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BOX_01
PRIVATE INSURANCE AND MEDIGAP SERIES
IF THERE IS AT LEAST ONE ESTABLISHMENT-PERSON-INSURER-TRIPLE WHERE THE
ESTABLISHMENT IS PRIVATE AND THE INSURER IS FLAGGED AS PROVIDING ‘HOSPITAL
AND PHYSICIAN BENEFITS’ OR IS FLAGGED AS PROVIDING ‘MEDICARE
SUPPLEMENT/MEDIGAP BENEFITS’, CONTINUE WITH LOOP_01
OTHERWISE, GO TO BOX_02
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Satisfaction with Health Plan (SP) Section
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LOOP_01
FOR EACH ELEMENT IN RU-ESTABLISHMENT-PERSON-INSURER-TRIPLES-ROSTER, ASK
SP01-END_LP01
LOOP DEFINITION: LOOP_01 COLLECTS SATISFACTION INFORMATION ON ALL PRIVATE
HEALTH INSURANCE PLANS CURRENTLY HELD BY THE RU THAT PROVIDE HOSPITAL AND
PHYSICIAN BENEFITS OR MEDIGAP BENEFITS. THIS LOOP CYCLES ON TRIPLES THAT
MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS PROVIDER OF PRIVATE INSURANCE WHICH PROVIDES
HOSPITAL/PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT OR MEDIGAP
AND
- PERSON IS A CURRENT RU MEMBER WHO IS THE POLICYHOLDER OF THE PRIVATE
HEALTH INSURANCE OBTAINED THROUGH THIS ESTABLISHMENT
AND
- INSURER IS THE SOURCE OF THE BENEFITS PROVIDED TO PERSON THROUGH
THE ESTABLISHMENT (I.E., THE INSURANCE COMPANY, HMO OR SELF-INSURED
COMPANY) AND IS FLAGGED AS ‘SUPPLYING HOSPITAL/PHYSICIAN BENEFITS’
OR ‘SUPPLYING MEDICARE SUPPLEMENT/MEDIGAP BENEFITS’
AND
- PERSON IS CURRENTLY INSURED BY THIS TRIPLE
NOTE: PRIVATE INSURANCE IS DEFINED AS:
- ESTABLISHMENTS FLAGGED AS ‘EMPLOYER’ AND FLAGGED AS ‘PROVIDES HEALTH
INSURANCE’ (ESTABLISHMENTS FLAGGED AS ‘SELF-EMPLOYED’ WITH A
FIRM-SIZE-1 ARE TREATED AS DIRECT PURCHASED, SEE NOTE BELOW)
- DIRECT PURCHASED INSURANCE, THAT IS, ESTABLISHMENTS CREATED
FROM THE HX23 SERIES
NOTE: HELD ON THE DATE OF THE CURRENT ROUND’S INTERVIEW DATE:
- FOR PRIVATE SOURCES -- POLICYHOLDER HELD INSURANCE AT THE TIME OF
THE CURRENT ROUND’S INTERVIEW DATE [HQ01 IS CODED ‘1’ (WHOLE TIME)
OR HQ02 IS CODED ‘1’ (YES, COVERED NOW) FOR THE POLICYHOLDER] OR
[OE01 OR OE12 OR OE26 IS CODED ‘1’ (YES) FOR THE PLAN]
- FOR PRIVATE SOURCES WHERE POLICYHOLDER IS DECEASED OR THE
POLICYHOLDER WAS ORIGINALLY SELECTED AS ‘POLICYHOLDER NOT IN
RU/DU’ -- AT LEAST ONE DEPENDENT (SELECTED AT HP16) IS COVERED
BY THE INSURANCE AT THE TIME OF THE CURRENT ROUND’S INTERVIEW
DATE [HQ01 IS CODED ‘1’(WHOLE TIME) OR HQ02 IS CODED ‘1’ (YES,
COVERED NOW FOR THE COVERED PERSON] OR [OE01 OR OE12 OR OE26
IS CODED ‘1’ (YES)] FOR THE PLAN
NOTE: ESTABLISHMENTS THAT ARE EMPLOYERS AND PROVIDE HEALTH INSURANCE AND
ARE FLAGGED AS ‘SELF-EMPLOYED’ WITH A FIRM-SIZE=1 ARE TREATED AS DIRECT
PURCHASED INSURANCE, THAT IS, LOOP_01 WILL CYCLE ON THE ESTABLISHMENT
PROVIDING THE INSURANCE, (I.E., CREATED FROM THE HX03 SERIES) NOT THE
EMPLOYER.
NOTE: ‘RF’ (REFUSED) AND ‘DK’ (DON’T KNOW) RESPONSES AT ANY QUESTION
LISTED ABOVE DOES NOT MEET THE CRITERIA.
2
Satisfaction with Health Plan (SP) Section
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SP01
Help Enabled
Comment Enabled
Jump Back Enabled
{POLICYHOLDER'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF INSURER BEING LOOPED ON}
The next questions ask about (POLICYHOLDER)’s (and other family
members’) experience(s) with (PLAN NAME), that is, (POLICYHOLDER)’s
{hospital and physician/Medicare Supplement or Medigap} coverage through
(ESTABLISHMENT).
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
DISPLAY INSTRUCTIONS:
DISPLAY ‘hospital and physician’ IF THIS INSURER IS FLAGGED AS
PROVIDING HOSPITAL AND PHYSICIAN BENEFITS (BUT NOT MEDICARE
SUPPLEMENT OR MEDIGAP BENEFITS).
DISPLAY ‘Medicare Supplement or Medigap’ IF THIS INSURER IS
FLAGGED AS PROVIDING MEDICARE SUPPLEMENT/MEDIGAP BENEFITS OR
MEDICARE SUPPLEMENT/MEDIGAP BENEFITS AND HOSPITAL AND
PHYSICIAN BENEFITS.
DISPLAY THE NAME OF THIS POLICYHOLDER'S CURRENT ROUND'S
PRIVATE OR MEDIGAP INSURER FOR PLAN NAME. THAT IS, DISPLAY
THE NAME OF THE PLAN (PROVIDING MEDICARE SUPPLEMENT / MEDIGAP
BENEFITS OR HOSPITAL / PHYSICIAN BENEFITS) ENTERED AT HX49,
HX51, OE11, OE25, OE36, OR OE38.
3
Satisfaction with Health Plan (SP) Section
Beta
SP02
Help Enabled
Variable Name
EPIN.GTDOCPRB
Comment Enabled
Jump Back Enabled
Label
HOW MUCH PROBLEM GETTING PERSONAL DOC
Size
2
{POLICYHOLDER'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF INSURER BEING LOOPED ON}
SHOW CARD SP-1.
Since (POLICYHOLDER) (and the family) joined (PLAN NAME), how much of
a problem, if any, was it to get a personal doctor or nurse (POLICYHOLDER)
(and the family) (are/is) happy with?
Would you say ...
a big problem,
a small problem, or
1
2
{SP03}
{SP03}
not a problem?
IF VOLUNTEERED: DON'T HAVE
PERSONAL DOCTOR OR NURSE
3
95
{SP03}
{SP03}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP03}
{SP03}
DISPLAY INSTRUCTIONS:
DISPLAY THE NAME OF THIS POLICYHOLDER'S CURRENT ROUND'S
PRIVATE OR MEDIGAP INSURER FOR PLAN NAME. THAT IS, DISPLAY
THE NAME OF THE PLAN (PROVIDING MEDICARE SUPPLEMENT / MEDIGAP
BENEFITS OR HOSPITAL / PHYSICIAN BENEFITS) ENTERED AT HX49,
HX51, OE11, OE25, OE36, OR OE38.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 7
4
Satisfaction with Health Plan (SP) Section
Beta
SP03
Help Enabled
Variable Name
EPIN.APRVTRET
Comment Enabled
Jump Back Enabled
Label
Size
2
NEED APPROVAL FOR TREATMENT
{POLICYHOLDER'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF INSURER BEING LOOPED ON}
In the last 12 months, did (POLICYHOLDER) (or anyone in the family) need
approval from (PLAN NAME) for any care, tests, or treatment?
YES
NO
1
2
{SP04}
{SP05}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP05}
{SP05}
DISPLAY INSTRUCTIONS:
DISPLAY THE NAME OF THIS POLICYHOLDER'S CURRENT ROUND'S
PRIVATE OR MEDIGAP INSURER FOR PLAN NAME. THAT IS, DISPLAY
THE NAME OF THE PLAN (PROVIDING MEDICARE SUPPLEMENT / MEDIGAP
BENEFITS OR HOSPITAL / PHYSICIAN BENEFITS) ENTERED AT HX49,
HX51, OE11, OE25, OE36, OR OE38.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 23
5
Satisfaction with Health Plan (SP) Section
Beta
SP04
Help Enabled
Variable Name
EPIN.APRVDLAY
Comment Enabled
Jump Back Enabled
Label
Size
2
DELAY WAITING FOR APPROVAL
{POLICYHOLDER'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF INSURER BEING LOOPED ON}
SHOW CARD SP-1.
In the last 12 months, how much of a problem, if any, were delays in health
care while (POLICYHOLDER) (or anyone in the family) waited for approval
from (PLAN NAME)?
Would you say ...
a big problem,
a small problem, or
1
2
{SP05}
{SP05}
not a problem?
