Summer 2021 HOS Newsletter
Volume 10, Issue 2
Welcome to the Summer 2021 edition of the Medicare Health Outcomes Survey (HOS) Newsletter. This newsletter provides general updates about the HOS Program and is shared with everyone who requests it. This issue and all previous issues are available on the HOS website.

The newsletter is also intended to help you understand and use the reports and data generated by the HOS to improve the health of beneficiaries, inform quality improvement activities, and contribute to research that benefits public health. We are always interested to hear of topics that are important to you and we encourage Medicare Advantage Organizations (MAOs) and other stakeholders to send suggestions and ideas to
What's New
This year is an exciting time of updates and progress for the HOS. Several changes that occurred in 2020 are being continued in 2021, along with additional changes initiated by the Centers for Medicare & Medicaid Services (CMS) in response to inquiries and requests by MAOs and others involved in the HOS.

Survey Administration in 2021
Details of the 2021 HOS and HOS-Modified (HOS-M) survey administration periods were released in March 2021. The HOS 2021 Administration Memo and the HOS-M 2021 Survey Administration Memo detail important information about this year’s survey administration, including plan reporting requirements, contracting with survey vendors, and the sampling process. The 2021 HOS and HOS-M surveys are being fielded from July 19, 2021 through November 1, 2021, following the timeline begun in 2020 and as announced on the Health Plan Management System (HPMS) site.

Survey vendor training was completed in May 2021 and the list of CMS-Approved Survey Vendors is available on the HOS website. The survey vendor training slides used for new and returning survey vendors are also available. The most recent HEDIS® Volume 6: Technical Specifications for the Medicare Health Outcomes Survey operational manuals (HEDIS 2016 Volume 6 – HEDIS Measurement Year [MY] 2020 Volume 6) are available at no cost from the NCQA Store ( Copies of older editions of manuals may be obtained from NCQA by calling NCQA Customer Support at (888) 275-7585.

Copies of the HOS and HOS-M survey instruments are also available for download from NCQA’s website ( Those interested in using the HOS and HOS-M survey instruments or questions from either instrument must submit a Survey Use Application and signed Terms of Use to NCQA ( For more information on the permitted uses of the HOS and HOS-M survey instruments, or to download the Survey Use Application and Terms of Use, visit NCQA’s website. Health plans are strongly discouraged from fielding non-CMS surveys to Medicare beneficiaries eight (8) weeks before and during the announced HOS data collection period. This time frame is sometimes referenced as the “blackout period.”

Results Reporting in 2021
As announced in the Winter edition of the newsletter, there is a new HOS report being released in 2021 to coincide with the 2018-2020 Cohort 21 Performance Measurement Report. The new HEDIS HOS Effectiveness of Care Report (HEDIS HOS report) presents results based on data from the HOS Round 23 surveys (combined Cohort 23 Baseline and Cohort 21 Follow Up data) collected in 2020. With this new HEDIS HOS Report, MAOs can simultaneously review their HEDIS measure results with their other HOS Performance Measurement results and design targeted interventions for their beneficiaries. MAO, state, region, and national results, as well as trend results over three rounds of data for the HEDIS measures, are depicted in the HEDIS HOS Report. This report also includes summaries of evidence-based interventions for improving health outcomes.

In keeping with CMS’s overall intention to expand the existing HOS measures, the Cohort 21 Performance Measurement Report will again include results from the new Physical Functioning Activities of Daily Living (PFADL) longitudinal change measure. This measure does not increase burden on survey respondents because it is derived from existing survey items in the HOS. Information about the new measure, the questions used in the calculation of the scale scores, and the case-mix adjustment procedures, are provided in the Medicare HOS PFADL Change Measure documentation.

As a result of the new timeline implemented in 2020 and 2021, the Cohort 23 Baseline reports are now scheduled to be released in November 2021 to eligible participating MAOs. The Cohort 23 Baseline Report provides plan-level cross-sectional information about the health of respondents, as well as benchmark comparisons to other plans and to the HOS total respondent population. Results for each plan are also trended across the three most recent years to help MAOs identify areas where they are doing well and to identify areas for potential improvement. New in the Cohort 23 Baseline Report will be tables providing the distribution of case-mix adjusted PCS and MCS percentile scores. The 2020 HOS-M reports will also be released to participating Program of All-Inclusive Care for the Elderly (PACE) organizations in November 2021.

CMS makes Public Use Files (PUFs) available to facilitate the dissemination of data collected by the Medicare HOS project for additional research studies. These files have been created for each cohort of data since Cohort 1. The PUFs are constructed to protect the privacy of beneficiaries and plans by excluding all individually identifying information and aggregating demographic categories such as race and age. New in 2021 and going forward, the PUF data will be made available in the CSV format that does not require specific import software. All prior cohorts for the baseline and analytic PUF data continue to have a text file available for download, along with the corresponding analytic PUF SAS import code. The Research Data Files page has more information about the PUFs.

