The Outcome and Assessment Information Set (OASIS) is a group of standard data elements developed, tested, and refined over the past two decades. The OASIS items have been raised several times since 1999 to address the burden of data collection, refine items for payment algorithms, and enhance outcome reporting. The information below are excerpts of pertinent information from the OASIS-C Manual. Please refer to the OASIS-C Manual for complete information.
What’s New About the OASIS-C Numbering System.
The OASIS-C represents the most comprehensive revision to OASIS since its original release in 1999. Please note that, with the exception of the tracking items and M0903/M0906, the OASIS-C items have been renumbered; thus the OASIS-B1 M0 item numbers do not correspond to the new OASIS-C numbering scheme.
Table 1: OASIS-C Numbering System.
Patient Tracking Items M0010 – M0069; M0140 – M0150
Clinical RecordsM0080 – M0110
Patient History Diagnoses -M1000s
Living Arrangements-M1100
Sensory Status-M1200s
Integumentary Status-M1300s
Respiratory Status-M1400s
Cardiac Status-M1500s
Elimination Status-M1600s
Neuro/Emotional Behavioral Status -M1700s
ADLs/IADLs-M1800s + M1900s
Medications-M2000s
Care Management-M2100s
Therapy Need and Plan of Care-M2200s
Emergent Care-M2300s
Date Collected at Transfer/Discharge -M2400s, M0903 + M0906
The Outcome and Assessment Information Set (OASIS) is a group of standard data elements developed, tested, and refined over the past two decades. The OASIS items have been raised several times since 1999 to address the burden of data collection, refine items for payment algorithms, and enhance outcome reporting. The information below are excerpts of pertinent information from the OASIS-C Manual. Please refer to the OASIS-C Manual for complete information.
Time Points
OASIS-C data are collected at the following time points:
Start of Care
Resumption of Care following inpatient facility stay
Recertification within the last five days of each 60-day recertification period
Other Follow-Up
Transfer to inpatient facility
Discharge from home care
Death at home
All of these assessments, with the exception of transfer to inpatient facility and death at home, must be conducted during a home visit because all require the clinician to have an in-person encounter with the patient. The transfer to an inpatient facility requires collection of limited OASIS data (most of which may be obtained through a telephone call).
At the start of care time point, the comprehensive assessment should be completed within five days of the start of care date. At the resumption of care, the comprehensive assessment must be completed within 48 hours of inpatient facility discharge. For the transfer to inpatient facility, discharge from home care, death at home, and other follow-up, the assessments must be completed within 48 hours of becoming aware of the transfer, discharge, death, or significant change in condition.
The Outcome and Assessment Information Set (OASIS) is a group of standard data elements developed, tested, and refined over the past two decades. The OASIS items have been raised several times since 1999 to address the burden of data collection, refine items for payment algorithms, and enhance outcome reporting. The information below are excerpts of pertinent information from the OASIS-C Manual. Please refer to the OASIS-C Manual for complete information.
Who completes OASIS-C?
As identified in (M0080) Discipline of Person Completing Assessment, the comprehensive assessment and OASIS data collection should be conducted by a registered nurse (RN) or any of the therapies (PT, SLP/ST, OT). An LPN/LVN, PTA, OTA, MSW, or Aide may not complete OASIS assessments.
In cases involving nursing, the RN completes the comprehensive assessment at SOC. Any discipline qualified to perform assessments – RN, PT, SLP, OT – may complete subsequent assessments. For a therapy-only case, the therapist usually conducts the comprehensive assessment. It is acceptable for a PT of SLP to conduct and complete the comprehensive assessment at SOC. An OT may conduct and complete the assessment when the need for occupational therapy establishes program eligibility. Note: Occupational therapy alone does not establish for the Medicare home health benefit at the start of care; however, occupational therapy may establish eligibility under other programs, such as Medicaid. The Medicare home health patient who is receiving services from multiple disciplines (i.e., skilled nursing, physical therapy, and occupational therapy) during the episode of care, can retain eligibility if, over time, occupational therapy is only remaining skilled discipline providing care. At that time, an OT can conduct OASIS assessments.
The Outcome and Assessment Information Set (OASIS) is a group of standard data elements developed, tested, and refined over the past two decades. The OASIS items have been raised several times since 1999 to address the burden of data collection, refine items for payment algorithms, and enhance outcome reporting. The information below are excerpts of pertinent information from the OASIS-C Manual. Please refer to the OASIS-C Manual for complete information.
