Nonsubstantive Change Request Memo

To: Jamie Wilson

Office of Information and Regulatory Affairs (OIRA)

Office of Management and Budget (OMB)

From: William Parham

Office of Strategic and Regulatory Affairs (OSORA)

Centers for Medicare and Medicaid Services (CMS)

Date: April 4, 2025

Subject: Non-Substantive Change Request – Medicare Current Beneficiary Survey

(OMB#: 0938-0568)

This memo requests approval of non-substantive changes to the information collection request titled Medicare Current Beneficiary Survey (CMS-P-0015A) and currently approved under OMB control number 0938-0930.

Background

The Medicare Current Beneficiary Survey (MCBS) is the most comprehensive and complete survey available on the Medicare population and is essential in capturing data not otherwise collected through operational or administrative data on the Medicare program. The MCBS is a continuous, multi-purpose longitudinal survey of Medicare beneficiaries that is sponsored by CMS and directed by the Office of Enterprise Data and Analytics (OEDA). The survey captures beneficiary information whether aged or disabled, living in the community or facilities, or serviced by managed care or fee-for-service. Questions are asked about beneficiaries’ health care use, charges, insurance coverage, and payments over time. Respondents are asked about their sources of health care coverage and payment, their demographic and housing characteristics, their health and work history, and their experiences and perceptions of quality with their health care system. Data produced as part of the MCBS are enhanced with CMS administrative data (e.g., fee-for-service claims, prescription drug event data, enrollment data, Medicaid payments and eligibility, and Medicare Advantage encounter records) to provide users with more accurate and complete estimates of total health care costs and utilization.

The collection was last approved by OMB on August 26, 2024, and expires on August 31, 2027.

Overview of Requested Changes

Non-substantive Changes

The purpose of this change request is to revise questions on the Medicare Current Beneficiary Survey (MCBS) to align with Executive Order (E.O.) 14168 Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.

This non-substantive change request includes:

• Item deletions and revisions in the Demographics and Income Questionnaire (DIQ), which is administered in the Fall round during the respondent’s first MCBS interview (Baseline), and

• Item deletions in the Satisfaction with Care Questionnaire (SCQ), which is administered in the Fall round during the MCBS Baseline and Continuing interviews.

These changes will be implemented in Fall 2025 Round 103, which begins fielding in mid-July 2025. OMB approval of these updates is requested by March 31, 2025, to allow for sufficient time to accomplish programming and testing of the question deletions and revisions.

The revised questionnaire sections are contained in Attachment A.

Purpose and use of information collection

During the Fall round, the respondent’s first MCBS interview (referred to as the Baseline interview) measures demographic characteristics in the Demographics and Income Questionnaire (DIQ). To align with E.O. 14168, CMS seeks approval to implement the following changes to the DIQ starting in Fall 2025 Round 103:

• Revise sexual orientation items. The DIQ currently contains two items about sexual orientation that are administered during the Baseline interview. The first item asks the beneficiary if they think of themselves as gay/lesbian, straight, bisexual, or something else. If the beneficiary responds “something else”, they are asked for a verbatim response. Starting in Fall 2025 R103, the “something else” response option and verbatim follow-up item will be removed. This update will have no impact on respondent burden due to the negligible count of respondents who receive this item.

• Remove question on gender identity. The DIQ currently contains an item that asks the respondent to report whether they are male, female, transgender, or none of these. Starting in Fall 2025 R103, this item will be removed. This update will reduce burden in the MCBS Community Baseline interview by 0.2 minutes each Fall round.

• Revise question on respondent sex. The MCBS Community Baseline interview currently asks beneficiaries to report their sex assigned at birth on their original birth certificate (male or female). Starting in Fall 2025 Round 103, the wording of this item will be revised to ask the respondent to report their sex (male or female). The revised item will be migrated from DIQ to the Introduction Questionnaire (INQ) to facilitate questionnaire routing. This is a burden neutral update.