Updated SEER-MHOS Data Linkage
The Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey (SEER-MHOS) is a data resource produced by CMS in partnership with the National Cancer Institute (NCI). The SEER-MHOS data set links the SEER cancer registries with MAO enrollees who participated in the HOS. The data set includes detailed information such as clinical, demographic and cause of death information from the SEER data set in addition to the health-related quality of life (HRQOL) data provided from the HOS. The linked SEER-MHOS data resource currently includes HOS data covering Cohorts 1-18. This Fall a new linkage will add Cohort 19 and update SEER registry cancer diagnosis information through 2017. The SEER-MHOS website provides more information about the data set and how to apply for a data use agreement (DUA).
HOS Timeline
HOS 2021 Administration Cycle
This year’s fielding of the Medicare HOS and HOS-M will run July 19, 2021 through November 1, 2021. Information about the 2021 survey administration protocols, survey instrument and mailing materials, and how HOS measures are calculated can be found in the HEDIS® MY 2020, Volume 6: Specifications for the Medicare Health Outcome Survey, available at no cost from the NCQA Store. Details for the requirements, protocols, and procedures for the HOS and HOS-M survey administration can be found in the HOS Quality Assurance Guidelines and Technical Specifications (QAG) and HOS-M QAG Addendum, respectively.

HOS Reports Now Available
The new HEDIS HOS report released in 2021 presents results of the HEDIS measures for each MAO based on data from the HOS Round 23 surveys (combined Cohort 23 Baseline and Cohort 21 Follow Up data) collected in 2020.

The most recent reports available are:
  • 2018-2020 HOS Cohort 21 Performance Measurement Reports
  • 2020 HEDIS HOS Effectiveness of Care Report
  • 2019 HOS Cohort 22 Baseline Reports
  • 2019 HOS-M Reports

Registered HPMS users have access to these reports through the HPMS site. Information about how you can get access to HPMS is available here from the CMS site. If you require assistance accessing reports in HPMS, please contact CMS via email at As noted previously, the 2020 HOS Cohort 23 Baseline and 2020 HOS-M reports will be available in November 2021.

HOS Data Sets Now Available
Current HOS data sets are now available that provide beneficiary-level HOS survey responses for each participating MAO. Eligible MAO recipients (refer to the HPMS memo for details) may request their HOS data sets. The data sets currently available to request are:
  • Data sets and accompanying DUGs for HOS Cohorts 1–21
  • Data sets and accompanying DUGs for HOS-M data sets for 2007–2019 (The 2020 HOS-M data set is scheduled to be released in November 2021.)

The DUG included with each data set provides detailed documentation about the file structure and the data set contents. In the DUG, you will find information on methodology and design; the survey instrument; data file characteristics; data file layout by position; annotated baseline surveys; and follow up surveys, when applicable.

The HOS website also provides downloadable sample Baseline, HOS-M, HEDIS HOS, and Performance Measurement Reports with actual aggregate national benchmark data compared to example plan data. These sample reports are found in the Sample Reports section on the Publications and Resources page.

Contact the HOS Team at to request data for your MAO or PACE organization. Encrypted data are distributed to eligible recipients via secure file transfer.
Medicare Star Ratings
The measures used to calculate 2022 Medicare Part C Star Ratings include results from the contract-level HEDIS Effectiveness of Care measures. The first plan preview period for the 2022 Medicare Star Ratings is in August 2021, and the second preview period will occur in September 2021. The 2022 Medicare Star Ratings are scheduled to be provided on the Medicare Plan Finder in early October 2021. Information about the Medicare Star Ratings is published on the CMS website.

Functional Health (Outcome) Measures
These HOS measures are longitudinal. They are obtained from the same cohort of beneficiaries, surveyed at baseline and two years later at follow-up.
  • Improving or Maintaining Physical Health
  • Improving or Maintaining Mental Health

Effectiveness of Care (Process) Measures
These HEDIS HOS measures are cross-sectional, collected from all survey respondents (baseline and follow up) in a single survey year.
  • Monitoring Physical Activity
  • Improving Bladder Control
  • Reducing the Risk of Falling

The HOS measures used in the 2022 Medicare Star Ratings Year are the three HEDIS Effectiveness of Care measures from the Cohort 21 Follow Up and Cohort 23 Baseline data that were collected in 2020. The Improving or Maintaining Physical and Mental Health outcome measures have been moved to the display page on for 2022 and 2023 as announced in the August 5, 2021 HPMS memo. The yellow highlighted sections of the following table depict the relationship between the data collection and reporting periods.

