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pdf2024 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
ACQ-ACCESS TO CARE
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.
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.
ACINT
ACINTRO
no entry
The next questions are about health care services [you/(SP)] may have used since [TODAY’S MONTH YEAR-12
MONTHS].
ERVISIT
AC1
yes/no
Since [TODAY’S MONTH YEAR-12 MONTHS], did [you/(SP)] go to a hospital emergency room?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) AC6A - EWAITUNT
(02) BOX AC1C
(-8) BOX AC1C
(-9) BOX AC1C
(00) DID NOT HAVE TO WAIT
(01) HOURS ONLY
(02) MINUTES ONLY
(03) HOURS AND MINUTES
(-8) Don't Know
(-9) Refused
(00) BOX AC1C.
(01) AC6A - EWAITHRS
(02) AC6A - EWAITMIN
(03) AC6A - EWAITHRS
(-8) BOX AC1C
(-9) BOX AC1C
AC1 - ERVISIT
EWAITUNT
AC6A
code one
Think about the most recent time [you/(SP)] went to the hospital emergency room. How long did [you/(SP)] have to
wait during [your/(SP)'s] visit before [you/(SP)] saw a doctor or some other medical person? Please include the
time spent in the waiting room and exam room.
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/(SP)'s] visit before [you/(SP)] saw a doctor or some other medical person? Please include the time (01) continuous answer
spent in the waiting room and exam room.
If AC6A - EWAITUNT = 3/HoursAndMinutes, go to AC6A EWAITMIN.
Else go to BOX AC1C.
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/(SP)'s] visit before [you/(SP)] saw a doctor or some other medical person? Please include the time (01) continuous answer
spent in the waiting room and exam room.
BOX AC1C
BOX AC1C
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 (AC9AC16A NOT ALREADY ASKED), GO TO AC9 - OPDREAS.
ELSE GO TO BOX AC1E.
AC8
yes/no
Since [TODAY’S MONTH YEAR-12 MONTHS], did [you/(SP)] go to a hospital clinic or outpatient department?
DO NOT INCLUDE HOSPITAL INPATIENT STAYS.
OPDVISIT
[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
CHECK ALL THAT APPLY.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) AC9 - OPDREAS
(02) BOX AC1E
(-8) BOX AC1E
(-9) BOX AC1E
(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
Page 1 of 7
2024 MCBS Community Questionnaire
ACQ-ACCESS TO CARE
Variable Name
MR Screen Name
Question Type
Question Text/Description
Code List
Routing
OPDOTHOS
AC9
verbatim text
OTHER (SPECIFY)
(01) continuous answer
BOX AC1D
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.
OPDSCOND
AC10
yes/no
Was that for a specific condition?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
AC12 - OPDAPPT
OPDAPPT
AC12
code one
(01) APPOINTMENT
Did [you/(SP)] have an appointment for this visit to the hospital clinic or outpatient department, or did [you/(SP)] just (02) WALKED IN
(-8) Don't Know
walk in?
(-9) Refused
(01) AC13 - OPDDRTEL
(02) AC16A - HWAITUNT
(-8) AC16A - HWAITUNT
(-9) AC16A - HWAITUNT
(01) SOMEONE MADE APPOINTMENT DURING
EARLIER VISIT
(02) SP CONTACTED OFFICE TO SET UP
APPOINTMENT
(03) DOCTOR'S OFFICE CONTACTED SP TO SET UP
Did someone make this appointment during an earlier visit, or did [you/(SP)] contact the hospital clinic or outpatient
APPOINTMENT
department to set up the appointment ?
(-8) Don't Know
(-9) Refused
(01) AC14 - OPDAWUNT
(02) AC14 - OPDAWUNT
(03) AC14 - OPDAWUNT
(-8) AC16A - HWAITUNT
(-9) AC16A - HWAITUNT
OPDDRTEL
AC13
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.
How long did [you/(SP)] have to wait for the appointment -- about how many days, weeks, or months?
(00) DID NOT HAVE TO WAIT
(01) DAYS
(02) WEEKS
(03) MONTHS
(-8) Don't Know
(-9) Refused
(00) AC16A - HWAITUNT
(01) AC14 - OPDAWDAY
(02) AC14 - OPDAWWKS
(03) AC14 - OPDAWMOS
(-8) AC16A - HWAITUNT
(-9) AC16A - HWAITUNT
OPDAWUNT
AC14
code one
OPDAWDAY
AC14
numeric
How long did [you/(SP)] have to wait for the appointment -- about how many days, weeks, or months?