IF VOLUNTEERED: NO VISITS IN LAST
12 MONTHS
3
95
{SP05}
{SP05}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP05}
{SP05}
DISPLAY INSTRUCTIONS:
DISPLAY THE NAME OF THIS POLICYHOLDER'S CURRENT ROUND'S
PRIVATE OR MEDIGAP INSURER FOR PLAN NAME. THAT IS, DISPLAY
THE NAME OF THE PLAN (PROVIDING MEDICARE SUPPLEMENT / MEDIGAP
BENEFITS OR HOSPITAL / PHYSICIAN BENEFITS) ENTERED AT HX49,
HX51, OE11, OE25, OE36, OR OE38.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 24
6
Satisfaction with Health Plan (SP) Section
Beta
SP05
Help Enabled
Variable Name
EPIN.LOOKINF
Comment Enabled
Jump Back Enabled
Label
Size
2
INFORMATION ON HOW PLAN WORKS
{POLICYHOLDER'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF INSURER BEING LOOPED ON}
In the last 12 months, did (POLICYHOLDER) (or anyone in the family) look for
any information about how (PLAN NAME) works in written material or on
the Internet?
YES
NO
1
2
{SP06}
{SP07}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP07}
{SP07}
DISPLAY INSTRUCTIONS:
DISPLAY THE NAME OF THIS POLICYHOLDER'S CURRENT ROUND'S
PRIVATE OR MEDIGAP INSURER FOR PLAN NAME. THAT IS, DISPLAY
THE NAME OF THE PLAN (PROVIDING MEDICARE SUPPLEMENT / MEDIGAP
BENEFITS OR HOSPITAL / PHYSICIAN BENEFITS) ENTERED AT HX49,
HX51, OE11, OE25, OE36, OR OE38.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 33
7
Satisfaction with Health Plan (SP) Section
Beta
SP06
Help Enabled
Variable Name
EPIN.PRBFDINF
Comment Enabled
Jump Back Enabled
Label
Size
2
PROBLEM FINDING INFORMATION
{POLICYHOLDER'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF INSURER BEING LOOPED ON}
SHOW CARD SP-1.
In the last 12 months, how much of a problem, if any, was it to find or
understand this information?
Would you say ...
a big problem,
1
{SP07}
a small problem, or
not a problem?
2
3
{SP07}
{SP07}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP07}
{SP07}
DISPLAY INSTRUCTIONS:
DISPLAY THE NAME OF THIS POLICYHOLDER'S CURRENT ROUND'S
PRIVATE OR MEDIGAP INSURER FOR PLAN NAME. THAT IS, DISPLAY THE
NAME OF THE PLAN (PROVIDING MEDICARE SUPPLEMENT / MEDIGAP
BENEFITS OR HOSPITAL / PHYSICIAN BENEFITS) ENTERED AT HX49,
HX51, OE11, OE25, OE36, OR OE38.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 34
8
Satisfaction with Health Plan (SP) Section
Beta
SP07
Help Enabled
Variable Name
EPIN.CUSTSERV
Comment Enabled
Jump Back Enabled
Label
HAS CALLED CUSTOMER SERVICE/ADMIN OFFICE
Size
2
{POLICYHOLDER'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF INSURER BEING LOOPED ON}
In the last 12 months, did (POLICYHOLDER) (or anyone in the family) call
(PLAN NAME)’s customer service to get information or help?
YES
NO
1
2
{SP08}
{SP09}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP09}
{SP09}
DISPLAY INSTRUCTIONS:
DISPLAY THE NAME OF THIS POLICYHOLDER'S CURRENT ROUND'S
PRIVATE OR MEDIGAP INSURER FOR PLAN NAME. THAT IS, DISPLAY
THE NAME OF THE PLAN (PROVIDING MEDICARE SUPPLEMENT / MEDIGAP
BENEFITS OR HOSPITAL / PHYSICIAN BENEFITS) ENTERED AT HX49,
HX51, OE11, OE25, OE36, OR OE38.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 35
9
Satisfaction with Health Plan (SP) Section
Beta
SP08
Help Enabled
Variable Name
EPIN.PRBCSTSV
Comment Enabled
Jump Back Enabled
Label
PROBLEM GETTING HELP FROM CUST SERVICE
Size
2
{POLICYHOLDER'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF INSURER BEING LOOPED ON}
SHOW CARD SP-1.
In the last 12 months, how much of a problem, if any, was it to get the help
(POLICYHOLDER) (or anyone in the family) needed when (POLICYHOLDER)
called (PLAN NAME)’s customer service?
Would you say ...
a big problem,
a small problem, or
1
2
{SP09}
{SP09}
not a problem?
3
{SP09}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP09}
{SP09}
DISPLAY INSTRUCTIONS:
DISPLAY THE NAME OF THIS POLICYHOLDER'S CURRENT ROUND'S
PRIVATE OR MEDIGAP INSURER FOR PLAN NAME. THAT IS, DISPLAY
THE NAME OF THE PLAN (PROVIDING MEDICARE SUPPLEMENT / MEDIGAP
BENEFITS OR HOSPITAL / PHYSICIAN BENEFITS) ENTERED AT HX49,
HX51, OE11, OE25, OE36, OR OE38.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 36
10
Satisfaction with Health Plan (SP) Section
Beta
SP09
Help Enabled
Variable Name
EPIN.PAPRWRK
Comment Enabled
Jump Back Enabled
Label
FILL OUT ANY PAPERWORK FOR PLAN
Size
2
{POLICYHOLDER'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF INSURER BEING LOOPED ON}
In the last 12 months, did (POLICYHOLDER) (or anyone in the family) have to
fill out any paperwork for (PLAN NAME)?
YES
NO
1
2
{SP10}
{SP11}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP11}
{SP11}
DISPLAY INSTRUCTIONS:
DISPLAY THE NAME OF THIS POLICYHOLDER'S CURRENT ROUND'S
PRIVATE OR MEDIGAP INSURER FOR PLAN NAME. THAT IS, DISPLAY
THE NAME OF THE PLAN (PROVIDING MEDICARE SUPPLEMENT / MEDIGAP
BENEFITS OR HOSPITAL / PHYSICIAN BENEFITS) ENTERED AT HX49,
HX51, OE11, OE25, OE36, OR OE38.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 37
11
Satisfaction with Health Plan (SP) Section
Beta
SP10
Help Enabled
Variable Name
EPIN.PRBPPRWK
Comment Enabled
Jump Back Enabled
Label
Size
2
PROBLEM WITH PLAN PAPERWORK
{POLICYHOLDER'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF INSURER BEING LOOPED ON}
SHOW CARD SP-1.
In the last 12 months, how much of a problem, if any, did (POLICYHOLDER)
(or anyone in the family) have with paperwork for (PLAN NAME)?
Would you say ...
a big problem,
1
{SP11}
a small problem, or
not a problem?
2
3
{SP11}
{SP11}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP11}
{SP11}
DISPLAY INSTRUCTIONS:
DISPLAY THE NAME OF THIS POLICYHOLDER'S CURRENT ROUND'S
PRIVATE OR MEDIGAP INSURER FOR PLAN NAME. THAT IS, DISPLAY
THE NAME OF THE PLAN (PROVIDING MEDICARE SUPPLEMENT / MEDIGAP
BENEFITS OR HOSPITAL / PHYSICIAN BENEFITS) ENTERED AT HX49,
HX51, OE11, OE25, OE36, OR OE38.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 38
12
Satisfaction with Health Plan (SP) Section
Beta
SP11
Help Enabled
Variable Name
EPIN.RATEPLAN
Comment Enabled
Jump Back Enabled
Label
Size
2
RATE EXPERIENCE WITH PLAN
{POLICYHOLDER'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF INSURER BEING LOOPED ON}
SHOW CARD SP-2.
We want to know your rating of all (POLICYHOLDER)’s (and the family’s)
experience with (PLAN NAME).
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
(PLAN NAME)?
ENTER RATING FROM 0-10:
NUMBER: _______
{END_LP01}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP01}
{END_LP01}
DISPLAY INSTRUCTIONS:
DISPLAY THE NAME OF THIS POLICYHOLDER'S CURRENT ROUND'S
PRIVATE OR MEDIGAP INSURER FOR PLAN NAME. THAT IS, DISPLAY
THE NAME OF THE PLAN (PROVIDING MEDICARE SUPPLEMENT / MEDIGAP
BENEFITS OR HOSPITAL / PHYSICIAN BENEFITS) ENTERED AT HX49,
HX51, OE11, OE25, OE36, OR OE38.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 39
Hard CHECK:
ACCEPTABLE RANGE FOR THIS RESPONSE IS 0 - 10.
