Here is the contractor suggestions noted in yellow, also attached is the instrument with the noted changes(see page 9):
Section L: LTC Long-Term Care
L1. Excluding any Medicare Supplement Policy, do you have a long-term care policy that covers nursing home care, assisted living, or long-term care services in the home?
01 Yes
02 No
98 Don’t Know
99 Refused
L2. How many times have you ever been a patient in a nursing home, assisted living, convalescent, or rest home?
01 ____1-99 times
02 0 //skip to 3//
98 Don’t Know
99 Refused
L2a. When were you admitted the last time? (month, year)
01____01-12 month
02____1900-2012 year
98 Don’t Know
99 Refused
L2b. How long were you there the last time?
01 1-30 days // answer L2c and skip L2d//
02 31-60 days
03 61-90 days
04 91 to 180 days
05 181+ days
98 Don’t Know
99 Refused
L2c. For the most recent admission, what were all of the sources of payment that covered or will cover the cost of your nursing home, assisted living, convalescent, or rest home care for that first month or billing period?
01 Private insurance
02 Self/private pay/out-of-pocket
03 Medicare (including Medicare HMO)
04 Medicaid (including Medicaid HMO)
05 Department of Veterans Affairs Contract or other Department of Veterans Affairs Programs
06 Other
98 Don’t Know
99 Refused
L2d.
What were all the sources of payment that covered or will cover the
cost of your care for the most
recent
past
month
or billing period?
01 Private insurance
02 Self/private pay/out-of-pocket
03 Medicare (including Medicare HMO)
04 Medicaid (including Medicaid HMO)
05 Department of Veterans Affairs Contract or other Department of Veterans Affairs Programs
06 Other
98 Don’t Know
99 Refused
L3.
In the last 30
days,
month,
that is, since <fill date>
how many times did you receive nursing services at home from someone
such as a visiting nurse, home health aide, or nurse's aide?
01
_____ RANGE
1-30
1-31
times
02 _____0//Skip to next Section//
98 Don’t Know//Skip to next Section//
99 REFUSED//Skip to next Section//
L3a.
What were all the sources of payment that covered or will cover the
cost of your nursing services at home care for the most
recent
past
month
or billing period?
01 Private insurance
02 Self/private pay/out-of-pocket
03 Medicare (including Medicare HMO)
04 Medicaid (including Medicaid HMO)
05 Department of Veterans Affairs Contract or other Department of Veterans Affairs Programs
06 Non-Paid/Family/Volunteer
07 Other
98 Don’t Know
99 Refused
Marybeth H. Matthews
Program
Analyst
Healthcare Analysis and Information Group
Office of
Strategic Planning and Analysis/Field Office
Office of the
Assistant Deputy Under Secretary for Health for Policy and Planning
(10P1)
(414)
384-2000 extension 42359
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | EIE Desktop Technologies |
| File Modified | 0000-00-00 |
| File Created | 2021-01-31 |