(01) continuous answer
AC16A - HWAITUNT
OPDAWWKS
AC14
numeric
How long did [you/(SP)] have to wait for the appointment -- about how many days, weeks, or months?
(01) continuous answer
AC16A - HWAITUNT
OPDAWMOS
AC14
numeric
How long did [you/(SP)] have to wait for the appointment -- about how many days, weeks, or months?
(01) continuous answer
AC16A - HWAITUNT
(00) DID NOT HAVE TO WAIT
(01) HOURS ONLY
(02) MINUTES ONLY
(03) HOURS AND MINUTES
(-8) Don't Know
(-9) Refused
(00) BOX AC1E
(01) AC16A - HWAITHRS
(02) AC16A - HWAITMIN
(03) AC16A - HWAITHRS
(-8) BOX AC1E
(-9) BOX AC1E
(01) continuous answer
If AC16A - HWAITUNT = 3/HoursAndMinutes, go to
AC16A - HWAITMIN
Else go to BOX AC1E.
(01) continuous answer
BOX AC1E
WE ARE ASKING HOW MUCH TIME PASSED BETWEEN THE FIRST CONTACT FOR SETTING THE
APPOINTMENT AND THE ACTUAL DATE OF THE APPOINTMENT
[Think about the most recent time [you/(SP)] went to a hospital clinic or outpatient department.]
HWAITUNT
AC16A
code one
AC16A
numeric
AC16A
numeric
How long did [you/(SP)] have to wait [beyond [your/(SP's)] appointment time] during [your/(SP)'s] most recent visit
before [you/(SP)] saw a doctor or some other medical person? Please include the time spent in the waiting room
and exam room.
[Think about the most recent time [you/(SP)] went to a hospital clinic or outpatient department.]
HWAITHRS
How long did [you/(SP)] have to wait [beyond [your/(SP's)] appointment time] time during [your/(SP)] most recent
visit before [you/(SP)] saw a doctor or some other medical person? Please include the time spent in the waiting
room and exam room.
[Think about the most recent time [you/(SP)] went to a hospital clinic or outpatient department.]
HWAITMIN
How long did [you/(SP)] have to wait [beyond [your/(SP's)] appointment time] during [your/(SP)'s] most recent visit
before [you/(SP)] saw a doctor or some other medical person? Please include the time spent in the waiting room
and exam room.
Page 2 of 7
2024 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
ACQ-ACCESS TO CARE
Question Text/Description
Code List
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) AC20 - DRSPCLTY
(02) BOX AC1G
(-8) BOX AC1G
(-9) BOX AC1G
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 NON-NEWLY ELIGIBLE (VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1)
BOX AC1E
routing
AND [(SP DID NOT REPORT A MEDICAL PROVIDER VISIT AT MP6 WHERE (MP6B – MPSDVIS ^= 1/YES AND
PROVIDER’S SPECIALTY IS A MEDICAL DOCTOR)]
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 - DRSPCLTY
ELSE GO TO BOX AC1G.
MDVISIT
AC19
yes/no
Next, I want to ask about [your/(SP)’s] visits to doctors since [TODAY’S MONTH YEAR-12 MONTHS]. [Have
you/Has (SP)] seen a medical doctor since [TODAY’S MONTH YEAR-12 MONTHS]? 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 3 of 7
2024 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
ACQ-ACCESS TO CARE
Question Text/Description
SHOW CARD AC1
[I have a few more questions about visits that [you/(SP)] had in the past.]
DRSPCLTY
AC20
code one
Think about the most recent time [you/(SP)] saw a medical doctor somewhere other than at home or at a hospital.
What was the doctor’s specialty?
[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF THEY MENTION A 'GENERIC'
SPECIALITY LIKE ‘HEART DOCTOR.’ IF RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY AND THE
GENERIC WORD IS SHOWN IN PARENTHESES FOLLOWING ONE OF THE RESPONSES, SELECT THE
RESPONSE CATEGORY FOR THAT SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE SELECT 'OTHER DR
SPECIALTY'.]
