Medicare Health Outcomes Survey-Modified (HOS-M) Overview

Introduction to Medicare HOS-M

The Medicare Health Outcomes Survey-Modified (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 CMS to vulnerable Medicare beneficiaries at greatest risk for poor health outcomes. These beneficiaries 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 of beneficiaries 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 Medicare beneficiaries is drawn annually from each participating plan and surveyed in the spring. Beginning in 2014, 1,200 beneficiaries are randomly selected for the HOS-M if the plan has a population of at least 1,200, and all eligible beneficiaries are included in the sample for plans with populations of less than 1,200. Prior to 2014, 1,200 beneficiaries were randomly selected for the HOS-M if the plan had a population of at least 1,400, and all eligible beneficiaries were included in the sample for plans with populations of less than 1,400. One of the HOS approved survey vendors administers the survey to all participating HOS-M plans. The HOS-M timeline is similar to the Medicare HOS Program Timeline.

Program Activity Timeframe
Survey Preparation, Administration, Data Cleaning Year 1 
Finalize Survey Specifications January
Train & Approve Vendors February
Select Yearly HOS-M Sample March
Prepare Vendor Materials March
Field Yearly HOS-M Sample April - June
Submit Raw Survey Data File August - September
Test & Clean Data September - November
Score Data December
Data Management, Analysis and Dissemination Year 2 
Aggregate Yearly HOS-M Data January - February
Produce Yearly HOS-M Report March - May
Disseminate HOS-M Report Summer
Produce Yearly HOS-M Data File & Data Users Guide Summer
Distribute HOS-M data to participating plans Summer/Fall


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 Health Outcomes Survey 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. For informational purposes, the HOS-M instruments are available for download from the Survey Instruments section. Information about HOS-M survey requirements, procedures and protocol may be found in the HEDIS®, Volume 6: Specifications for the Medicare Health Outcomes Survey manuals on the Survey Administration page.

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 Medicare beneficiaries from each organization compared to the entire HOS-M sample. A Sample PACE Report (PDF, 1.0 MB) is available for download.

The corresponding beneficiary 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 TBD TBD TBD   TBD TBD
1 Ineligible beneficiaries met one of the following criteria: deceased; not enrolled in the health plan; have an incorrect address and phone number; have a language barrier; or removed from sample due to death, disenrollment, or long-term institutionalization during survey administration.
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 beneficiaries are removed from the denominator in the response rate calculations. In other words, Response Rate = [Number of Respondents/(TotalSample - Ineligibles)]x100%.


Availability of Reports and Data

All 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 assistance is required regarding HPMS access, please contact CMS via email at hpms_access@cms.hhs.gov. Following HPMS notification that the data are available, a plan may contact the Medicare HOS Information and Technical Support email at hos@HCQIS.org to request their data and the 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        March 23, 2009*,1        March 9, 20092 2007 PDF, 646 KB
2008        Sept 30, 2009*,1        Oct 30, 20092 2008 PDF, 387 KB
2009        Oct 5, 2010*,1        Sept 14, 20102 2009 PDF, 651 KB
2010        Aug 23, 2011*,1        July 15, 20112 2010 PDF, 412 KB
2011        Aug 10, 2012*,1        Aug 10, 20122 2011 PDF, 457 KB
2012        July 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        July 31, 20152 2014 PDF, 619 KB
2015        May 16, 2016*,1        Aug 1, 20162 2015 PDF, 465 KB
       June 1, 2017*,1       Aug 4, 20172 2016 PDF, 457 KB
2017        June 1, 2018*,1       July 20, 20182 2017 PDF, 462 KB
2018       May 31, 2019*,1       Summer 2019    Summer 2019
2019    Summer 2020       Summer 2020    Summer 2020

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 06/17/2019

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