Crosswalk

Crosswalk for Changes to Medicare Health Outcomes Survey
(HOS) Questionnaire (OMB 0938-0701)

Question # on
Current OMB 0938-0701

Type of Change

Rationale for Change

Question 64

Move #64: to follow
current Question #66

Increase ease of completion

Question 65

Add: Skip pattern, from
new Question #65 to
Question #69 if the
beneficiary lives in a
Nursing Home or Other

Increase ease of completion

Question 68

Add: Instruction to
complete both items
(Hours per day and Days
per week)

Increase ease of completion
and reduce missing data

Question 70

Delete: Question 70

Eliminate redundant question

Questions 64, 65,
66, 70, 71, and 72

Renumbering

Necessitated by the relocation
of current Question #64 and the
deletion of current Question #70