Section 484.20(a) Standard: Encoding OASIS Data
Once the comprehensive assessment has been completed and OASIS data collected, HHAs enter the OASIS information into the computer system, which we call “encoding.” All the time points of the OASIS assessments have a uniform time frame of thirty days from the date the assessment is completed. (M0090 – Date Assessment Completed) for encoding and submitting data. Once the OASIS data are encoded (in software available from CMS or other software that conforms to the CMS standard electronic record layout, edit specifications, and data dictionary), the agency will review each assessment and edit it for transmission to the State Agency. During this preparation period, the HHA must run software application that subjects each patient data set to the CMS edit specifications and makes it transmission –ready. The agency must correct any information that does not pass the CMS specified edits (e.g., data is missing, incorrect, or inconsistent). Staff entering data may need to contact the qualified clinician who assessed the patient for assistance and clinical notes, which document the assessment, are better at a point in time closer to the assessment activity than if the edits and corrections are delayed.
HHAs have flexibility in the method used to encode their data. Data can be encoded directly by the skilled professional who conducts the assessment into a laptop or hand held computer, by a clerical staff member from a hard copy of the completed assessment, or by a data entry operator or service with whom the HHA may contract to enter the data. Any of these acceptable methods of meeting the regulatory reporting requirements for OASIS. However, the HHA is ultimately responsible for meeting the reporting requirements as well as maintaining patient confidentiality.
Non-clinical staff may not assess patients or complete assessment items; however, clerical staff or data entry operators may enter into the computer the OASIS data collected by the skilled professional. In entering the data, HHAs must comply with all requirements for safeguarding the confidentiality of protected health (patient-identifiable) information.
Once the OASIS data are encoded, HHAs use their software to review and edit the data prior to transmission to the State Agency. When editing the data prior to the transmission, it is important to remember that the edits include an electronic safety net to preclude the transmission of erroneous or inconsistent information and enforce he required formatting for the data set items. When transmitted, the patient assessment data are stabilized at the time point of the assessment, preventing the override of current assessment information with future or past information.
The Outcome and Assessment Information Set (OASIS) is a group of standard data elements developed, tested, and refined over the past two decades. The OASIS items have been raised several times since 1999 to address the burden of data collection, refine items for payment algorithms, and enhance outcome reporting. The information below are excerpts of pertinent information from the OASIS-C Manual. Please refer to the OASIS-C Manual for complete information.
Section 484.20(b) Standard: Accuracy of Encoded OASIS Data
The encoded OASIS data must accurately reflect the patient’s status at the time the information is collected. Before transmission, the HHA must ensure that data items on its own clinical record match the encoded data that are sent to the State. We expect that once the qualified skilled professional completes the assessment, the HHA will develop a means to ensure that the OASIS data input into the computer and transmitted to the State Agency (or CMS contractor) exactly reflect the data collected by the skilled professional. Appendix B contains recommendations for conducting data quality audits on a routine basis and includes information from the original OASIS Implementation Manual (Chapter 12). In addition, the State survey process for HHAs may include review of OASIS data collected versus data encoded and transmitted to the State.
The Outcome and Assessment Information Set (OASIS) is a group of standard data elements developed, tested, and refined over the past two decades. The OASIS items have been raised several times since 1999 to address the burden of data collection, refine items for payment algorithms, and enhance outcome reporting. The information below are excerpts of pertinent information from the OASIS-C Manual. Please refer to the OASIS-C Manual for complete information.
Section 484.20(c) Standard: Transmittal of OASIS Data
The encoded OASIS data must accurately reflect the patient’s status at the time the information is collected. Before transmission, the HHA must ensure that data items on its own clinical record match the encoded data that are sent to the State. We expect that once the qualified skilled professional completes the assessment, the HHA will develop a means to ensure that the OASIS data input into the computer and transmitted to the State Agency (or CMS contractor) exactly reflect the data collected by the skilled professional. Appendix B contains recommendations for conducting data quality audits on a routine basis and includes information from the original OASIS Implementation Manual (Chapter 12). In addition, the State survey process for HHAs may include review of OASIS data collected versus data encoded and transmitted to the State.
