The HRSN Quesionnaire was developed by the Centers for Medicare and Medicaid Services (CMS) for use by the Accountable Health Communities (AHC) in part to determine "if systematically finding and dealing with the health-related social needs of Medicare and Medicaid beneficiaries has any effect on their total health care costs and makes their health outcomes better." Note that unlike most assessment instruments, the HSRN does not have a total score. Although some sections are scored, in a number of the sections, certain possible responses are underlined, while others are not. The selection of any underlined responses indicates that the Patient "might have an unmet health-related social need". To accomodate this, the FHIM sets a score value of 1 for any underlined response, and 0 for the non-underlined responses. Note also that only the "Core Questions" 1-10 are required. Questions 11-26 are optional "Supplemental Questions".