13
Satisfaction with Health Plan (SP) Section
Beta
END_LP01
CYCLE ON NEXT TRIPLE ON RU-ESTABLISHMENT-PERSON-INSURER-TRIPLES-ROSTER
THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
IF NO MORE TRIPLES MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE
WITH BOX_02
BOX_02
MEDICARE MANAGED CARE SERIES
IF THERE IS AT LEAST ONE ESTABLISHMENT-PERSON PAIR WHERE THE ESTABLISHMENT
IS MEDICARE AND THE MEDICARE BENEFITS ARE THROUGH A MANAGED CARE PLAN,
CONTINUE WITH LOOP_02
OTHERWISE, GO TO BOX_03
LOOP_02
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON-PAIRS ROSTER, ASK SP12END_LP02
LOOP DEFINITION: LOOP_02 COLLECTS SATISFACTION INFORMATION ON ALL PERSONS
WITH MEDICARE MANAGED CARE PLANS. THIS LOOP CYCLES ON PAIRS THAT MEET THE
FOLLOWING CONDITIONS:
- ESTABLISHMENT IS MEDICARE
AND
- MEDICARE COVERAGE IS THROUGH A MANAGED CARE PLAN
AND
- PERSON IS CURRENTLY COVERED BY THE MEDICARE MANAGED CARE PLAN
NOTE: MEDICARE MANAGED CARE COVERAGE IS DEFINED AS:
- IF MEDICARE CREATED IN CURRENT ROUND, THEN HX31 OR HX32 OR HX32A
IS CODED ‘1’ (YES)
- IF MEDICARE CREATED IN A PREVIOUS ROUND AND THERE HAS BEEN NO
CHANGE IN MEDICARE COVERAGE (PR01 IS CODED ‘2’ (NO), ‘RF’ (REFUSED),
OR ‘DK’ (DON’T KNOW)), THEN HX31 OR HX32 OR HX32A WAS CODED ‘1’
(YES) WHEN THE INSURANCE WAS CREATED OR PR02 OR PR03 OR PR03A
WAS CODED ‘1’ (YES) IN A PREVIOUS ROUND
- IF MEDICARE CREATED IN A PREVIOUS ROUND AND THERE HAS BEEN A
CHANGE IN MEDICARE COVERAGE (PR01 IS CODED ‘1’ (YES)), THEN PR02
OR PR03 OR PR03A IS CODED ‘1’ (YES) DURING THE CURRENT ROUND
14
Satisfaction with Health Plan (SP) Section
Beta
SP12
Help Enabled
Comment Enabled
Jump Back Enabled
{PERSON'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF CURRENT ROUND MEDICARE MANAGED CARE
PLAN}
The next questions ask about (PERSON)’s experience with (PLAN NAME),
that is, (PERSON)’s coverage through Medicare.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
DISPLAY INSTRUCTIONS:
FOR ‘NAME OF CURRENT ROUND MEDICARE MANAGED CARE PLAN’,
DISPLAY THE NAME OF THIS PERSON’S CURRENT ROUND’S MEDICARE
INSURER. THAT IS, DISPLAY THE NAME OF THE PLAN SELECTED AT
HX31OV OR ENTERED AT HX33 (IF MEDICARE CREATED THIS ROUND OR
IF UNCHANGED FROM A PREVIOUS ROUND) OR THE PLAN SELECTED AT
PR02OV OR ENTERED AT PR04 (IF MEDICARE CREATED IN A PREVIOUS
ROUND AND COVERAGE HAS CHANGED OR IT IS THE MOST RECENT
INSURER ENTERED).
15
Satisfaction with Health Plan (SP) Section
Beta
SP13
Help Enabled
Variable Name
EPRS.PRBGTDOC
Comment Enabled
Jump Back Enabled
Label
HOW MUCH PROBLEM GETTING PERSONAL DOC
Size
2
{PERSON'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF CURRENT ROUND MEDICARE MANAGED CARE
PLAN}
SHOW CARD SP-1.
Since (PERSON) joined (PLAN NAME), that is, (PERSON)’s coverage through
Medicare, how much of a problem, if any, was it to get a personal doctor or
nurse (PERSON) (are/is) happy with?
Would you say ...
a big problem,
1
{SP14}
a small problem, or
not a problem?
2
3
{SP14}
{SP14}
IF VOLUNTEERED: DON'T HAVE
PERSONAL DOCTOR OR NURSE
95
{SP14}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP14}
{SP14}
DISPLAY INSTRUCTIONS:
FOR ‘NAME OF CURRENT ROUND MEDICARE MANAGED CARE PLAN’,
DISPLAY THE NAME OF THIS PERSON’S CURRENT ROUND’S MEDICARE
INSURER. THAT IS, DISPLAY THE NAME OF THE PLAN SELECTED AT
HX31OV OR ENTERED AT HX33 (IF MEDICARE CREATED THIS ROUND OR
IF UNCHANGED FROM A PREVIOUS ROUND) OR THE PLAN SELECTED AT
PR02OV OR ENTERED AT PR04 (IF MEDICARE CREATED IN A PREVIOUS
ROUND AND COVERAGE HAS CHANGED OR IT IS THE MOST RECENT
INSURER ENTERED).
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 7
16
Satisfaction with Health Plan (SP) Section
Beta
SP14
Help Enabled
Variable Name
EPRS.TRETAPRV
Comment Enabled
Jump Back Enabled
Label
Size
2
NEED APPROVAL FOR TREATMENT
{PERSON'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF CURRENT ROUND MEDICARE MANAGED CARE
PLAN}
In the last 12 months, did (PERSON) need approval from (PLAN NAME), that
is, (PERSON)’s coverage through Medicare, for any care, tests or treatment?
YES
1
{SP15}
NO
2
{SP16}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP16}
{SP16}
DISPLAY INSTRUCTIONS:
FOR ‘NAME OF CURRENT ROUND MEDICARE MANAGED CARE PLAN’,
DISPLAY THE NAME OF THIS PERSON’S CURRENT ROUND’S MEDICARE
INSURER. THAT IS, DISPLAY THE NAME OF THE PLAN SELECTED AT
HX31OV OR ENTERED AT HX33 (IF MEDICARE CREATED THIS ROUND OR
IF UNCHANGED FROM A PREVIOUS ROUND) OR THE PLAN SELECTED AT
PR02OV OR ENTERED AT PR04 (IF MEDICARE CREATED IN A PREVIOUS
ROUND AND COVERAGE HAS CHANGED OR IT IS THE MOST RECENT
INSURER ENTERED).
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 23
17
Satisfaction with Health Plan (SP) Section
Beta
SP15
Help Enabled
Variable Name
EPRS.DLAYAPRV
Comment Enabled
Jump Back Enabled
Label
Size
2
DELAY WAITING FOR APPROVAL
{PERSON'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF CURRENT ROUND MEDICARE MANAGED CARE
PLAN}
SHOW CARD SP-1.
In the last 12 months, how much of a problem, if any, were delays in health
care while (PERSON) waited for approval from (PLAN NAME), that is,
(PERSON)’s coverage through Medicare?
Would you say ...
a big problem,
1
{SP16}
a small problem, or
not a problem?
2
3
{SP16}
{SP16}
IF VOLUNTEERED: NO VISITS IN LAST
12 MONTHS
95
{SP16}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP16}
{SP16}
DISPLAY INSTRUCTIONS:
FOR ‘NAME OF CURRENT ROUND MEDICARE MANAGED CARE PLAN’,
DISPLAY THE NAME OF THIS PERSON’S CURRENT ROUND’S MEDICARE
INSURER. THAT IS, DISPLAY THE NAME OF THE PLAN SELECTED AT
HX31OV OR ENTERED AT HX33 (IF MEDICARE CREATED THIS ROUND OR
IF UNCHANGED FROM A PREVIOUS ROUND) OR THE PLAN SELECTED AT
PR02OV OR ENTERED AT PR04 (IF MEDICARE CREATED IN A PREVIOUS
ROUND AND COVERAGE HAS CHANGED OR IT IS THE MOST RECENT
INSURER ENTERED).
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 24
18
Satisfaction with Health Plan (SP) Section
Beta
SP16
Help Enabled
Variable Name
EPRS.INFLOOK
Comment Enabled
Jump Back Enabled
Label
Size
2
INFORMATION ON HOW PLAN WORKS
{PERSON'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF CURRENT ROUND MEDICARE MANAGED CARE
PLAN}
In the last 12 months, did (PERSON) look for any information about how
(PLAN NAME), that is, (PERSON)’s coverage through Medicare, works in
written material or on the Internet?
YES
NO
1
2
{SP17}
{SP18}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP18}
{SP18}
DISPLAY INSTRUCTIONS:
FOR ‘NAME OF CURRENT ROUND MEDICARE MANAGED CARE PLAN’,
DISPLAY THE NAME OF THIS PERSON’S CURRENT ROUND’S MEDICARE
INSURER. THAT IS, DISPLAY THE NAME OF THE PLAN SELECTED AT
HX31OV OR ENTERED AT HX33 (IF MEDICARE CREATED THIS ROUND OR
IF UNCHANGED FROM A PREVIOUS ROUND) OR THE PLAN SELECTED AT
PR02OV OR ENTERED AT PR04 (IF MEDICARE CREATED IN A PREVIOUS
ROUND AND COVERAGE HAS CHANGED OR IT IS THE MOST RECENT
INSURER ENTERED).
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 33
19
Satisfaction with Health Plan (SP) Section
Beta
SP17
Help Enabled
Variable Name
EPRS.FDINFPRB
Comment Enabled
Jump Back Enabled
Label
Size
2
PROBLEM FINDING INFORMATION
{PERSON'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF CURRENT ROUND MEDICARE MANAGED CARE
PLAN}
SHOW CARD SP-1.
In the last 12 months, how much of a problem, if any, was it to find or
understand this information?
Would you say ...
a big problem,
a small problem, or
1
2
{SP18}
{SP18}
not a problem?
3
{SP18}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP18}
{SP18}
DISPLAY INSTRUCTIONS:
FOR ‘NAME OF CURRENT ROUND MEDICARE MANAGED CARE PLAN’,
DISPLAY THE NAME OF THIS PERSON’S CURRENT ROUND’S MEDICARE
INSURER. THAT IS, DISPLAY THE NAME OF THE PLAN SELECTED AT
HX31OV OR ENTERED AT HX33 (IF MEDICARE CREATED THIS ROUND OR
IF UNCHANGED FROM A PREVIOUS ROUND) OR THE PLAN SELECTED AT
PR02OV OR ENTERED AT PR04 (IF MEDICARE CREATED IN A PREVIOUS
ROUND AND COVERAGE HAS CHANGED OR IT IS THE MOST RECENT
INSURER ENTERED).