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)
Code List
Routing
(01) ALLERGY/IMMUNOLOGY
(02) ANESTHESIOLOGY
(03) CARDIOLOGY (HEART)
(04) DERMATOLOGY (SKIN)
(05) ENDOCRINOLOGY/METABOLISM
(DIABETES,THYROID)
(06) FAMILY PRACTICE
(07) GASTROENTEROLOGY
(08) GENERAL PRACTICE
(09) GENERAL SURGERY
(10) GERIATRICS (ELDERLY)
(11) GYNECOLOGY - OBSTETRICS
(12) HEMATOLOGY (BLOOD)
(13) HOSPITAL RESIDENCE
(14) INTERNAL MEDICINE (INTERNIST)
(15) NEPHROLOGY (KIDNEYS)
(16) NEUROLOGY
(17) NUCLEAR MEDICINE
(18) ONCOLOGY (TUMORS, CANCER)
(19) OPHTHALMOLOGY (EYES)
(20) ORTHOPEDICS
(21) OSTEOPATHY (DO)
(22) OTORHINOLARYNGOLOGY (EAR, NOSE,
THROAT)
(23) PAIN MANAGEMENT SPECIALIST
(24) PATHOLOGY
(25) PHYS MED/REHAB
(26) PHYSICIAN’S ASSISTANT
(27) PLASTIC SURGERY
(28) PODIATRIST
(29) PROCTOLOGY
(30) PSYCHIATRY/PSYCHIATRIST
(31) PULMONARY (LUNGS)
(32) RADIOLOGY
(33) RHEUMATOLOGY (ARTHRITIS)
(34) THORACIC SURGERY (CHEST)
(35) UROLOGY
(36) VASCULAR SURGEON/SPECIALIST
(37) AUDIOLOGIST
(38) CHIROPRACTOR
(39) DENTIST
(40) OPTOMETRIST
(41) PHYSICAL THERAPIST
(42) PSYCHOLOGIST
(43) NURSE PRACTITIONER
(91) OTHER DR SPECIALTY
(-8) Don't Know
(-9) Refused
(01) AC21 - MDREAS
(02) AC21 - MDREAS
(03) AC21 - MDREAS
(04) AC21 - MDREAS
(05) AC21 - MDREAS
(06) 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
(23) AC21 - MDREAS
(24) AC21 - MDREAS
(25) AC21 - MDREAS
(26) AC21 - MDREAS
(27) AC21 - MDREAS
(28) AC21 - MDREAS
(29) AC21 - MDREAS
(30) AC21 - MDREAS
(31) AC21 - MDREAS
(32) AC21 - MDREAS
(33) AC21 - MDREAS
(34) AC21 - MDREAS
(35) AC21 - MDREAS
(36) AC21 - MDREAS
(37) AC21 - MDREAS
(38) AC21 - MDREAS
(39) AC21 - MDREAS
(40) AC21 - MDREAS
(41) AC21 - MDREAS
(42) AC21 - MDREAS
(43) AC21 - MDREAS
(91) AC20 - MDSPCLOS
(-8) AC21 - MDREAS
(-9) 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
Page 4 of 7
2024 MCBS Community Questionnaire
Variable Name
MR Screen Name
BOX AC1F
Question Type
routing
ACQ-ACCESS TO CARE
Question Text/Description
Code List
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
AC22
yes/no
Was that for a specific condition?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
AC24 - MDAPPT
MDAPPT
AC24
code one
Did [you/(SP)] have an appointment for this visit with the doctor, or did [you/(SP)] just walk in?
(01) APPOINTMENT
(02) WALKED IN
(-8) Don't Know
(-9) Refused
(01) AC25 - MDDRTEL
(02) AC28A1 - DWAITUNT
(-8) AC28A1 - DWAITUNT
(-9) AC28A1 - DWAITUNT
MDDRTEL
AC25
code one
(01) SOMEONE MADE APPOINTMENT DURING
EARLIER VISIT
(02) SP CONTACTED OFFICE TO SET UP
APPOINTMENT
(03) DOCTOR'S OFFICE CONTACTED SP TO SET UP
Did someone make this appointment during an earlier visit, or did [you/(SP)] contact the doctor’s office to set up the APPOINTMENT
appointment?
(04) STANDING APPOINTMENT
(-8) Don't Know
(-9) Refused
We are interested in knowing how the appointment was made for the visit to the doctor’s office you just told me
about.
How long did [you/(SP)] have to wait for the appointment with the medical doctor -- about how many days, weeks,
or months?
(01) AC26 - MDAWUNT
(02) AC26 - MDAWUNT
(03) AC26 - MDAWUNT
(04) AC28A1 - DWAITUNT
(-8) AC28A1 - DWAITUNT
(-9) AC28A1 - DWAITUNT
(00) DID NOT HAVE TO WAIT
(01) DAYS
(02) WEEKS
(03) MONTHS
(-8) Don't Know
(-9) Refused
(00) AC28A1 - DWAITUNT
(01) AC26 - MDAWDAY
(02) AC26 - MDAWWKS
(03) AC26 - MDAWMOS
(-8) AC28A1 - DWAITUNT
(-9) AC28A1 - DWAITUNT
MDAWUNT
AC26
code one
MDAWDAY
AC26
numeric
How long did [you/(SP)] have to wait for the appointment with the medical doctor -- about how many days, weeks,
or months?