CMS requires that the HHA electronically transmit the accurate, completed, and encoded OASIS data to the State Agency (or CMS contractor) within 30 days of the completion of the assessment (M0090 Date Assessment Completed). Data must be transmitted in a format that meets the requirements specified in the data format standard (i.e., conforming to the CMS standard electronic record layouts, edit specifications, and data dictionary). CMS believes that this time frame for transmitting the data will minimize the burden on the HHA associated with frequency of transmission, maintain uniform assessment reporting time frames, and maintain a clear reporting time frame that eliminates the variation of days in a month. Therefore, HHAs are free to develop schedules for transmitting the data that best suit their needs. HHAs must use CMS-specified electronic communications protocols to contact the State Agency or CMS contractor, transmit the export file, and receive validation information. HHAs required to submit OASIS data must do so using browser software to access the State system via the Medicare Data Communications Network, which provides a direct telephone connection for submission and interim reports. Once transmitted, the State Agency or CMS contractor validates the information while the HHA remains on-line to ensure that some basic elements such as format and HHA information conform to CMS requirements. Once these file checks are completed, a message indicating whether the file has been accepted or rejected is sent back to the HHA’s terminal and appears on its computer screen and is reported on the initial validation report displaying all Fatal File and Warning messages in relation to the submission file as a whole. If the submission passes the initial validation check, each individual record is then checked for errors or exceptions to the data specifications, and a Final Validation Report is generated. If the individual record is rejected, a message is sent to the HHA along with the rejected submission file for correction. A file or individual record may be rejected for a variety of reasons, (e.g., the provider identification name or number submitted may be incorrect, the number of records indicated in the trailer record does not match the actual number of records submitted). The HHA must make the corrections and resubmit the file to the State.
The Outcome and Assessment Information Set (OASIS) is a group of standard data elements developed, tested, and refined over the past two decades. The OASIS items have been raised several times since 1999 to address the burden of data collection, refine items for payment algorithms, and enhance outcome reporting. The information below are excerpts of pertinent information from the OASIS-C Manual. Please refer to the OASIS-C Manual for complete information.
Condition of Participation: Comprehensive Assessment of Patients
42 CFR 484.55 requires that a patient receive from the HHA a patient-specific, comprehensive assessment that accurately reflects the patient’s current health status and includes information that may be used to demonstrate the patient’s progress toward achievement of desired outcomes. The comprehensive assessment must (1) identify the patient’s continuing need for home care; (2) meet the patient’s medical, nursing, rehabilitative, social, and discharge planning needs; and (3) for Medicare patients, identify eligibility for the home health benefit, including the patient’s homebound status. The comprehensive assessment must also incorporate the exact use of the current version of the OASIS data set, which is found on the CMS OASIS web site at HYPERLINK http://www.cms.hhs.Qov/oasis; http://www.cms.hhs.Qov/oasis; click on “Data Set.” A comprehensive assessment identifies patient progress toward desired outcomes or goals of the care plan.
CMS expects that HHAs will collect OASIS data in the context of a comprehensive assessment on adult Medicare or Medicaid patients (age 18 or over) receiving skilled health services from the HHA, except for patients receiving care for pre- and post-partum conditions. Patients receiving skilled health services, whose care is reimbursed by other than Medicare or Medicaid, must receive comprehensive assessments, but the collection of OASIS data is not required. For patients receiving only personal care services, regardless of payer source, a comprehensive assessment is also required, but not the collection of OASIS data. Patients who receive poly services such as homemaker, chore, or companion services do not require the comprehensive assessment.
The Outcome and Assessment Information Set (OASIS) is a group of standard data elements developed, tested, and refined over the past two decades. The OASIS items have been raised several times since 1999 to address the burden of data collection, refine items for payment algorithms, and enhance outcome reporting. The information below are excerpts of pertinent information from the OASIS-C Manual. Please refer to the OASIS-C Manual for complete information.
Five standards are contained in the Comprehensive Assessment CoP.
Following are the requirements for each standard.
a. §484.55 Standard: Initial Assessment Visit
The initial visit is performed to determine the immediate care and support needs of the patient. This visit is conducted within 48 hours of referral or within 48 hours of a patient’s return home from an inpatient stay, or on the physician-ordered start of care date. The initial assessment visit is intended to ensure that the patient’s most critical needs for home care services are identified and met in a timely fashion. For Medicare patients, this initial assessment determines eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be conducted by a registered nurse unless rehabilitation therapy services are the only services ordered by the physician. Under the Medicare home health benefit, any one of three services (skilled nursing, physical therapy, or speech-language pathology) can establish program eligibility. If rehabilitation therapy services are the only services ordered by the physician, the initial assessment may be made by the appropriate rehabilitation skilled professional if the need for that service establishes eligibility for the home health benefit. The law governing home health eligibility prevents occupational therapy from establishing eligibility for the Medicare home health benefit at the initial assessment, though once eligibility is established, then continuing occupational therapy could establish eligibility for a subsequent episode (meaning that the occupational therapist could complete the Recertification assessment). If no skilled service is delivered at this initial assessment, this visit will not be considered the SOC nor is it considered a reimbursable visit for the Medicare home health benefit.
