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Frequently Asked Questions about the Medicare Health Outcomes Survey (HOS)

HOS and HOS-Modified (HOS-M) Documentation

Where can I find the current HOS and HOS-M survey vendor lists and survey administration documents?
The most current information for the HOS and HOS-M survey vendor lists is available under the HOS Survey Vendors and HOS-M Survey Vendors sections on 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 Medicare Advantage Organizations (MAOs) and Program of All-Inclusive Care for the Elderly (PACE) plans, and the HOS exclusion memo. Additional information about HOS program requirements may be found in the HOS Quality Assurance Guidelines (QAG) and HOS-M QAG Addendum, both of which are available in the Methodology section of the Resources page.

Where can I obtain copies of the HOS and HOS-M survey questionnaire?
The HOS and HOS-M survey instruments can be downloaded from the National Committee for Quality Assurance (NCQA) website (www.ncqa.org/hedis/measures/hos). 

Where can I obtain more information about the Veterans RAND 12-Item Health Survey (VR-12)?
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.

Where can I obtain information about the Centers for Medicare & Medicaid Services (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 about the CMS Medicare Star Ratings 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.

HOS Eligibility, Enrollment, and Administration

When are new MAOs eligible to participate in the HOS?
MAOs with Medicare contracts in effect on or before January 1 of the preceding year are required to report Baseline HOS in the current year if they have a minimum enrollment of 500 beneficiaries by February 1st. NCQA will send a notice to the MAOs alerting them of their upcoming eligibility and the required preparations for the HOS fielding. MAOs must then contract with a CMS Approved HOS Survey Vendor to administer the survey. Please visit the Survey Vendors page on the HOS website for the most current information about HOS survey vendors. 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 from NCQA at www.ncqa.org/hedis/measures/hos.

When may MAOs use HOS or HOS-like questions with their health plan members?
The HOS instrument is copyrighted by CMS and NCQA. If a plan wishes to use questions from the HOS, they need to obtain prior permission from NCQA and CMS. Those interested in using the HOS and HOS-M survey instrument or questions from either instrument must submit a Survey Use Application and signed Terms of Use to NCQA (hos@ncqa.org). For more information on the permitted uses of the HOS and HOS-M survey instruments, as well as the Survey Use Application and Terms of Use, visit NCQA’s website at www.ncqa.org/hedis/measures/hos.

Health plans are strongly discouraged from fielding non-CMS surveys to their members eight (8) weeks prior to or during the announced HOS data collection period. This timeframe is sometimes referenced as the "blackout period."  Health plans may conduct focus groups during the HOS data administration, assuming the focus groups address broader health topics, are not specific to HOS-related topics, and are conducted throughout the year.

What is oversampling in the HOS, and how can I submit a request to oversample?
Oversampling is surveying a sample of members that is larger than the required sample size of 1,200. In the current survey year, any MAO that is required to report HOS will have the opportunity to request oversampling. Oversampling is at the contract level for the baseline sample and should be expressed as a whole number percentage of the sample size. The follow-up sample is still selected based on the follow-up members with eligible Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from two years prior. MAOs must notify the HOS Project Team at NCQA (hos@ncqa.org) of oversampling requests by the due date that is specified in the current Survey Administration Plan Memo on the Survey Administration page. All oversampling requests are subject to approval by CMS.

HOS and HOS-M Reports

How will I know when the HOS reports are available?
The HOS reports are distributed annually, about one year after data collection ends, 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 electronic communication through HPMS announcing the availability of the reports. If assistance is required regarding HPMS access, you may contact CMS via email at hpms_access@cms.hhs.gov or visit the CMS website.

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 to PACE organizations annually, approximately one year after data collection ends, 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 electronic communication announcing availability of the reports. If assistance is required regarding HPMS access, you may contact CMS via email at hpms_access@cms.hhs.gov or visit the CMS website.

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 hpms_access@cms.hhs.gov or visit the CMS website for information on how to establish access to HPMS: https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/HPMS/UserIDProcess.html.The most recent sample reports are available under the Sample Reports section.

HOS Calculations and Results

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 Performance Measurement report. A sample Performance Measurement report is available for download under the Sample Reports section. 

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.

What are the reporting requirements at baseline and follow up for calculating the Star Ratings Measures?
Results for the three cross-sectional Effectiveness of Care (Process) Measures are calculated using the HOS data collected in a single survey year, i.e., a round of data. Data are combined for an MAO contract that fielded both the HOS baseline and follow-up surveys. If a contract fielded only the HOS baseline or HOS follow up (not both), results are calculated using the data available. In either case, results are reportable only if a denominator of 100 is achieved. Please note that the same survey is fielded to both baseline and follow up respondents in the same survey year.

The results for the two longitudinal Functional Health (Outcome) Measures cannot be calculated until follow up data are available. Assuming no consolidated contracts are involved, a newly established MAO administering their first HOS survey would not have follow up data or outcome results for two years.

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.

• Introduction to the Medicare Health Outcomes Survey (HOS)
• Getting the Most from Your Medicare Health Outcomes Survey (HOS) Baseline Report
• Using Your Medicare Health Outcomes Survey (HOS) Data
• Understanding the Medicare Health Outcomes Survey (HOS) Performance Results Used in the MA Plan Ratings

HOS and HOS-M Data Sets and Research Files

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). The availability of the data sets now coincides with the distribution of the Performance Measurement Reports (as of Cohort 20 in 2020). 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 can 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@hsag.com to request your data. Data sets will be formatted as Comma Separated Values (CSV) files. The data are sent via electronic secure file transfer to the designated recipient (one per company). Per CMS policy, one copy of beneficiary level data, per contract, per cohort, is provided to MAOs at no cost. At the time of data disbursement, the designated recipient 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 (LDSs) and Research Identifiable Files (RIFs). The PUFs have been constructed so that all the beneficiary identifying information contained in the corresponding RIFs (including the Medicare Beneficiary Identifier [MBI], Medicare Health Insurance Claim [HIC] number where available, Social Security Number [SSN] where available, names, address fields, and the plan identifying information) have been removed. In addition, plan identifiers have been removed and 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, and the physical and mental health summary scores. They also contain protected beneficiary-level health information such as date of birth, gender, race/ethnicity, and county of residence. However, there are differences between the two types of data sets. For example, the specific direct person identifiers (i.e., name, address, MBI, HIC number where available, and SSN where available) are included in the RIFs and allow identification of the same individual across multiple cohorts; however, these identifiers are excluded in the LDSs. Note that SSNs are no longer included in RIFs beginning with Cohort 21. Additionally, the plan identifiers and plan characteristics that are included in the RIFs are blinded, modified, or excluded in the LDSs to prevent identification of specific MAO contracts. 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. 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. 

This page was last modified on 02/16/2022