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 34
20
Satisfaction with Health Plan (SP) Section
Beta
SP18
Help Enabled
Variable Name
EPRS.CUSTSVC
Comment Enabled
Jump Back Enabled
Label
Size
2
CALL CUSTOMER SERVICE
{PERSON'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF CURRENT ROUND MEDICARE MANAGED CARE
PLAN}
In the last 12 months, did (PERSON) call (PLAN NAME)’s, that is,
(PERSON)’s coverage through Medicare, customer service to get
information or help?
YES
1
{SP19}
NO
2
{SP20}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP20}
{SP20}
DISPLAY INSTRUCTIONS:
FOR ‘NAME OF CURRENT ROUND MEDICARE MANAGED CARE PLAN’,
DISPLAY THE NAME OF THIS PERSON’S CURRENT ROUND’S MEDICARE
INSURER. THAT IS, DISPLAY THE NAME OF THE PLAN SELECTED AT
HX31OV OR ENTERED AT HX33 (IF MEDICARE CREATED THIS ROUND OR
IF UNCHANGED FROM A PREVIOUS ROUND) OR THE PLAN SELECTED AT
PR02OV OR ENTERED AT PR04 (IF MEDICARE CREATED IN A PREVIOUS
ROUND AND COVERAGE HAS CHANGED OR IT IS THE MOST RECENT
INSURER ENTERED).
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 35
21
Satisfaction with Health Plan (SP) Section
Beta
SP19
Help Enabled
Variable Name
EPRS.CSTSVPRB
Comment Enabled
Jump Back Enabled
Label
PROBLEM GETTING HELP FROM CUST SERVICE
Size
2
{PERSON'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF CURRENT ROUND MEDICARE MANAGED CARE
PLAN}
SHOW CARD SP-1.
In the last 12 months, how much of a problem, if any, was it to get the help
(PERSON) needed when (PERSON) called (PLAN NAME)’s, that is,
(PERSON)’s coverage through Medicare, customer service?
Would you say ...
a big problem,
1
{SP20}
a small problem, or
not a problem?
2
3
{SP20}
{SP20}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP20}
{SP20}
DISPLAY INSTRUCTIONS:
FOR ‘NAME OF CURRENT ROUND MEDICARE MANAGED CARE PLAN’,
DISPLAY THE NAME OF THIS PERSON’S CURRENT ROUND’S MEDICARE
INSURER. THAT IS, DISPLAY THE NAME OF THE PLAN SELECTED AT
HX31OV OR ENTERED AT HX33 (IF MEDICARE CREATED THIS ROUND OR
IF UNCHANGED FROM A PREVIOUS ROUND) OR THE PLAN SELECTED AT
PR02OV OR ENTERED AT PR04 (IF MEDICARE CREATED IN A PREVIOUS
ROUND AND COVERAGE HAS CHANGED OR IT IS THE MOST RECENT
INSURER ENTERED).
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 36
22
Satisfaction with Health Plan (SP) Section
Beta
SP20
Help Enabled
Variable Name
EPRS.PAPRWORK
Comment Enabled
Jump Back Enabled
Label
FILL OUT ANY PAPERWORK FOR PLAN
Size
2
{PERSON'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF CURRENT ROUND MEDICARE MANAGED CARE
PLAN}
In the last 12 months, did (PERSON) have to fill out any paperwork for (PLAN
NAME), that is (PERSON)’s coverage through Medicare?
YES
1
{SP21}
NO
2
{SP22}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP22}
{SP22}
DISPLAY INSTRUCTIONS:
FOR ‘NAME OF CURRENT ROUND MEDICARE MANAGED CARE PLAN’,
DISPLAY THE NAME OF THIS PERSON’S CURRENT ROUND’S MEDICARE
INSURER. THAT IS, DISPLAY THE NAME OF THE PLAN SELECTED AT
HX31OV OR ENTERED AT HX33 (IF MEDICARE CREATED THIS ROUND OR
IF UNCHANGED FROM A PREVIOUS ROUND) OR THE PLAN SELECTED AT
PR02OV OR ENTERED AT PR04 (IF MEDICARE CREATED IN A PREVIOUS
ROUND AND COVERAGE HAS CHANGED OR IT IS THE MOST RECENT
INSURER ENTERED).
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 37
23
Satisfaction with Health Plan (SP) Section
Beta
SP21
Help Enabled
Variable Name
EPRS.PPRWKPRB
Comment Enabled
Jump Back Enabled
Label
Size
2
PROBLEM WITH PLAN PAPERWORK
{PERSON'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF CURRENT ROUND MEDICARE MANAGED CARE
PLAN}
SHOW CARD SP-1.
In the last 12 months, how much of a problem, if any, did (PERSON) have with
paperwork for (PLAN NAME), that is, (PERSON)’s coverage through
Medicare?
Would you say ...
a big problem,
1
{SP22}
a small problem, or
not a problem?
2
3
{SP22}
{SP22}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP22}
{SP22}
DISPLAY INSTRUCTIONS:
FOR ‘NAME OF CURRENT ROUND MEDICARE MANAGED CARE PLAN’,
DISPLAY THE NAME OF THIS PERSON’S CURRENT ROUND’S MEDICARE
INSURER. THAT IS, DISPLAY THE NAME OF THE PLAN SELECTED AT
HX31OV OR ENTERED AT HX33 (IF MEDICARE CREATED THIS ROUND OR
IF UNCHANGED FROM A PREVIOUS ROUND) OR THE PLAN SELECTED AT
PR02OV OR ENTERED AT PR04 (IF MEDICARE CREATED IN A PREVIOUS
ROUND AND COVERAGE HAS CHANGED OR IT IS THE MOST RECENT
INSURER ENTERED).
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 38
24
Satisfaction with Health Plan (SP) Section
Beta
SP22
Help Enabled
Variable Name
EPRS.PLANRATE
Comment Enabled
Jump Back Enabled
Label
Size
2
RATE EXPERIENCE WITH PLAN
{PERSON'S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
PLAN NAME: {NAME OF CURRENT ROUND MEDICARE MANAGED CARE
PLAN}
SHOW CARD SP-2.
We want to know your rating of all (PERSON)’s experience with (PLAN
NAME), that is, (PERSON)’s coverage through Medicare.
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
(PLAN NAME)?
ENTER RATING FROM 0-10:
NUMBER: _______________________
{END_LP02}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP02}
{END_LP02}
DISPLAY INSTRUCTIONS:
FOR ‘NAME OF CURRENT ROUND MEDICARE MANAGED CARE PLAN’,
DISPLAY THE NAME OF THIS PERSON’S CURRENT ROUND’S MEDICARE
INSURER. THAT IS, DISPLAY THE NAME OF THE PLAN SELECTED AT
HX31OV OR ENTERED AT HX33 (IF MEDICARE CREATED THIS ROUND OR
IF UNCHANGED FROM A PREVIOUS ROUND) OR THE PLAN SELECTED AT
PR02OV OR ENTERED AT PR04 (IF MEDICARE CREATED IN A PREVIOUS
ROUND AND COVERAGE HAS CHANGED OR IT IS THE MOST RECENT
INSURER ENTERED).
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 39
Hard CHECK:
ACCEPTABLE RANGE FOR THIS RESPONSE IS 0 - 10.
25
Satisfaction with Health Plan (SP) Section
Beta
END_LP02
CYCLE ON NEXT PAIR ON THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER THAT MEETS
THE CONDITIONS STATED IN THE LOOP DEFINITION
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE WITH
BOX_03
BOX_03
MEDICAID AND HOSPITAL/PHYSICIAN SERIES
IF AT LEAST ONE CURRENT RU MEMBER IS COVERED BY MEDICAID/SCHIP OR GOVTHOSPITAL/PHYSICIAN DURING THE CURRENT ROUND, CONTINUE WITH SP23
OTHERWISE, GO TO BOX_04
26
Satisfaction with Health Plan (SP) Section
Beta
SP23
Help Enabled
Comment Enabled
Jump Back Enabled
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND MEDICAID-SCHIP/GOVT-H/P
INSURER}}
The next questions ask about the family’s experience with {(PLAN NAME),
that is, their coverage through} {{Medicaid/{STATE NAME FOR MEDICAID}}
or {STATE CHIP NAME}/the program sponsored by a state or local
government agency which provides hospital and physician benefits}.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
DISPLAY INSTRUCTIONS:
DISPLAY ‘PLAN NAME: ... INSURER}’ IF THERE IS AN INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE DURING THE CURRENT ROUND.
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF ... INSURER’, DISPLAY THE NAME OF THE CURRENT
ROUND’S INSURER FOR THE FAMILY’S MEDICAID/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE.
DISPLAY ‘(PLAN NAME), ... through’ IF THERE IS AN INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE DURING THE CURRENT ROUND.
OTHERWISE, USE A NULL DISPLAY.
DISPLAY ‘{Medicaid/{STATE NAME FOR MEDICAID}}or {STATE CHIP
NAME}’ IF FAMILY HAS MEDICAID/SCHIP. (FAMILY HAS GOV'T
HOSPITAL/PHYSICIAN INSURANCE)
IN THAT DISPLAY, DISPLAY ‘Medicaid’ IF STATE IN WHICH
INTERVIEW IS BEING CONDUCTED USES THE NAME ‘MEDICAID’.
DISPLAY ‘STATE NAME FOR MEDICAID’ (SUBSTITUTING THE REAL STATE
NAME FOR PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING
CONDUCTED DOES NOT USE THE NAME ‘MEDICAID IN THE PHRASE.’
