Medicare Health Outcomes Survey-Modified (HOS-M) Overview
Introduction to Medicare HOS-M
The Medicare HOS-M was fielded for the first time in the spring of 2005. Originally entitled the Program of All-Inclusive Care for the Elderly (PACE) Health Survey, the HOS-M is administered by the Centers for Medicare & Medicaid Services (CMS) to vulnerable people with Medicare who are at greatest risk for poor health outcomes and are enrolled in PACE organizations.
The HOS-M is a modified version of the Medicare HOS. Similar to the HOS, the HOS-M design is based on a randomly selected sample of individuals from each participating PACE organization. The HOS-M is a cross-sectional survey, measuring the physical and mental health functioning at a single point in time. This differs from the HOS, which has a follow-up component.
One of the main goals of the HOS-M is to assess annually the frailty of the population in these health plans in order to adjust plan payments. Initial eligibility for payment purposes is based on community-residing members who do not have end-stage renal disease (ESRD) and are age 55 or over.
Note that the Minnesota Senior Health Options, Minnesota Disability Health Options, Wisconsin Partnership Program, and Massachusetts MassHealth Senior Care Options transitioned from Medicare dual eligible demonstration status into the Medicare Advantage program in 2008. As a result, frailty adjusted payment rates for these Special Needs Plans (SNPs) were phased out after 2010. Starting in 2010, these SNPs were required to participate in HOS as part of CMS standard Medicare Advantage reporting requirements. In 2012 and 2013, CMS used six Activity of Daily Living (ADL) items collected from the HOS to determine frailty adjusted payments for Fully Integrated Dual Eligible (FIDE) SNPs, if the sample of SNP enrollees had similar average levels of frailty as the PACE program. Since 2014, FIDE SNPs can choose to use either the HOS or HOS-M for their frailty assessment. PACE organizations continue to participate in HOS-M and receive frailty-adjusted payments based on the HOS-M survey data collected.
Medicare HOS-M Program Timeline
A sample of people with Medicare is drawn annually from each participating plan and surveyed each year. Since 2014, 1,200 members are randomly selected for the HOS-M if the plan has an eligible population of at least 1,200; all eligible members are included in the sample for plans with populations of less than 1,200. Prior to 2014, 1,200 members were randomly selected for the HOS-M if the plan had a population of at least 1,400, and all eligible members were included in the sample for plans with populations of less than 1,400. The HOS-M must be administered by a CMS-approved survey vendor. The list of CMS-approved survey vendors can be found in the HOS-M Survey Vendors section.
The HOS-M timeline is similar to the Medicare HOS Program Timeline. General information is provided in the table below. More detailed HOS-M information can be found in the HOS-M QAG for PACE and the FIDE SNP QAG.
| Program Activity | Timeframe |
| Survey Preparation, Administration, Data Cleaning | Measurement Year |
| CMS Finalizes Survey Specifications | January |
| CMS Approves HOS Survey Vendors | February |
| CMS Selects Annual HOS-M Sample | May |
| Survey Vendors Prepare HOS-M Materials | June - July |
| Survey Vendors Field HOS-M | July - November |
| Survey Vendors Submit Raw Survey Data | October - November |
| HSAG Tests & Cleans Data | November - December |
| Data Management, Analysis, Dissemination | Following Year |
| Frailty Results Posted in HPMS | April - May |
| HOS-M Reports Distributed in HPMS | October - November |
| Prior Year’s HOS-M Data Available by Request | November |
Development of the Medicare HOS-M Instrument
The Medicare HOS-M contains the following core components:
- The Veterans RAND 12-Item Health Survey (VR-12)
- Activity of Daily Living (ADL) items
The HOS-M instrument is a shorter, modified version of the Medicare HOS and contains six ADL items as the core items used to calculate the frailty adjustment factor. The survey also includes 12 physical and mental health status questions from the VR-12. In addition, the HOS-M includes questions about the following: lifting or carrying objects as heavy as 10 pounds; walking a quarter mile; health or physical problems interfering with daily activities, receiving help with ADLs; physical and emotional health compared to one year ago; memory loss; urinary incontinence; and a question on whether the survey was self-completed or completed by a proxy. If the participant received assistance completing the survey, the respondent was asked information about the proxy respondent. Information about HOS-M survey requirements, procedures, and protocol may be found in the Healthcare Effectiveness Data and Information Set (HEDIS®), Volume 6: Specifications for the Medicare Health Outcomes Survey manuals. The most recent NCQA HEDIS®, Volume 6: Specifications for the Medicare Health Outcomes Survey manuals, are available at no cost from the NCQA Store at (https://store.ncqa.org/hedis-quality-measurement/hedis-specifications-for-the-medicare-health-outcomes-survey.html). The HOS and HOS-M survey instruments can be downloaded from NCQA’s website (www.ncqa.org/hedis/measures/hos).
Dissemination of HOS-M Results to Plans
After each yearly administration of the Medicare HOS-M, a plan specific report is produced for each PACE organization participating in the survey. The HOS-M report presents physical (PCS) and mental (MCS) component summary scores, ADL items, and selected health status measures, for the frail, elderly people with Medicare from each organization compared to the entire HOS-M sample. A Sample PACE Report (PDF, 0.96 MB) is available for download.
