Frequently Asked Questions about the Medicare HOS
Where can I find the current HOS survey vendor list and survey administration documents?
The current HOS survey vendor list is available on the Survey Vendors section under the Program page. The survey administration documents are available under the Survey Administration section. The documents include the HOS and HOS-M survey administration memos for MAOs and PACE plans, and the HOS exclusion memo. Information about HOS program requirements may be found in the NCQA HEDIS®, Volume 6: Specifications for the Medicare Health Outcomes Survey manual and HOS Quality Assurance Guidelines in the Methodology section of the Resources page.
When are new MAOs eligible to participate in the HOS?
MAOs with a minimum enrollment of 500 beneficiaries by February 1st of the current year, and with Medicare contracts in effect on or before January 1 of the preceding year, are required to report the Baseline HOS. CMS will send a notice to the MAOs alerting them of the upcoming eligibility and the required preparations for the HOS fielding. MAOs must then contract with a CMS HOS Approved Survey Vendor to administer the survey. CMS has posted a list of the Survey Vendors on the HOS website. For additional information on the standard MAO reporting requirements and the reporting for HEDIS, HOS, and CAHPS, see Section 30 in the CMS Managed Care Manual, Chapter 5 – Quality Assessment, Publication # 100-16. Additional information about HOS program requirements may be found in the current NCQA HEDIS®, Volume 6: Specifications for the Medicare Health Outcomes Survey manual available in the Methodology section of the Resources page.
Where can I obtain copies of the HOS survey questionnaire?
Copies of the HOS and HOS-Modified (HOS-M) survey instruments may be downloaded from the Survey Instruments section of the HOS website. In addition, the HOS and HOS-M questionnaires may also be found in the corresponding NCQA HEDIS®, Volume 6: Specifications for the Medicare Health Outcomes Survey manuals, which may be purchased by calling the NCQA Customer Support Telephone Line at 1-888-275-7585 or via NCQA's Secure Online Order Center (www.ncqa.org). The current manual is available online for download in the Methodology section under the Resources page.
When may MAOs use HOS-like questions with their health plan members?
Where can I obtain more information about the Veterans RAND 12-Item Health Survey?
The VR-12 is a generic patient reported outcome measure (PROM) used to measure health related quality of life, and is one of the components of the Medicare HOS. Other VR assessments include the VR-36 long-form counterpart and the VR-6D derived from the VR-12. The VR-36, VR-12 and VR-6D questionnaires, scoring algorithms, and documentation are available on request. For detailed information and to request permission to use, see the measure developer's website.
How will I know when the HOS reports are available?
The HOS reports are distributed annually, one year after data collection, for each new baseline and completed cohort of data (two-year follow up data combined with a previous baseline). The HOS program and administration timelines are posted on the HOS website on the About HOS and the Program Timeline sections of the Program page to provide a reasonable estimate of when the HOS reports will be completed and ready for distribution each year. The "Medicare HOS Report and Data Distribution" table on the Data Dissemination section provides the distribution dates from previous years. The approved users of the CMS Health Plan Management System (HPMS) at your MAO will receive an announcement through HPMS of the availability of the reports. If assistance is required regarding HPMS access, you may contact CMS via email at email@example.com. Private Fee-for-Service (PFFS) plans and Regional Preferred Provider Organizations (RPPOs) are excluded from any state or regional measures in the reports, although they are included in the national HOS numbers.
How will I know when the HOS-M reports are available?
The HOS-M reports are distributed annually, one year after data collection, for the new cross-sectional survey data. The HOS-M program timelines are posted on the HOS-Modified Overview page to provide a reasonable estimate of when the HOS-M reports will be completed and ready for distribution each year. The “Availability of Reports and Data” section provides the distribution dates from previous years. The approved users of the CMS HPMS at your plan will receive an announcement of the availability of the reports. If assistance is required regarding HPMS access, you may contact CMS via email at firstname.lastname@example.org.
How can MAOs and PACE organizations obtain their HOS reports?
All HOS report distribution (HOS and HOS-M) occurs electronically to participating MAOs and PACE organizations through HPMS. For individual MAOs and PACE organizations to access their HOS reports, an HPMS User ID is required. If you do not have an HPMS User ID, you may contact your organization's CMS Quality Point of Contact to obtain access to the reports. If assistance is required regarding HPMS access, you may contact CMS via email at email@example.com. The most recent sample reports are available in the Overview section on the Resources page.
What does it mean if my MAO has been identified as an "outlier" in a HOS Performance Measurement Report?
Outliers are MAOs that performed significantly better (i.e., better than expected) or significantly worse (i.e., worse than expected) when compared to the national average. The national average is based on all MAOs that participated in performance measurement. MAOs can be outliers on a measure of physical health (which is based on death and the VR-12 Physical Component Summary score), or on a measure of mental health (which is based on the VR-12 Mental Component Summary score). Additional information is available in the Methodology section of the Performance Measurement report. A sample Performance Measurement report is available for download from the Overview section on the Resources page.
How are the performance measurement results calculated for the HOS Performance Measurement Reports?