The green highlighted sections of the table indicate the 2021 Medicare Star Ratings Year. The 2021 Medicare Star Ratings data are from the Cohort 20 Improving or Maintaining Physical and Mental Health outcome measures and the HEDIS Effectiveness of Care measures that were collected in 2019.

Medicare HOS Survey Administration and Part C Star Ratings Timeline
This is the timeline for HOS data collection, reports to MAOs, and year of Star Ratings report.
Summer 2021 Star Ratings
*PCS and MCS are moved to the display page for the 2022 and 2023 Star Ratings Years.
Of Note
Of Note
Recent Research from the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) Data Resource
The SEER-MHOS linked data present longitudinal information on over 180,000 cancer patients as well as over two million Medicare beneficiaries with no history of cancer. The SEER Program collects data on cancer cases in an effort to reduce the burden of cancer among the U.S. population. This purpose is in line with the goal of the HOS to gather valid and reliable clinically meaningful data, including improving the care of MAO beneficiaries with cancer. Several peer-reviewed journal articles have been published reporting on the results of research using the SEER-MHOS data on how outcomes can be improved for beneficiaries with cancer. These references and a listing of other SEER-MHOS research publications can be found in the Applications and Results pages on the HOS website and are also listed on the SEER-MHOS website. A listing of current projects using SEER-MHOS data under DUAs, shared with permission from the identified Principal Investigators, can also be found on the SEER-MHOS website.

Management of Fatigue Among Cancer Survivors
Fatigue can be a serious and distressing symptom experienced by people undergoing treatment for cancer regardless of the type of cancer or the modality of treatment. Fatigue can also impact both physical functioning and mental health overall for cancer patients. A recent study, published in the Supportive Care in Cancer journal, examined the symptom experience of fatigue and the trajectory of fatigue over the course of cancer diagnosis and treatments.[1] Using the SEER-MHOS linked data available for 1,214 older adult survivors of breast, colorectal, and prostate cancer, the researchers measured fatigue prior to the cancer diagnosis and at two subsequent time points.

In general, it was found that many cancer survivors did report fatigue that worsened over time, though some (33%) reported that they were not fatigued. Among those experiencing fatigue, 8.2% reported severe fatigue worsening over time and 14.4% reported severe fatigue persisting over time. Membership in the two trajectory groups of worsening fatigue was predicted by age, cancer stage, and depressed mood (all p < 0.0001).[1] This study indicates that it is important for healthcare providers to expect fatigue in cancer patients and to evaluate them for possible treatment strategies that can reduce the impact of fatigue. In doing so, overall Health Related Quality of Life can be improved for people experiencing several different frequently occurring types of cancer.

[1] Byrne M, Leiser J, Mitchell SA, Kent EE, Siembida EJ, Somers T, Arem H. Trajectories of fatigue in a population-based sample of older adult breast, prostate, and colorectal cancer survivors: an analysis using the SEER-MHOS data resource. Support Care Cancer. 2021 May 29. Available at doi: 10.1007/s00520-021-06267-w. PMID: 34052930. Accessed on July 12, 2021.

Prognosis in Frail Patients with Gynecologic Cancers
Though determination of frailty has long been an important component of comprehensive geriatric assessment, researchers have more recently been developing and testing an index of accumulated frailty with the population of cancer patients. The 25-item patient-reported Rockwood Accumulation of Deficits Frailty Index (DAFI) can be constructed using data from the SEER-MHOS database. Most recently they published results of their testing in the journal Gynecologic Oncology.[2] Of the women in the SEER-MHOS data diagnosed with gynecologic malignancies between 1998 and 2015 (n=1,336), 49% were found to be frail, and the frail patients had a 16% increased risk of death. In addition, each 10% increase in the DAFI was associated with an increased death risk of 16%.[2]

The association of frailty and mortality was found to be stronger for endometrial and vaginal/vulvar cancers and was found to be significant regardless of the women’s age.[2] The authors of the study recommend the DAFI as a useful tool to measure prognosis and functional frailty for women with gynecologic cancers.

[2] Mullen MM, McKinnish TR, Fiala MA, et al. A deficit-accumulation frailty index predicts survival outcomes in patients with gynecologic malignancy. Gynecol. Oncol. 2021 Jun;161(3):700-704. Available at doi: 10.1016/j.ygyno.2021.02.027. PMID: 33648746. Accessed on July 12, 2021.
HOS Applications
Frequently Asked Questions
The questions received by our Medicare HOS Information and Technical Support team often follow the cyclical nature of the annual HOS cycle. The questions below are the ones most frequently asked at this time of year when reports become available, when data are disseminated to eligible recipients, and when Star Ratings are published. The answers below have been reviewed and updated with the most current information available to MAOs and other users of the HOS data.