FOR THE SPECIFIC NAME TO USE BY STATE, SEE BOX ON HX06.
OTHERWISE, DISPLAY ‘the program ... benefits’.
IN THE PHRASE ‘or STATE CHIP NAME’, SUBSTITUTE THE REAL STATE
NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE BY STATE, SEE
BOX ON HX06.
27
Satisfaction with Health Plan (SP) Section
Beta
28
Satisfaction with Health Plan (SP) Section
Beta
SP24
Help Enabled
Variable Name
HOME.GTDCPRBM
Comment Enabled
Jump Back Enabled
Label
HOW MUCH PROBLEM GETTING PERSONAL DOC
Size
2
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND MEDICAID-SCHIP/GOVT-H/P
INSURER}}
SHOW CARD SP-1.
Since the family joined {(PLAN NAME)/the coverage through} {Medicaid/
{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME}/the program
sponsored by a state or local government agency which provides hospital and
physician benefits}, how much of a problem, if any, was it to get a personal
doctor or nurse the family is happy with?
Would you say ...
a big problem,
1
{SP25}
a small problem, or
not a problem?
2
3
{SP25}
{SP25}
IF VOLUNTEERED: DON'T HAVE
PERSONAL DOCTOR OR NURSE
95
{SP25}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
29
{SP25}
{SP25}
Satisfaction with Health Plan (SP) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY ‘PLAN NAME: ... INSURER}’ IF THERE IS AN INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE DURING THE CURRENT ROUND.
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF ... INSURER’, DISPLAY THE NAME OF THE CURRENT
ROUND’S INSURER FOR THE FAMILY’S MEDICAID/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE.
DISPLAY ‘(PLAN NAME)’ IF THERE IS AN INSURER ASSOCIATED WITH
THE FAMILY’S MEDICAID/SCHIP OR GOV’T-HOSPITAL/PHYSICIAN
INSURANCE DURING THE CURRENT ROUND. OTHERWISE, DISPLAY ‘the
coverage through’.
DISPLAY ‘{Medicaid/{STATE NAME FOR MEDICAID}}or {STATE CHIP
NAME}’ IF FAMILY HAS MEDICAID/SCHIP AND THERE IS NO INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP INSURANCE DURING
THE CURRENT ROUND. DISPLAY ‘the program ... benefits’ IF THE
FAMILY HAS GOVT-HOSPITAL/PHYSICIAN AND THERE IS NO INSURER
ASSOCIATED WITH THE FAMILY’S GOVT-HOSPITAL/PHYSICIAN INSURANCE
DURING THE CURRENT ROUND.
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘MEDICAID’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM) IF
THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE
THE NAME ‘MEDICAID IN THE PHRASE.’ FOR THE SPECIFIC NAME TO
USE BY STATE, SEE BOX ON HX06.
IN THE PHRASE ‘or STATE CHIP NAME’ SUBSTITUTE THE REAL STATE
NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE BY STATE, SEE
BOX ON HX06.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 7
30
Satisfaction with Health Plan (SP) Section
Beta
SP25
Help Enabled
Variable Name
HOME.APRVTRTM
Comment Enabled
Jump Back Enabled
Label
Size
2
NEED APPROVAL FOR TREATMENT
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND MEDICAID-SCHIP/GOVT-H/P
INSURER}}
In the last 12 months, did anyone in the family need approval from {(PLAN
NAME)/the coverage through} {Medicaid/{STATE NAME FOR MEDICAID}} or
{STATE CHIP NAME}/the program sponsored by a state or local government
agency which provides hospital and physician benefits} for any care, tests or
treatment?
YES
NO
1
2
{SP26}
{SP27}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
31
{SP27}
{SP27}
Satisfaction with Health Plan (SP) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY ‘PLAN NAME: ... INSURER}’ IF THERE IS AN INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE DURING THE CURRENT ROUND.
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF ... INSURER’, DISPLAY THE NAME OF THE CURRENT
ROUND’S INSURER FOR THE FAMILY’S MEDICAID/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE.
DISPLAY ‘(PLAN NAME)’ IF THERE IS AN INSURER ASSOCIATED WITH
THE FAMILY’S MEDICAID/SCHIP OR GOV’T-HOSPITAL/PHYSICIAN
INSURANCE DURING THE CURRENT ROUND. OTHERWISE, DISPLAY ‘the
coverage through’.
DISPLAY ‘{Medicaid/{STATE NAME FOR MEDICAID}}or {STATE CHIP
NAME}’ IF FAMILY HAS MEDICAID/SCHIP AND THERE IS NO INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP INSURANCE DURING
THE CURRENT ROUND. DISPLAY ‘the program ... benefits’ IF THE
FAMILY HAS GOVT-HOSPITAL/PHYSICIAN AND THERE IS NO INSURER
ASSOCIATED WITH THE FAMILY’S GOVT-HOSPITAL/PHYSICIAN INSURANCE
DURING THE CURRENT ROUND.
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘MEDICAID’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM) IF
THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE
THE NAME ‘MEDICAID' IN THE PHRASE . FOR THE SPECIFIC NAME TO
USE BY STATE, SEE BOX ON HX06.
IN THE PHRASE ‘or STATE CHIP NAME’, SUBSTITUTE THE REAL STATE
NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE BY STATE, SEE
BOX ON HX06.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 23
32
Satisfaction with Health Plan (SP) Section
Beta
SP26
Help Enabled
Variable Name
HOME.APRVDLYM
Comment Enabled
Jump Back Enabled
Label
Size
2
DELAY WAITING FOR APPROVAL
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND MEDICAID-SCHIP/GOVT-H/P
INSURER}}
SHOW CARD SP-1.
In the last 12 months, how much of a problem, if any, were delays in health
care while the family waited for approval from {(PLAN NAME)/the coverage
through} {Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP
NAME}/the program sponsored by a state or local government agency which
provides hospital and physician benefits}?
Would you say ...
a big problem,
1
{SP27}
a small problem, or
not a problem?
2
3
{SP27}
{SP27}
IF VOLUNTEERED: NO VISITS IN LAST
12 MONTHS
95
{SP27}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
33
{SP27}
{SP27}
Satisfaction with Health Plan (SP) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY ‘PLAN NAME: ... INSURER}’ IF THERE IS AN INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE DURING THE CURRENT ROUND.
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF ... INSURER’, DISPLAY THE NAME OF THE CURRENT
ROUND’S INSURER FOR THE FAMILY’S MEDICAID/SCHIP/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE.
DISPLAY ‘(PLAN NAME)’ IF THERE IS AN INSURER ASSOCIATED WITH
THE FAMILY’S MEDICAID/SCHIP OR GOV’T-HOSPITAL/PHYSICIAN
INSURANCE DURING THE CURRENT ROUND. OTHERWISE, DISPLAY ‘the
coverage through’.
DISPLAY ‘{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP
NAME}’ IF FAMILY HAS MEDICAID/SCHIP AND THERE IS NO INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP INSURANCE DURING
THE CURRENT ROUND. DISPLAY ‘the program ... benefits’ IF THE
FAMILY HAS GOVT-HOSPITAL/PHYSICIAN AND THERE IS NO INSURER
ASSOCIATED WITH THE FAMILY’S GOVT-HOSPITAL/PHYSICIAN INSURANCE
DURING THE CURRENT ROUND.
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘MEDICAID’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM) IF
THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE
THE NAME ‘MEDICAID' IN THE PHRASE. FOR THE SPECIFIC NAME TO
USE BY STATE, SEE BOX ON HX06.
IN THE PHRASE ‘or STATE CHIP NAME’, SUBSTITUTE THE REAL STATE
NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE BY STATE, SEE
BOX ON HX06.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 24
34
Satisfaction with Health Plan (SP) Section
Beta
SP27
Help Enabled
Variable Name
HOME.LKINFOM
Comment Enabled
Jump Back Enabled
Label
Size
2
INFORMATION ON HOW PLAN WORKS
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND MEDICAID-SCHIP/GOVT-H/P
INSURER}}
In the last 12 months, did anyone in the family look for any information about
how {(PLAN NAME)/the coverage through} {Medicaid/{STATE NAME FOR
MEDICAID}} or {STATE CHIP NAME}/the program sponsored by a state or
local government agency which provides hospital and physician benefits}
works in written material or on the Internet?
YES
1
{SP28}
NO
2
{SP29}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
35
{SP29}
{SP29}
Satisfaction with Health Plan (SP) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY ‘PLAN NAME: ... INSURER}’ IF THERE IS AN INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE DURING THE CURRENT ROUND.
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF ... INSURER’, DISPLAY THE NAME OF THE CURRENT
ROUND’S INSURER FOR THE FAMILY’S MEDICAID/SCHIP/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE.
DISPLAY ‘(PLAN NAME)’ IF THERE IS AN INSURER ASSOCIATED WITH
THE FAMILY’S MEDICAID/SCHIP OR GOV’T-HOSPITAL/PHYSICIAN
INSURANCE DURING THE CURRENT ROUND. OTHERWISE, DISPLAY ‘the
coverage through’.
DISPLAY ‘{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP
NAME}’ IF FAMILY HAS MEDICAID/SCHIP AND THERE IS NO INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP INSURANCE DURING
THE CURRENT ROUND. DISPLAY ‘the program ... benefits’ IF THE
FAMILY HAS GOVT-HOSPITAL/PHYSICIAN AND THERE IS NO INSURER
ASSOCIATED WITH THE FAMILY’S GOVT-HOSPITAL/PHYSICIAN INSURANCE
DURING THE CURRENT ROUND.
