? Now I would like to read the response options to you and see what you think about them? The response options to the race question were as follows and you could select all that apply: £ American Indian or Alaska Native Asian and the choices for the category were: £ Asian Indian £ Chinese £ Filipino £ Japanese £ Korean £ Vietnamese £ Other Asian £ Black or African American Native Hawaiian and Pacific Islander and the choices for the category were: £ Guamanian or Chamorro £ Native Hawaiian £ Samoan £ Other Pacific Islander £ White £ I choose not to answer.	Rev	Based on the results from the Wave 1 cognitive interviews conducted in April-July 2023, CMS is requesting the addition of prompts to the interview protocol to aid in CMS’ understanding of participant recall of the race and ethnicity questions on the enrollment form.	Page 3-4

Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesignation.

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