Note that for payers other than Medicare, the occupational therapist may complete the initial assessment if the need for occupational therapy establishes program eligibility.
The comprehensive assessment is not required to be completed at the initial assessment visit, although the HHA may choose to do so. If a skilled service is delivered at the initial assessment visit, thus establishing the SOC, the comprehensive assessment may be initiated at this visit and completed within the time frames discussed below, depending on agency policy.
b. §484.55(b) Standard: Completion of the Comprehensive Assessment
The comprehensive assessment must be completed in a timely manner, consistent with the patient’s immediate needs, but no later than five calendar days after the start of care.
This requirement does not preclude an HHA from completing the comprehensive assessment during the SOC visit, and many HHAs currently operate in such a manner. This time frame provides operational flexibility to the HHA while maintaining patient safety in ensuring that all patient needs will be identified within a standard time period. Some HHAs have policies requiring that a nurse conduct the comprehensive assessment. Home care staff should follow agency policies governing which disciplines can complete the comprehensive assessment.
C. §484.55(c) Standard: Drug Regimen Review
Under this requirement, the comprehensive assessment must include a review of all medications the patient is currently using to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects and drug interactions, duplicate drug therapy, and noncompliance with drug therapy.
While patients receive their drug regimen from the physician, review of this regimen is an integral part of the comprehensive assessment. In addition, this review is an important safeguard for patients who may receive medications from a variety of physicians and pharmacies. Some agencies have policies requiring nurses to do the drug regimen review. In addition, some state practice acts may preclude therapists from completing the drug regimen review. Home care staff should follow state regulations and agency polices governing which disciplines can complete the drug regimen review.
d. §484.55(d) Standard: Update of the Comprehensive Assessment
The comprehensive assessment, which includes OASIS items for Medicare and Medicaid patients, must be updated and revised as frequently as the patient’s condition requires, but not less frequently than every 60 days beginning with the start of care date; within 48 hours of the patient’s return home from an inpatient facility stay of 24 hours or more for any reason except diagnostic testing; and at discharge. The update of the comprehensive assessment must include completion of all required OASIS items for that time point, plus any others determined necessary by the HHA for a comprehensive assessment. This assessment provides information for determination of changes in treatment or plan of care. Therefore, a comprehensive assessment also is required when there is a major decline or improvement in a patient’s health status as defined by the HHA.
An inpatient facility admission as an event is generally a predictor of a change in the patient’s health status and therefore should be captured in the OASIS data. In addition, because patients frequently improve rapidly upon returning home from an inpatient facility, it is important for the HHA to assess the patient’s true needs as quickly as possible after discharge from the inpatient facility. Therefore, the comprehensive assessment is required within 48 hours of the patient’s return to the home from an inpatient facility admission of 24 hours or more for any reason other than diagnostic tests.
Follow-up assessments must be completed every 60 days that a patient is under care. For Medicare and Medicaid patients, when a follow-up assessment is due, it must be completed no earlier than four calendar days before, and no later than the day marking the end of the 60-day period (i.e., day 56 through day 60 of the period).
e. §484.55(e) Standard: Incorporation of the OASIS Data Set
OASIS must be incorporated into the HHAs own assessment, exactly as written. Both the language and the groupings of the OASIS items must be maintained. Integrating the OASIS items into the agency’s own assessment system in the sequence presented in the OASIS form would facilitate data entry of the items into data collection and reporting software. However, HHAs may integrate the items in such a way that best Suits the agency’s own assessment.
The OASIS data set is not intended to constitute a complete comprehensive assessment instrument. Rather, the data set comprises items that are a necessary part of a complete comprehensive assessment and that are essential to uniformly and consistently measure patient outcomes. An HHA can use the data set as the foundation for valid and reliable information for patient assessment, care planning, service delivery, and improvement efforts.
The OASIS items are already used in one form or another by virtually all HHAs that conduct thorough assessments, and simply adding the OASIS data set to the rest of the HHA’s paperwork would be burdensome and duplicative. Therefore, we expect HHAs to replace similar assessment items with OASIS items in their assessment forms to avoid lengthening the assessment unnecessarily. This may be accomplished by modification of existing forms or using commercially available comprehensive assessment forms that include OASIS items. The Mxxxx numbers for each OASIS data item should be retained to allow for easy recognition of the required OASIS item in the HHA comprehensive assessments.