(01) continuous answer
AC28A1 - DWAITUNT
MDAWWKS
AC26
numeric
How long did [you/(SP)] have to wait for the appointment with the medical doctor -- about how many days, weeks,
or months?
(01) continuous answer
AC28A1 - DWAITUNT
MDAWMOS
AC26
numeric
How long did [you/(SP)] have to wait for the appointment with the medical doctor -- about how many days, weeks,
or months?
(01) continuous answer
AC28A1 - DWAITUNT
(00) DID NOT HAVE TO WAIT
(01) HOURS ONLY
(02) MINUTES ONLY
(03) HOURS AND MINUTES
(-8) Don't Know
(-9) Refused
(00) BOX AC1G
(01) AC28A1 - DWAITHRS
(02) AC28A1 - DWAITMIN
(03) AC28A1 - DWAITHRS
(-8) BOX AC1G
(-9) BOX AC1G
WE ARE ASKING HOW MUCH TIME PASSED BETWEEN THE FIRST CONTACT FOR SETTING THE
APPOINTMENT AND THE ACTUAL DATE OF THE APPOINTMENT
DWAITUNT
AC28A1
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 [beyond [your/(SP's)] appointment time] during [your/(SP)'s] most recent visit
before [you/(SP)] saw a doctor or some other medical person? Please include the time spent in the waiting room
and exam room.
DWAITHRS
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 [beyond [your/(SP's)] appointment time] during [your/(SP)'s] most recent visit
before [you/(SP)] 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 - DWAITUNT = 3/HoursAndMinutes, go to
AC28A1 - DWAITMIN
Else go to BOX AC1G.
DWAITMIN
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 [beyond [your/(SP's)] appointment time] during [your/(SP)'s] most recent visit
before [you/(SP)] 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 - MPHPRAC.
ELSE IF SP HAS A CURRENT MEDICARE MANAGED CARE PLAN, GO TO AC33 - MHREFDIF.
ELSE GO TO BOX AC3.
Page 5 of 7
2024 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
ACQ-ACCESS TO CARE
Question Text/Description
The following questions are about health care that [you/(SP)] received through (CURRENT MEDICARE MANAGED
CARE PLAN NAME).
MHREFDIF
AC33
code one
While a member of (CURRENT MEDICARE MANAGED CARE PLAN NAME), [have you/has (SP)] had difficulty in
obtaining referrals for the services of a specialist or other medical person within (CURRENT MEDICARE
MANAGED CARE PLAN NAME) that [you/(SP)] thought were necessary?
[IF NECESSARY, SAY: ‘The referral must have been for services provided by a specialist or medical provider who
is associated with your Medicare Managed Care plan, not a specialist or medical provider who is "outside" of the
plan.’]
MPSPCLTY
AC34A
code one
SHOW CARD AC1
What kind of specialist or medical person was this?
[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF THEY MENTION A 'GENERIC'
SPECIALITY LIKE ‘HEART DOCTOR.’ IF RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY AND THE
GENERIC WORD IS SHOWN IN PARENTHESES FOLLOWING ONE OF THE RESPONSES, SELECT THE
RESPONSE CATEGORY FOR THAT SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE SELECT 'OTHER DR
SPECIALTY'.]