Details of how the HOS Performance Measurement Results are calculated may be obtained from Appendix 1 Calculations of Outcomes section of the Performance Measurement Report. A self-paced training webinar on "Understanding the Medicare Health Outcomes Survey (HOS) Performance Results Used in the MA Plan Ratings" is available in the Trainings section on the Resources page.
Where can I obtain ideas for quality improvement activities based upon the HOS results for my MAO?
The Medicare HOS website contains a Trainings section which gives some real world uses of HOS data to help MAOs with ideas for quality improvement initiatives. The HOS Resources page is an excellent source of journal articles and technical reports that use HOS data. For example, the resource "Opportunities for Improving Medicare HOS Results through Practices in Quality Preventive Health Care for the Elderly" is available to help MAOs develop and apply strategies that address the HOS items used in the CMS Medicare Part C Star Ratings. The literature review "Functional Status in Older Adults: Intervention Strategies for Impacting Patient Outcomes" is a synthesis of selected articles of functional status outcomes in older adults and is designed to supplement the resource guide.
Is there any training available to assist MAOs in understanding how to use their HOS Reports?
Four self-paced training webinars are available in the Trainings section.
What HOS data sets are available to the MAOs?
The beneficiary-level data files distributed to the MAOs are the analytic data sets, which contain the survey data for a completed cohort (combined baseline and two-year follow up). These data sets are available after the distribution of the Performance Measurement Reports. Downloads of each new MAO report also include a summary level data file with contract-level information, including the HOS summary measures from the report that are used for the Medicare Part C Star Ratings. The Data Dissemination section on the HOS website contains information about the analytic data sets that have been distributed to the MAOs and the summary level data files included with the reports.
What HOS-M data sets are available to the PACE plans?
The beneficiary-level data files distributed to the PACE plans are the data sets from a cross-sectional HOS-M survey (a baseline survey without a follow up). These data sets are available after the distribution of the HOS-M Reports. The “Availability of Reports and Data” section on the HOS-Modified Overview page contains information about the data sets that have been distributed to PACE plans.
How do I obtain the HOS data sets for my MAO or the HOS-M data sets for my PACE plan?
An announcement of the availability of the new cohort data is sent to the participating plans through the HPMS. Contact the HOS team via email at hos@HCQIS.org to request your data. Data sets will be formatted as Comma Separated Values (CSV) files that are accessible with MS Excel. The data are sent via electronic secure file transfer to the designated recipient (one per company). At the time of data disbursement, you will receive an email containing instructions and a link to the secure file manager facility. Clicking on the link will allow for creation of an account and password establishment. The data will be available to download at that time.
What types of data sets are available to researchers?
Three basic types of data sets are available to researchers: Public Use Files (PUFs), Limited Data Sets (LDS) and Research Identifiable Files (RIFs). The PUFs have been constructed so that all the beneficiary identifying information, including the Medicare Health Insurance Claim (HIC) numbers, Social Security Numbers (SSN), name and address fields have been removed. In addition, some demographic fields such as race and age are aggregated to prevent identification of any individuals.
There are two types of PUFs, baseline and analytic. Analytic PUFs contain a completed cohort of data for all baseline respondents and are constructed to be self-contained with a baseline and follow up component for each beneficiary's record. There is no field that allows identification of a particular individual across the cohorts in the analytic PUFs. Baseline PUFs have been constructed with a unique anonymous ID field that does allow identification of the same individual across multiple baseline cohorts.
LDSs and RIFs are comprised of the entire national sample for a given cohort (including both respondents and non-respondents), and contain all of the HOS survey items, the physical and mental health summary scores, as well as plan identifiers and additional variables describing the plan's characteristics. They also contain protected beneficiary-level health information such as date of birth. However, there are differences between the two types of data sets. For example, the specific direct person identifiers (i.e., name, address, Medicare Health Insurance Claim [HIC] number, and Social Security Number) are included in the RIFs and allow identification of the same individual across multiple cohorts; however, these identifiers are excluded in the LDSs. For more information, go to the Research Data Files section.
How can I obtain the research files?
The PUFs are available for download on the HOS website. A signed Data Use Agreement with CMS is required to obtain either LDS or RIF data files. A small fee is assessed for each cohort of data. Effective September 1, 2016, all research requests for LDS data files must be submitted through the CMS Limited Data Set File Process, while the requests for RIF data files will continue to be processed through the Research Data Assistance Center (ResDAC) at the University of Minnesota. ResDAC is a CMS contractor that provides assistance to academic, government and non-profit researchers interested in using Medicare and/or Medicaid data. ResDAC is available to assist in the completion and/or review of data requisition forms for Medicare HOS RIF data files prior to their submission to CMS. For information about how to request either LDS or RIF data files, go to the Research Data Files section on the Data page.
Where can I obtain information about the CMS Medicare Star Ratings?
For information about the HOS results included in the Medicare Star Ratings, you may go to the HOS and the Star Ratings page of the HOS website. Additional information is available on the CMS website at www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html. For any questions related to Medicare Part C and D Star Ratings, you may send an email inquiry directly to PartCandDStarRatings@cms.hhs.gov. Please be sure to include your MAO contract number in the email, where applicable.
This page was last modified on 02/15/2017