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘MEDICAID’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM) IF
THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE
THE NAME ‘MEDICAID' IN THE PHRASE. FOR THE SPECIFIC NAME TO
USE BY STATE, SEE BOX ON HX06.
IN THE PHRASE ‘or STATE CHIP NAME’, SUBSTITUTE THE REAL STATE
NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE BY STATE, SEE
BOX ON HX06.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 33
36
Satisfaction with Health Plan (SP) Section
Beta
SP28
Help Enabled
Variable Name
HOME.PRBINFOM
Comment Enabled
Jump Back Enabled
Label
Size
2
PROBLEM FINDING INFORMATION
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND MEDICAID-SCHIP/GOVT-H/P
INSURER}}
SHOW CARD SP-1.
In the last 12 months, how much of a problem, if any, was it to find or
understand this information?
Would you say ...
a big problem,
1
{SP29}
a small problem, or
not a problem?
2
3
{SP29}
{SP29}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP29}
{SP29}
DISPLAY INSTRUCTIONS:
DISPLAY ‘PLAN NAME: ... INSURER}’ IF THERE IS AN INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE DURING THE CURRENT ROUND.
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF ... INSURER’, DISPLAY THE NAME OF THE CURRENT
ROUND’S INSURER FOR THE FAMILY’S MEDICAID/SCHIP OR GOV’T
HOSPITAL/PHYSICIAN INSURANCE.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 34
37
Satisfaction with Health Plan (SP) Section
Beta
SP29
Help Enabled
Variable Name
HOME.CUSTSVCM
Comment Enabled
Jump Back Enabled
Label
Size
2
CALL CUSTOMER SERVICE
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND MEDICAID-SCHIP/GOVT-H/P
INSURER}}
In the last 12 months, did anyone in the family call {(PLAN NAME)’s/the
coverage through} {Medicaid/{STATE NAME FOR MEDICAID}} or {STATE
CHIP NAME}/the program sponsored by a state or local government agency
which provides hospital and physician benefits} customer service to get
information or help?
YES
1
{SP30}
NO
2
{SP31}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
38
{SP31}
{SP31}
Satisfaction with Health Plan (SP) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY ‘PLAN NAME: ... INSURER}’ IF THERE IS AN INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE DURING THE CURRENT ROUND.
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF ... INSURER’, DISPLAY THE NAME OF THE CURRENT
ROUND’S INSURER FOR THE FAMILY’S MEDICAID/SCHIP/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE.
DISPLAY ‘(PLAN NAME)’ IF THERE IS AN INSURER ASSOCIATED WITH
THE FAMILY’S MEDICAID/SCHIP OR GOV’T-HOSPITAL/PHYSICIAN
INSURANCE DURING THE CURRENT ROUND. OTHERWISE, DISPLAY ‘the
coverage through’.
DISPLAY ‘{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP
NAME}’ IF FAMILY HAS MEDICAID/SCHIP AND THERE IS NO INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP INSURANCE DURING
THE CURRENT ROUND. DISPLAY ‘the program ... benefits’ IF THE
FAMILY HAS GOVT-HOSPITAL/PHYSICIAN AND THERE IS NO INSURER
ASSOCIATED WITH THE FAMILY’S GOVT-HOSPITAL/PHYSICIAN INSURANCE
DURING THE CURRENT ROUND.
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘MEDICAID’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM) IF
THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE
THE NAME ‘MEDICAID' IN THE PHRASE. FOR THE SPECIFIC NAME TO
USE BY STATE, SEE BOX ON HX06.
IN THE PHRASE ‘or STATE CHIP NAME’, SUBSTITUTE THE REAL STATE
NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE BY STATE, SEE
BOX ON HX06.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 35
39
Satisfaction with Health Plan (SP) Section
Beta
SP30
Help Enabled
Variable Name
HOME.PRBSVCM
Comment Enabled
Jump Back Enabled
Label
PROBLEM GETTING HELP FROM CUST SERVICE
Size
2
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND MEDICAID-SCHIP/GOVT-H/P
INSURER}}
SHOW CARD SP-1.
In the last 12 months, how much of a problem, if any, was it to get the help the
family needed when they called this health plan’s customer service?
Would you say ...
a big problem,
a small problem, or
1
2
{SP31}
{SP31}
not a problem?
3
{SP31}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP31}
{SP31}
DISPLAY INSTRUCTIONS:
DISPLAY ‘PLAN NAME: ... INSURER}’ IF THERE IS AN INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE DURING THE CURRENT ROUND.
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF ... INSURER’, DISPLAY THE NAME OF THE CURRENT
ROUND’S INSURER FOR THE FAMILY’S MEDICAID/SCHIP OR GOV’T
HOSPITAL/PHYSICIAN INSURANCE.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 36
40
Satisfaction with Health Plan (SP) Section
Beta
SP31
Help Enabled
Variable Name
HOME.PPRWRKM
Comment Enabled
Jump Back Enabled
Label
FILL OUT ANY PAPERWORK FOR PLAN
Size
2
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND MEDICAID-SCHIP/GOVT-H/P
INSURER}}
In the last 12 months, did anyone in the family have to fill out any paperwork
for {(PLAN NAME)/the coverage through} {Medicaid/{STATE NAME FOR
MEDICAID}} or {STATE CHIP NAME}/the program sponsored by a state or
local government agency which provides hospital and physician benefits}?
YES
1
{SP32}
NO
2
{SP33}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
41
{SP33}
{SP33}
Satisfaction with Health Plan (SP) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY ‘PLAN NAME: ... INSURER}’ IF THERE IS AN INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE DURING THE CURRENT ROUND.
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF ... INSURER’, DISPLAY THE NAME OF THE CURRENT
ROUND’S INSURER FOR THE FAMILY’S MEDICAID/SCHIP/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE.
DISPLAY ‘(PLAN NAME)’ IF THERE IS AN INSURER ASSOCIATED WITH
THE FAMILY’S MEDICAID/SCHIP OR GOV’T-HOSPITAL/PHYSICIAN
INSURANCE DURING THE CURRENT ROUND. OTHERWISE, DISPLAY ‘the
coverage through’.
DISPLAY ‘{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP
NAME}’ IF FAMILY HAS MEDICAID/SCHIP AND THERE IS NO INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP INSURANCE DURING
THE CURRENT ROUND. DISPLAY ‘the program ... benefits’ IF THE
FAMILY HAS GOVT-HOSPITAL/PHYSICIAN AND THERE IS NO INSURER
ASSOCIATED WITH THE FAMILY’S GOVT-HOSPITAL/PHYSICIAN INSURANCE
DURING THE CURRENT ROUND.
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘MEDICAID’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM) IF
THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE
THE NAME ‘MEDICAID' IN THE PHRASE. FOR THE SPECIFIC NAME TO
USE BY STATE, SEE BOX ON HX06.
IN THE PHRASE ‘or STATE CHIP NAME’, SUBSTITUTE THE REAL STATE
NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE BY STATE, SEE
BOX ON HX06.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 37
42
Satisfaction with Health Plan (SP) Section
Beta
SP32
Help Enabled
Variable Name
HOME.PRBPWKM
Comment Enabled
Jump Back Enabled
Label
Size
2
PROBLEM WITH PLAN PAPERWORK
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND MEDICAID-SCHIP/GOVT-H/P
INSURER}}
SHOW CARD SP-1.
In the last 12 months, how much of a problem, if any, did the family have with
paperwork for this health plan?
Would you say ...
a big problem,
a small problem, or
1
2
{SP33}
{SP33}
not a problem?
3
{SP33}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP33}
{SP33}
DISPLAY INSTRUCTIONS:
DISPLAY ‘PLAN NAME: ... INSURER}’ IF THERE IS AN INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE DURING THE CURRENT ROUND.
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF ... INSURER’, DISPLAY THE NAME OF THE CURRENT
ROUND’S INSURER FOR THE FAMILY’S MEDICAID/SCHIP OR GOV’T
HOSPITAL/PHYSICIAN INSURANCE.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 38
43
Satisfaction with Health Plan (SP) Section
Beta
SP33
Help Enabled
Variable Name
HOME.RATPLANM
Comment Enabled
Jump Back Enabled
Label
Size
2
RATE EXPERIENCE WITH PLAN
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND MEDICAID-SCHIP/GOVT-H/P
INSURER}}
SHOW CARD SP-2.
We want to know your rating of all the family’s experience with {(PLAN
NAME)/the coverage through} {Medicaid/{STATE NAME FOR MEDICAID}}
or {STATE CHIP NAME}/the program sponsored by a state or local
government agency which provides hospital and physician benefits}.
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
this health plan?
ENTER RATING FROM 0-10:
NUMBER: _______________________
{BOX_04}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
44
{BOX_04}
{BOX_04}
Satisfaction with Health Plan (SP) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY ‘PLAN NAME: ... INSURER}’ IF THERE IS AN INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE DURING THE CURRENT ROUND.
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF ... INSURER’, DISPLAY THE NAME OF THE CURRENT
ROUND’S INSURER FOR THE FAMILY’S MEDICAID/SCHIP/SCHIP OR GOV’THOSPITAL/PHYSICIAN INSURANCE.
DISPLAY ‘(PLAN NAME)’ IF THERE IS AN INSURER ASSOCIATED WITH
THE FAMILY’S MEDICAID/SCHIP OR GOV’T-HOSPITAL/PHYSICIAN
INSURANCE DURING THE CURRENT ROUND. OTHERWISE, DISPLAY ‘the
coverage through’.