To align with E.O. 14168, CMS also seeks approval to implement the following change in the Satisfaction with Care Questionnaire (SCQ), which is administered during both MCBS Baseline and Continuing interviews:

• Remove item about perceived discrimination. The SCQ currently contains an item that measures perceived discrimination from health care providers due to certain personal attributes, including race or ethnicity, language or accent, gender or gender identity, sexual orientation, age, culture or religion, disability, or medical history. Starting in Fall 2025 Round 103, this item will be removed. This update will reduce burden in the MCBS Community Baseline and Continuing interviews by 0.7 minutes each Fall round.

The modifications to the DIQ, INQ, and SCQ are highlighted in green text in Attachment A. In addition, a crosswalk of the item changes is shown below in Table A.

Table A. Crosswalk of Item Changes:

MCBS Community Questionnaire	Questionnaire Section and Variable Name	Type of Change	Question/Item	Requested Change	Change in Respondent Burden
Fall 2025 Round 103 Baseline Community Questionnaire	Demographics and Income Questionnaire (DIQ), SOGIINT	Question Revision	[Next we have some questions about [your/(SP)'s] demographic characteristics, including [sexual orientation,] gender identity, education, income, and religious preference. Like all your answers, these will be used to understand the health of different groups in the population and will be kept confidential.]	[Next we have some questions about [your/(SP)'s] demographic characteristics, including [sexual orientation,] education, income, and religious preference. Like all your answers, these will be used to understand the health of different groups in the population and will be kept confidential.]	None; only removing the words “gender identity”
Fall 2025 Round 103 Baseline Community Questionnaire	DIQ, SEXORINT	Question Revision	Do you think of yourself as lesbian or gay; straight, that is, not lesbian or gay; bisexual; something else; or you don't know the answer?  LESBIAN OR GAY  STRAIGHT, THAT IS, NOT LESBIAN OR GAY  BISEXUAL  SOMETHING ELSE  I DON'T KNOW THE ANSWER	Do you think of yourself as lesbian or gay; straight, that is, not lesbian or gay; bisexual; or you don't know the answer?  LESBIAN OR GAY  STRAIGHT, THAT IS, NOT LESBIAN OR GAY  BISEXUAL  I DON'T KNOW THE ANSWER	None; only removed “something else” response option
Fall 2025 Round 103 Baseline Community Questionnaire	DIQ, SEXORIOS	Question Deletion	What do you mean by something else?	Remove question	None; due to negligible count of respondents who receive this item
Fall 2025 Round 103 Baseline Community Questionnaire	DIQ, GENIDENT	Question Deletion	[(Do you)/(Does (SP)/(As of (DATE OF DEATH), did SP)] [currently] describe [yourself/themselves] as male, female or transgender?  MALE  FEMALE  TRANSGENDER  NONE OF THESE	Remove question	Reduce burden by 10 seconds per interview
Fall 2025 Round 103 Baseline Community Questionnaire	DIQ1, SEXASGN	Question Revision	What sex [(were you)/(was (SP))] assigned at birth on [your/(SP)’s] original birth certificate?  MALE  FEMALE	What is your sex?  FEMALE  MALE	None; item revision has comparable burden
Fall 2025 Round 103 Baseline and Continuing Community Questionnaires	Satisfaction with Care Questionnaire (SCQ), RCEQTY LANGEQTY GENDEQTY SEXEQTY AGEEQTY CULTEQTY DISEQTY HISTEQTY	Question Deletion	Now I have a question about [your/(SP's)] health care experiences. [Over the past year/Since (TODAY'S DATE - 12 MONTHS)], did anyone from a clinic, emergency room, or doctor’s office where [you/(SP)] got care treat [you/(SP)] in an unfair or insensitive way because of any of the following things about [you/(SP)]? Race or ethnicity? Language or accent? Gender or gender identity? Sexual orientation? Age? Culture or religion? Disability? Medical history?	Remove question	Reduce respondent burden by 40 seconds per interview

Attachments:

The revised questionnaire sections are contained in Attachment A:

• Demographics and Income Questionnaire (DIQ)

• Introduction Questionnaire (INQ)

• Satisfaction with Care Questionnaire (SCQ)

1 The revised item (RESPDSEX) will be moved from the DIQ to the Introduction Questionnaire (INQ) to facilitate routing in later sections of the questionnaire.