MHSPCLOS
AC34A
verbatim text
OTHER (SPECIFY)
Code List
Routing
(01) YES
(02) NO
(03) N/A, HAVEN'T TRIED TO OBTAIN REFERRAL
(-8) Don't Know
(-9) Refused
(01) AC34A - MPSPCLTY
(02) AC36 - MHREFPAY
(03) AC36 - MHREFPAY
(-8) AC36 - MHREFPAY
(-9) AC36 - MHREFPAY
(01) ALLERGY/IMMUNOLOGY
(02) ANESTHESIOLOGY
(03) CARDIOLOGY (HEART)
(04) DERMATOLOGY (SKIN)
(05) ENDOCRINOLOGY/METABOLISM
(DIABETES,THYROID)
(06) FAMILY PRACTICE
(07) GASTROENTEROLOGY
(08) GENERAL PRACTICE
(09) GENERAL SURGERY
(10) GERIATRICS (ELDERLY)
(11) GYNECOLOGY - OBSTETRICS
(12) HEMATOLOGY (BLOOD)
(13) HOSPITAL RESIDENCE
(14) INTERNAL MEDICINE (INTERNIST)
(15) NEPHROLOGY (KIDNEYS)
(16) NEUROLOGY
(17) NUCLEAR MEDICINE
(18) ONCOLOGY (TUMORS, CANCER)
(19) OPHTHALMOLOGY (EYES)
(20) ORTHOPEDICS
(21) OSTEOPATHY (DO)
(22) OTORHINOLARYNGOLOGY (EAR, NOSE,
THROAT)
(23) PAIN MANAGEMENT SPECIALIST
(24) PATHOLOGY
(25) PHYS MED/REHAB
(26) PHYSICIAN’S ASSISTANT
(27) PLASTIC SURGERY
(28) PODIATRIST
(29) PROCTOLOGY
(30) PSYCHIATRY/PSYCHIATRIST
(31) PULMONARY (LUNGS)
(32) RADIOLOGY
(33) RHEUMATOLOGY (ARTHRITIS)
(34) THORACIC SURGERY (CHEST)
(35) UROLOGY
(36) VASCULAR SURGEON/SPECIALIST
(37) AUDIOLOGIST
(38) CHIROPRACTOR
(39) DENTIST
(40) OPTOMETRIST
(41) PHYSICAL THERAPIST
(42) PSYCHOLOGIST
(43) NURSE PRACTITIONER
(91) OTHER DR SPECIALTY
(-8) Don't Know
(-9) Refused
(01) AC35 - MHDIFCLT
(02) AC35 - MHDIFCLT
(03) AC35 - MHDIFCLT
(04) AC35 - MHDIFCLT
(05) AC35 - MHDIFCLT
(07) AC35 - MHDIFCLT
(08) AC35 - MHDIFCLT
(09) AC35 - MHDIFCLT
(10) AC35 - MHDIFCLT
(11) AC35 - MHDIFCLT
(12) AC35 - MHDIFCLT
(13) AC35 - MHDIFCLT
(14) AC35 - MHDIFCLT
(15) AC35 - MHDIFCLT
(16) AC35 - MHDIFCLT
(17) AC35 - MHDIFCLT
(18) AC35 - MHDIFCLT
(19) AC35 - MHDIFCLT
(20) AC35 - MHDIFCLT
(21) AC35 - MHDIFCLT
(22) AC35 - MHDIFCLT
(23) 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
(32) AC35 - MHDIFCLT
(33) AC35 - MHDIFCLT
(34) AC35 - MHDIFCLT
(35) AC35 - MHDIFCLT
(36) AC35 - MHDIFCLT
(37) AC35 - MHDIFCLT
(38) AC35 - MHDIFCLT
(39) AC35 - MHDIFCLT
(40) AC35 - MHDIFCLT
(41) AC35 - MHDIFCLT
(42) AC35 - MHDIFCLT
(43) AC35 - MHDIFCLT
(91) AC34A - MHSPCLOS
(-8) AC35 - MHDIFCLT
(-9) AC35 - MHDIFCLT
(01) continuous answer
AC35 - MHDIFCLT
Page 6 of 7
2024 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
ACQ-ACCESS TO CARE
Question Text/Description
Code List
Routing
(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
OTHER (SPECIFY)
(01) continuous answer
AC36 - MHREFPAY
(01) YES
(02) NO
(03) N/A, HAVEN'T NEEDED EMERGENCY
TREATMENT
(-8) Don't Know
(-9) Refused
BOX AC3
What kind of difficulty did [you/(SP)] have?
MHDIFCLT
AC35
code all
MHOTHOS
AC35
verbatim text
MHREFPAY
[PROBE: Any other difficulty?]
CHECK ALL THAT APPLY.
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.]
BOX AC3
routing
IF 11TH ROUND INTERVIEW AND (INTTYPE IN C001) AND (MREFDATE) IS AFTER (JANUARY 1 (ROUND
YEAR)) GO TO STQ.
ELSE GO TO PMQ.
Page 7 of 7
| File Type | application/pdf |
| File Title | Medicare Current Beneficiary Survey Section Specifications for ACQ |
| Subject | Medicare beneficiaries, MCBS community questionnaire, 2024, Access to Care, ACQ |
| Author | NORC |
| File Modified | 2024-03-22 |
| File Created | 2024-02-16 |