DISPLAY ‘{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP
NAME}’ IF FAMILY HAS MEDICAID/SCHIP AND THERE IS NO INSURER
ASSOCIATED WITH THE FAMILY’S MEDICAID/SCHIP INSURANCE DURING
THE CURRENT ROUND. DISPLAY ‘the program ... benefits’ IF THE
FAMILY HAS GOVT-HOSPITAL/PHYSICIAN AND THERE IS NO INSURER
ASSOCIATED WITH THE FAMILY’S GOVT-HOSPITAL/PHYSICIAN INSURANCE
DURING THE CURRENT ROUND.
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘MEDICAID’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM) IF
THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE
THE NAME ‘MEDICAID' IN THE PHRASE. FOR THE SPECIFIC NAME TO
USE BY STATE, SEE BOX ON HX06.
IN THE PHRASE ‘or STATE CHIP NAME’, SUBSTITUTE THE REAL STATE
NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE BY STATE, SEE
BOX ON HX06.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 39
Hard CHECK:
ACCEPTABLE RANGE FOR THIS RESPONSE IS 0 - 10.
BOX_04
TRICARE/CHAMPVA SERIES
IF AT LEAST ONE CURRENT RU MEMBER IS COVERED BY TRICARE/CHAMPVA DURING THE
CURRENT ROUND, CONTINUE WITH SP34
OTHERWISE, GO TO BOX_05
45
Satisfaction with Health Plan (SP) Section
Beta
SP34
Help Enabled
Comment Enabled
Jump Back Enabled
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND TRICARE/CHAMPVA
INSURER(S)}}
The next questions ask about the family’s experience with {(PLAN NAME),
that is,} their coverage through TRICARE or CHAMPVA.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
PROGRAMMER NOTES:
FOR THE ESTABLISHMENT NAME IN THE HEADER, DISPLAY ‘TRICARE OR
CHAMPVA’.
DISPLAY ‘PLAN NAME: ... INSURER(S)}’ IF THERE IS A
TRICARE/CHAMPVA INSURER ASSOCIATED WITH THE FAMILY’S
TRICARE/CHAMPVA INSURANCE (CHECK HX12A, PR19A, OR PR21A).
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF CURRENT ROUND TRICARE/CHAMPVA INSURER(S)’,
DISPLAY THE NAME(S) OF THE CURRENT ROUND’S INSURER(S) FOR THE
FAMILY’S TRICARE/CHAMPVA INSURANCE. NOTE: IF MULTIPLE
INSURERS ARE SELECTED AT HX12A, PR19A, OR PR21A, SEPARATE THE
INSURER NAMES WITH A ‘/’.
DISPLAY ‘(PLAN NAME), that is,’ IF THERE IS A TRICARE/CHAMPVA
INSURER ASSOCIATED WITH THE FAMILY’S TRICARE/CHAMPVA INSURANCE
(CHECK HX12A, PR19A, OR PR21A). OTHERWISE, USE A NULL DISPLAY.
46
Satisfaction with Health Plan (SP) Section
Beta
SP35
Help Enabled
Variable Name
HOME.GTDCPRBT
Comment Enabled
Jump Back Enabled
Label
HOW MUCH PROBLEM GETTING PERSONAL DOC
Size
2
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND TRICARE/CHAMPVA
INSURER(S)}}
SHOW CARD SP-1.
Since the family joined TRICARE or CHAMPVA, how much of a problem, if
any, was it to get a personal doctor or nurse the family is happy with?
Would you say ...
a big problem,
a small problem, or
1
2
{SP36}
{SP36}
not a problem?
IF VOLUNTEERED: DON'T HAVE
PERSONAL DOCTOR OR NURSE
3
95
{SP36}
{SP36}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP36}
{SP36}
DISPLAY INSTRUCTIONS:
FOR THE ESTABLISHMENT NAME IN THE HEADER, DISPLAY ‘TRICARE OR
CHAMPVA’.
DISPLAY ‘PLAN NAME: ... INSURER(S)}’ IF THERE IS A
TRICARE/CHAMPVA INSURER ASSOCIATED WITH THE FAMILY’S
TRICARE/CHAMPVA INSURANCE (CHECK HX12A, PR19A, OR PR21A).
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF CURRENT ROUND TRICARE/CHAMPVA INSURER(S)’,
DISPLAY THE NAME(S) OF THE CURRENT ROUND’S INSURER(S) FOR THE
FAMILY’S TRICARE/CHAMPVA INSURANCE. NOTE: IF MULTIPLE
INSURERS ARE SELECTED AT HX12A, PR19A, OR PR21A, SEPARATE THE
INSURER NAMES WITH A ‘/’.
47
Satisfaction with Health Plan (SP) Section
Beta
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 7
48
Satisfaction with Health Plan (SP) Section
Beta
SP36
Help Enabled
Variable Name
HOME.APRVTRTT
Comment Enabled
Jump Back Enabled
Label
Size
2
NEED APPROVAL FOR TREATMENT
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND TRICARE/CHAMPVA
INSURER(S)}}
In the last 12 months, did anyone in the family need approval from TRICARE
or CHAMPVA for any care, tests or treatment?
YES
1
{SP37}
NO
2
{SP38}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP38}
{SP38}
DISPLAY INSTRUCTIONS:
FOR THE ESTABLISHMENT NAME IN THE HEADER, DISPLAY ‘TRICARE OR
CHAMPVA’.
DISPLAY ‘PLAN NAME: ... INSURER(S)}’ IF THERE IS A
TRICARE/CHAMPVA INSURER ASSOCIATED WITH THE FAMILY’S
TRICARE/CHAMPVA INSURANCE (CHECK HX12A, PR19A, OR PR21A).
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF CURRENT ROUND TRICARE/CHAMPVA INSURER(S)’,
DISPLAY THE NAME(S) OF THE CURRENT ROUND’S INSURER(S) FOR THE
FAMILY’S TRICARE/CHAMPVA INSURANCE. NOTE: IF MULTIPLE
INSURERS ARE SELECTED AT HX12A, PR19A, OR PR21A, SEPARATE THE
INSURER NAMES WITH A ‘/’.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 23
49
Satisfaction with Health Plan (SP) Section
Beta
SP37
Help Enabled
Variable Name
HOME.APRVDLYT
Comment Enabled
Jump Back Enabled
Label
Size
2
DELAY WAITING FOR APPROVAL
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND TRICARE/CHAMPVA
INSURER(S)}}
SHOW CARD SP-1.
In the last 12 months, how much of a problem, if any, were delays in health
care while the family waited for approval from TRICARE or CHAMPVA?
Would you say ...
a big problem,
a small problem, or
1
2
{SP38}
{SP38}
not a problem?
IF VOLUNTEERED: NO VISITS IN LAST
12 MONTHS
3
95
{SP38}
{SP38}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP38}
{SP38}
DISPLAY INSTRUCTIONS:
FOR THE ESTABLISHMENT NAME IN THE HEADER, DISPLAY ‘TRICARE OR
CHAMPVA’.
DISPLAY ‘PLAN NAME: ... INSURER(S)}’ IF THERE IS A
TRICARE/CHAMPVA INSURER ASSOCIATED WITH THE FAMILY’S
TRICARE/CHAMPVA INSURANCE (CHECK HX12A, PR19A, OR PR21A).
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF CURRENT ROUND TRICARE/CHAMPVA INSURER(S)’,
DISPLAY THE NAME(S) OF THE CURRENT ROUND’S INSURER(S) FOR THE
FAMILY’S TRICARE/CHAMPVA INSURANCE. NOTE: IF MULTIPLE
INSURERS ARE SELECTED AT HX12A, PR19A, OR PR21A, SEPARATE THE
INSURER NAMES WITH A ‘/’.
50
Satisfaction with Health Plan (SP) Section
Beta
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 24
51
Satisfaction with Health Plan (SP) Section
Beta
SP38
Help Enabled
Variable Name
HOME.LKINFOT
Comment Enabled
Jump Back Enabled
Label
Size
2
INFORMATION ON HOW PLAN WORKS
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND TRICARE/CHAMPVA
INSURER(S)}}
In the last 12 months, did anyone in the family look for any information about
how their coverage through TRICARE or CHAMPVA works in written
material or on the Internet?
YES
NO
1
2
{SP39}
{SP40}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP40}
{SP40}
DISPLAY INSTRUCTIONS:
FOR THE ESTABLISHMENT NAME IN THE HEADER, DISPLAY ‘TRICARE OR
CHAMPVA’.
DISPLAY ‘PLAN NAME: ... INSURER(S)}’ IF THERE IS A
TRICARE/CHAMPVA INSURER ASSOCIATED WITH THE FAMILY’S
TRICARE/CHAMPVA INSURANCE (CHECK HX12A, PR19A, OR PR21A).
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF CURRENT ROUND TRICARE/CHAMPVA INSURER(S)’,
DISPLAY THE NAME(S) OF THE CURRENT ROUND’S INSURER(S) FOR THE
FAMILY’S TRICARE/CHAMPVA INSURANCE. NOTE: IF MULTIPLE
INSURERS ARE SELECTED AT HX12A, PR19A, OR PR21A, SEPARATE THE
INSURER NAMES WITH A ‘/’.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 33
52
Satisfaction with Health Plan (SP) Section
Beta
SP39
Help Enabled
Variable Name
HOME.PRBINFOT
Comment Enabled
Jump Back Enabled
Label
Size
2
PROBLEM FINDING INFORMATION
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND TRICARE/CHAMPVA
INSURER(S)}}
SHOW CARD SP-1.