I received a CMS announcement about the availability of data. Does that mean my plan has data available?
CMS announcements about the availability of data are sent to all plans and therefore are not an automatic indication of data availability. A plan will have Performance Measurement data available if the plan participated in both the baseline and the follow up phases of the survey for that cohort and continues to participate in HOS when the data are distributed. For example, for plans to have Cohort 21 Performance Measurement data available, they would have had to participate in both the 2018 Baseline and the 2020 Follow up surveys. Plans that did not collect survey data at both of those times will not have reports and data available. This may be the case with plans that are newer (started in 2019 Baseline or later) to the HOS. Similarly, a PACE organization will have HOS-M data available if the PACE participated in the previous year’s data collection.

Plans that are no longer participating in the Medicare Advantage or PACE programs when the data are distributed will not be eligible to obtain their data. Although your plan may have previously participated in the HOS or HOS-M, not all plans will have data available for the particular cohort of data being released. Plans that are not eligible will be informed of the reason they cannot obtain data. Also, announcement of HOS data availability does not mean that HOS-M data are also available at that time and vice versa.

How do I obtain the HOS (or HOS-M) reports and beneficiary-level data sets?
HPMS users at your MAO or PACE organization will receive an announcement of the availability of HOS or HOS-M reports. An HPMS User ID and password are required to access HPMS. If you require further assistance regarding HPMS access, please contact CMS via email at or visit the CMS website.

For beneficiary-level data sets, an announcement of the new data availability is sent to HPMS users at your MAO or PACE organization. For example, last year, the memo announcing availability of the HOS Cohort 20 data was released on August 3, 2020 and the memo about the 2019 HOS-M data went out on July 6, 2020. Effective this year, HOS data distribution will continue to occur in August, but HOS-M data distribution will now be occurring annually in the Fall. Contact the HOS team via email at to request your data once the CMS announcement memo has been published. Data sets will be formatted as CSV files. Your organization’s designated recipient will be given instructions on how to set up an account and download the data via secure file transfer. Documentation for the data file is also included.

CMS policy provides one copy of beneficiary-level data to MAOs at no cost, including files made available in previous years that have not yet been requested. You may request your organization’s past data by contacting the HOS team as described above. However, if the data have already been delivered and downloaded, there is a replacement fee for each data set (per contract, per cohort).

CMS also posts the frailty scores for PACE organizations on HPMS. You may obtain frailty scores in your plan’s Survey Results for Frailty Adjustment Report under the “Risk Adjustment” tab in HPMS. Below your contract’s Results table in HPMS, there is a link to a Technical Notes document that provides information on how the frailty scores are calculated for the requested year.

Can there be multiple recipients within my organization for the data?
Per CMS policy, one copy of beneficiary-level data is provided to MAOs at no cost. One copy means a single distribution of the data and therefore only one designated recipient of the data. If multiple people need to review the data, please designate a single authorized recipient who can then distribute the data file as necessary once they receive it.

I received and downloaded my data, but where is my plan specific report?
Plan specific results are included in your plan’s HOS or HOS-M report. All HOS report distribution occurs electronically to participating MAOs and PACE organizations by CMS through HPMS.

An HPMS User ID and password are required to access the reports. 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, or you may contact CMS via e-mail at for assistance. Information about how you can get access to HPMS is available here from the CMS site. If you have HPMS access and encounter difficulty accessing your reports, you may email for technical assistance.

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. Data are combined for contracts fielding both the HOS baseline and follow up surveys. If a contract fields 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.

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 very first HOS survey would not have follow up data or outcome results until the cohort of data is complete.

Can you explain the “blackout period” for contacting beneficiaries, and what is the suggested timeframe for that period?
The “blackout period” is the eight weeks before and during HOS data collection throughout which health plans should not field other surveys. CMS strongly discourages the fielding of non-CMS surveys during the HOS administration blackout period to prevent burden on Medicare beneficiaries and to prevent a negative effect on response rates and scores.

Available Articles and Technical Reports
In addition to the reports highlighted above, new HOS-related articles and technical reports are continuously added to the HOS website as they become available. We welcome the opportunity to post HOS-related, peer-reviewed articles written by MAOs. Please send the articles to for CMS review and approval. All manuscripts using HOS data must be approved by CMS prior to publication. For a full listing of HOS-related articles in the literature and technical reports, please visit the Resources section of the HOS website.
Medicare HOS Contacts

General Questions about the Medicare HOS:
Contact Medicare HOS Information and Technical Support
Telephone: 1-888-880-0077

Questions about the HOS Program or Policy:
Contact the Centers for Medicare & Medicaid Services at

Medicare HOS website:
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