HOS-Modified

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, 0.90 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	TBD	TBD	TBD	TBD	TBD

¹ Ineligible members met one or more of the following criteria: deceased; bad address and phone number; bad address and mail-only protocol (Russian only); 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 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	TBD	TBD	TBD

¹ Reports made available electronically to plans via HPMS
²Plans notified of availability of data
* Reports and/or Access Information Available in HPMS

This page was last modified on 04/18/2024

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