In the last 12 months, how much of a problem, if any, was it to find or
understand this information?
Would you say...
a big problem,
a small problem, or
1
2
{SP40}
{SP40}
not a problem?
3
{SP40}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP40}
{SP40}
DISPLAY INSTRUCTIONS:
FOR THE ESTABLISHMENT NAME IN THE HEADER, DISPLAY ‘TRICARE OR
CHAMPVA’.
DISPLAY ‘PLAN NAME: ... INSURER(S)}’ IF THERE IS A
TRICARE/CHAMPVA INSURER ASSOCIATED WITH THE FAMILY’S
TRICARE/CHAMPVA INSURANCE (CHECK HX12A, PR19A, OR PR21A).
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF CURRENT ROUND TRICARE/CHAMPVA INSURER(S)’,
DISPLAY THE NAME(S) OF THE CURRENT ROUND’S INSURER(S) FOR THE
FAMILY’S TRICARE/CHAMPVA INSURANCE. NOTE: IF MULTIPLE
INSURERS ARE SELECTED AT HX12A, PR19A, OR PR21A, SEPARATE THE
INSURER NAMES WITH A ‘/’.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 34
53
Satisfaction with Health Plan (SP) Section
Beta
54
Satisfaction with Health Plan (SP) Section
Beta
SP40
Help Enabled
Variable Name
HOME.CUSTSVCT
Comment Enabled
Jump Back Enabled
Label
Size
2
CALL CUSTOMER SERVICE
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND TRICARE/CHAMPVA
INSURER(S)}}
In the last 12 months, did anyone in the family call TRICARE or CHAMPVA’s
customer service to get information or help?
YES
NO
1
2
{SP41}
{SP42}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP42}
{SP42}
DISPLAY INSTRUCTIONS:
FOR THE ESTABLISHMENT NAME IN THE HEADER, DISPLAY ‘TRICARE OR
CHAMPVA’.
DISPLAY ‘PLAN NAME: ... INSURER(S)}’ IF THERE IS A
TRICARE/CHAMPVA INSURER ASSOCIATED WITH THE FAMILY’S
TRICARE/CHAMPVA INSURANCE (CHECK HX12A, PR19A, OR PR21A).
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF CURRENT ROUND TRICARE/CHAMPVA INSURER(S)’,
DISPLAY THE NAME(S) OF THE CURRENT ROUND’S INSURER(S) FOR THE
FAMILY’S TRICARE/CHAMPVA INSURANCE. NOTE: IF MULTIPLE
INSURERS ARE SELECTED AT HX12A, PR19A, OR PR21A, SEPARATE THE
INSURER NAMES WITH A ‘/’.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 35
55
Satisfaction with Health Plan (SP) Section
Beta
SP41
Help Enabled
Variable Name
HOME.PRBSVCT
Comment Enabled
Jump Back Enabled
Label
PROBLEM GETTING HELP FROM CUST SERVICE
Size
2
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND TRICARE/CHAMPVA
INSURER(S)}}
SHOW CARD SP-1.
In the last 12 months, how much of a problem, if any, was it to get the help the
family needed when they called TRICARE or CHAMPVA’s customer service?
Would you say ...
a big problem,
a small problem, or
1
2
{SP42}
{SP42}
not a problem?
3
{SP42}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP42}
{SP42}
DISPLAY INSTRUCTIONS:
FOR THE ESTABLISHMENT NAME IN THE HEADER, DISPLAY ‘TRICARE OR
CHAMPVA’.
DISPLAY ‘PLAN NAME: ... INSURER(S)}’ IF THERE IS A
TRICARE/CHAMPVA INSURER ASSOCIATED WITH THE FAMILY’S
TRICARE/CHAMPVA INSURANCE (CHECK HX12A, PR19A, OR PR21A).
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF CURRENT ROUND TRICARE/CHAMPVA INSURER(S)’,
DISPLAY THE NAME(S) OF THE CURRENT ROUND’S INSURER(S) FOR THE
FAMILY’S TRICARE/CHAMPVA INSURANCE. NOTE: IF MULTIPLE
INSURERS ARE SELECTED AT HX12A, PR19A, OR PR21A, SEPARATE THE
INSURER NAMES WITH A ‘/’.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 36
56
Satisfaction with Health Plan (SP) Section
Beta
57
Satisfaction with Health Plan (SP) Section
Beta
SP42
Help Enabled
Variable Name
HOME.PPRWRKT
Comment Enabled
Jump Back Enabled
Label
FILL OUT ANY PAPERWORK FOR PLAN
Size
2
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND TRICARE/CHAMPVA
INSURER(S)}}
In the last 12 months, did anyone in the family have to fill out any paperwork
for their coverage through TRICARE or CHAMPVA?
YES
1
{SP43}
NO
2
{SP44}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP44}
{SP44}
DISPLAY INSTRUCTIONS:
FOR THE ESTABLISHMENT NAME IN THE HEADER, DISPLAY ‘TRICARE OR
CHAMPVA’.
DISPLAY ‘PLAN NAME: ... INSURER(S)}’ IF THERE IS A
TRICARE/CHAMPVA INSURER ASSOCIATED WITH THE FAMILY’S
TRICARE/CHAMPVA INSURANCE (CHECK HX12A, PR19A, OR PR21A).
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF CURRENT ROUND TRICARE/CHAMPVA INSURER(S)’,
DISPLAY THE NAME(S) OF THE CURRENT ROUND’S INSURER(S) FOR THE
FAMILY’S TRICARE/CHAMPVA INSURANCE. NOTE: IF MULTIPLE
INSURERS ARE SELECTED AT HX12A, PR19A, OR PR21A, SEPARATE THE
INSURER NAMES WITH A ‘/’.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 37
58
Satisfaction with Health Plan (SP) Section
Beta
SP43
Help Enabled
Variable Name
HOME.PRBPWKT
Comment Enabled
Jump Back Enabled
Label
Size
2
PROBLEM WITH PLAN PAPERWORK
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND TRICARE/CHAMPVA
INSURER(S)}}
SHOW CARD SP-1.
In the last 12 months, how much of a problem, if any, did the family have with
paperwork for their coverage through TRICARE or CHAMPVA?
Would you say ...
a big problem,
a small problem, or
1
2
{SP44}
{SP44}
not a problem?
3
{SP44}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{SP44}
{SP44}
DISPLAY INSTRUCTIONS:
FOR THE ESTABLISHMENT NAME IN THE HEADER, DISPLAY ‘TRICARE OR
CHAMPVA’.
DISPLAY ‘PLAN NAME: ... INSURER(S)}’ IF THERE IS A
TRICARE/CHAMPVA INSURER ASSOCIATED WITH THE FAMILY’S
TRICARE/CHAMPVA INSURANCE (CHECK HX12A, PR19A, OR PR21A).
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF CURRENT ROUND TRICARE/CHAMPVA INSURER(S)’,
DISPLAY THE NAME(S) OF THE CURRENT ROUND’S INSURER(S) FOR THE
FAMILY’S TRICARE/CHAMPVA INSURANCE. NOTE: IF MULTIPLE
INSURERS ARE SELECTED AT HX12A, PR19A, OR PR21A, SEPARATE THE
INSURER NAMES WITH A ‘/’.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 38
59
Satisfaction with Health Plan (SP) Section
Beta
60
Satisfaction with Health Plan (SP) Section
Beta
SP44
Help Enabled
Variable Name
HOME.RATPLANT
Comment Enabled
Jump Back Enabled
Label
Size
2
RATE EXPERIENCE WITH PLAN
{NAME OF ESTABLISHMENT}
{PLAN NAME: {NAME OF CURRENT ROUND TRICARE/CHAMPVA
INSURER(S)}}
SHOW CARD SP-2.
We want to know your rating of all the family’s experience with their coverage
through TRICARE or CHAMPVA.
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
the coverage through TRICARE or CHAMPVA?
ENTER RATING FROM 0-10:
NUMBER: _______
{BOX_05}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_05}
{BOX_05}
DISPLAY INSTRUCTIONS:
FOR THE ESTABLISHMENT NAME IN THE HEADER, DISPLAY ‘TRICARE OR
CHAMPVA’.
DISPLAY ‘PLAN NAME: ... INSURER(S)}’ IF THERE IS A
TRICARE/CHAMPVA INSURER ASSOCIATED WITH THE FAMILY’S
TRICARE/CHAMPVA INSURANCE (CHECK HX12A, PR19A, OR PR21A).
OTHERWISE, USE A NULL DISPLAY.
FOR ‘NAME OF CURRENT ROUND TRICARE/CHAMPVA INSURER(S)’,
DISPLAY THE NAME(S) OF THE CURRENT ROUND’S INSURER(S) FOR THE
FAMILY’S TRICARE/CHAMPVA INSURANCE. NOTE: IF MULTIPLE
INSURERS ARE SELECTED AT HX12A, PR19A, OR PR21A, SEPARATE THE
INSURER NAMES WITH A ‘/’.
PROGRAMMER NOTES:
CAHPS 3.0 ADULT CORE ITEM 39
61
Satisfaction with Health Plan (SP) Section
Beta
Hard CHECK:
ACCEPTABLE RANGE FOR THIS RESPONSE IS 0 - 10.
BOX_05
GO TO NEXT QUESTIONNAIRE SECTION
62
| File Type | application/pdf |
| File Title | C:\Documents and Settings\POLACHEK_L\Local Settings\Temporary Internet Files\OLK8\SP (BETA).snp |
| Author | polachek_l |
| File Modified | 2006-02-20 |
| File Created | 2006-02-20 |