The corresponding member level data for a report are disseminated to all participating plans. In addition to the data files, each plan receives a Data Users Guide (DUG) that describes the Medicare HOS-M file specifications and appropriate ways to use Medicare HOS-M data.
Medicare HOS-M Survey Status Information
| HOS-M Data Collection Year |
Date Fielded | Population | Plans | Sample Size | Ineligible Surveys1 | Completed Surveys2 | Response Rate3 |
| 2007 | April 2007 | PACE/SNP | 52 | 23,682 | 2,861 | 16,200 | 77.8% |
| 2008 | April 2008 | PACE/SNP | 52 | 25,194 | 3,236 | 16,360 | 74.5% |
| 2009 | April 2009 | PACE/SNP | 58 | 26,743 | 3,285 | 17,396 | 74.2% |
| 2010 | April 2010 | PACE | 58 | 14,366 | 1,471 | 9,652 | 74.9% |
| 2011 | April 2011 | PACE | 68 | 16,226 | 1,646 | 9,915 | 68.0% |
| 2012 | April 2012 | PACE | 72 | 17,964 | 1,807 | 10,372 | 64.2% |
| 2013 | April 2013 | PACE | 84 | 20,404 | 1,692 | 12,143 | 64.9% |
| 2014 | April 2014 | PACE | 87 | 22,394 | 1,964 | 12,683 | 62.1% |
| 2015 | April 2015 | PACE | 98 | 24,665 | 2,636 | 13,083 | 59.4% |
| 2016 | April 2016 | PACE | 106 | 27,289 | 2,611 | 14,891 | 60.3% |
| 2017 | April 2017 | PACE | 115 | 30,478 | 2,836 | 17,220 | 62.3% |
| 2018 | April 2018 | PACE | 121 | 33,103 | 3,042 | 17,991 | 59.8% |
| 2019 | April 2019 | PACE | 123 | 36,199 | 3,600 | 18,331 | 56.2% |
| 2020 | Aug-Nov 2020 | PACE | 124 | 38,624 | 5,588 | 18,644 | 56.4% |
| 2021 | July-Nov 2021 | PACE | 131 | 37,792 | 3,322 | 18,171 | 52.7% |
| 2022 | July-Oct 2022 | PACE | 133 | 39,027 | 3,346 | 18,166 | 50.9% |
| 2023 | July-Nov 2023 | PACE | 143 | 39,290 | 3,580 | 20,063 | 51.1% |
2 A completed survey is defined as a survey that can be used to calculate physical or mental health summary scores.
3 Please note, ineligible members are removed from the denominator in the response rate calculations. In other words, Response Rate = [Number of Respondents / (Total Sample - Ineligibles)]x100%.
Availability of Reports and Data
Distribution of HOS-M Reports occurs electronically to participating PACE organizations through the CMS Health Plan Management System (HPMS). Plans are alerted of report availability through HPMS. If HPMS access assistance is required, please contact CMS at hpms_access@cms.hhs.gov. Following HPMS notification that the data are available, a plan may contact Medicare HOS Information and Technical Support at hos@hsag.com to request their data and DUG.
Complete information about the dissemination and availability of Medicare HOS-M Reports and data to plans is available in the table below. The HOS-M DUGs are available for download from the table below.
| HOS-M Data Collection Year |
Report | Data | Data Users Guide |
| 2007 | Mar 23, 2009*,1 | Mar 9, 20092 | 2007 PDF, 646 KB |
| 2008 | Sep 30, 2009*,1 | Oct 30, 20092 | 2008 PDF, 387 KB |
| 2009 | Oct 5, 2010*,1 | Sep 14, 20102 | 2009 PDF, 651 KB |
| 2010 | Aug 23, 2011*,1 | Jul 15, 20112 | 2010 PDF, 412 KB |
| 2011 | Aug 10, 2012*,1 | Aug 10, 20122 | 2011 PDF, 457 KB |
| 2012 | Jul 24, 2013*,1 | Aug 9, 20132 | 2012 PDF, 651 KB |
| 2013 | May 23, 2014*,1 | Aug 1, 20142 | 2013 PDF, 611 KB |
| 2014 | May 19, 2015*,1 | Jul 31, 20152 | 2014 PDF, 619 KB |
| 2015 | May 16, 2016*,1 | Aug 1, 20162 | 2015 PDF, 465 KB |
| 2016 |
Jun 1, 2017*,1 | Aug 4, 20172 | 2016 PDF, 457 KB |
| 2017 | Jun 1, 2018*,1 | Jul 20, 20182 | 2017 PDF, 462 KB |
| 2018 | May 31, 2019*,1 | Jul 19, 20192 | 2018 PDF, 778 KB |
| 2019 | May 29, 2020*,1 | Jul 6, 20202 | 2019 PDF, 480 KB |
| 2020 | Nov 5, 2021*,1 |
Nov 5, 20212 |
2020 PDF, 711 KB |
| 2021 | Nov 4, 2022*,1 | Nov 4, 20222 | 2021 PDF, 866 KB |
| 2022 | Oct 27, 2023*,1 | Oct 27, 20232 | 2022 PDF, 867 KB |
| 2023 | Oct 31, 2024*,1 | Oct 31, 20242 | 2023 PDF, 839 KB |
1 Reports made available electronically to plans via HPMS
2 Plans notified of availability of data
* Reports and/or Access Information Available in HPMS
This page was last modified on 12/18/2024
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