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OASIS-B1 (12/2002) Data Set - Approved Final Version

The Centers for Medicare & Medicaid Services (CMS) announces the approval by the Office of Management and Budget (OMB) of the proposed changes to the reduced burden OASIS in response to the Department of Health and Human Services department-wide initiative to reduce regulatory burden in healthcare.

CMS has removed the following items from the OASIS instrument:

• (M0160) Financial Factors, (M0310) Structural Barriers, (M0320) Safety Hazards, (M0330) Sanitation Hazards, (M0600) Patient Behaviors.
• We have removed 18 demographic items to a Patient Tracking Sheet to be completed at the Start of Care assessment and updated only when needed.
• Two assessments will no longer be required, reason for assessment 2 - Start of care with no further visits planned, and reason for assessment 10 - Discharge- no further visits after start of care.
• One new OASIS item (M0245) is added to facilitate compliance with the Health Insurance Portability and Accountability Act effective October 1, 2003.

Since the reason for assessment 2 -Start of care with no further visits planned has been eliminated, agencies should follow these recommendations if a patient needs only one visit in the episode. According to the Condition of Participation at 42 CFR 484.55, each patient must receive a comprehensive assessment. However, in this case, the agency is not required to collect the OASIS items and the agency is not required to encode or submit that assessment. This assessment can be placed in the clinical record for documentation and planning purposes. A discharge assessment is no longer required for one-visit episodes.

If the home health agency has a Medicare fee-for-service patient and expects to receive payment for the single visit, agencies must follow the PPS payment rules. This means, that for payment for Medicare fee-for-service patients, you must encode and submit reason for assessment 1 for patients with one-time only no further visits planned episodes.

Since we have eliminated reason for assessment 10 - Discharge - no further visits after start of care, there is now no discharge indicator for the patient who had only one visit, is no longer with from the agency, and there is no possibility of completing a discharge assessment. If there is only one visit made and the patient is no longer available, no discharge assessments are required.

Details are found in the Survey & Certification letter published August 8, 2002 (S&C-02-41) found at: http://www.cms.hhs.gov/medicaid/ltcsp/ltcmemos.asp. and the November 22, 2002 satellite broadcast available at: http://cms.internetstreaming.com.

OASIS-B1 (12/2002) Data Sets

Below are the files that make up the reduced burden OASIS in zipped Microsoft Word format, to allow agencies to cut and paste into their comprehensive assessment records, and in read-only (PDF) format. PFD files require the use of Acrobat Reader in order to view those files. Click on each file to view them.

• pts.zip (7K) or pts.pdf PDF 73K - Patient Tracking Sheet - Required for start of care (RFA1).
• SOC.zip (32K) or SOC.pdf PDF 478K - Start of Care and Resumption of Care items (RFA 1 and 3)
• FU.zip (18K) or FU.pdf PDF 241K - Follow-up items (RFA 4 and 5)
• xfr.zip (10K) or xfr.pdf PDF 116K - Transfer to inpatient facility items (RFA 6 and 7)
• DC.zip (29K) or DC.pdf PDF 413K - Discharge items (RFA 8 and 9)
• All.zip (33K) or All.pdf PDF 543K - Master document with all required items and all timepoints

HHAs have the option of either modifying their existing assessment forms to include only the reduced OASIS instrument (plus all other agency-determined components of the follow-up comprehensive assessment) or of retaining their current assessment forms (OASIS-B1 (8/2000). This change applies only to the specific OASIS items required to be collected, encoded, and submitted. Use of a new reduced OASIS assessment form is completely optional. HHAs may incorporate the changes effective December 16, 2002 or may choose to wait until October 1, 2003, when M0245 will be required. Once the reduced OASIS is implemented, if an agency continues to encode and submit the entire OASIS for the time points that do not require the entire OASIS, the extra items (that are not on the reduced form) will be ignored and will not be stored in the state database. No errors or warnings will occur. If vendor software is not updated before implementation on Dec 16, 2002, then no HHA submission problems will result.

Please note that the new reduced OASIS-B1 (12/2002) applies only to OASIS completed on Dec 16, 2002 and later.

OASIS B-1 (8/2000) Final Version

Effective no later than October 1, 2000, the OASIS B-1 (8/2000) is the version to be used by all home health agencies for collecting and reporting OASIS data. No additional changes have been made to the OASIS B-1 (8/2000) draft version previously posted at this site. Beginning September 1, 2000, agencies billing Medicare for the treatment of Medicare patients must use the OASIS B-1 (8/2000) version for the phase-in and continued implementation of the home health prospective payment system.

1. OASIS B-1 (8/2000) Data Set Files in Read-Only and Microsoft Word Formats

*Below are the files that make up the OASIS B-1 (8/2000) data sets in read-only format. They require the use of the Acrobat Reader in order to review them.

• soc-x.pdf - Start of Care and Resumption of Care items.
• fu-x.pdf - Follow-up items.
• xfr-x.pdf - Transfer to inpatient facility items.
• dc-x.pdf - Discharge items.

Download the zipped executable file, (0715oasx.zip), containing the above 4 files. (This file has been updated to reflect a slight change in the discharge (dc-x.doc) assessment in the top section of page one that says, "Items to be used at this timepoint." The rest of the document is identical.)

*Below are the files that make up the OASIS B-1 (8/2000) data sets in Microsoft Word 97 format. In this format, agencies may cut and paste the changes into their existing assessment tools.

soc-x.zip - Start of Care and Resumption of Care items. This document contains the full text of OASIS items that are expected to be incorporated into the comprehensive assessment to be completed at start of care, or upon resumption of care following an inpatient stay.

fu-x.zip - Follow-up items. This document contains the full text of OASIS items that are expected to be incorporated into the comprehensive assessment to be completed at the time of recertification (or other follow-up).

xfr-x.zip - Transfer to inpatient facility items. This document contains the full text of OASIS items that are expected to be completed when a home care patient is transferred to an inpatient facility for 24 hours or more, regardless of whether the patient is discharged form the home care agency at that time. This document is provided for those agencies electing to use a separate form for transfers to an inpatient facility. For agencies that elect to use a single form for all transfers and/or discharges, these items can be found in the discharge items document below (dc-x.doc).

dc-x.zip - Discharge items. This document contains the full text of OASIS items that are expected to be incorporated into the comprehensive assessment to be completed at the time of discharge from home care or transfer to an inpatient facility. If an agency elects to use a separate form for transfer to an inpatient facility and to use a discharge form only for discharges that do no involve such a transfer, then selected items (M0890 and M0900) may be omitted from the discharge form.

2. OASIS B-1 (8/2000) Data Set Files with Changes Highlighted

Below are the files that make up the OASIS B-1 (8/2000) data sets with new language highlighted in red and deleted language highlighted in blue for ease in locating changes you may need to make to your existing comprehensive assessment tools.

• Soc-rdln.zip
• Fu-rdln2.zip
• Xfr-rdln.zip
• Dc-rdln2.zip

3. Additional files

In addition to those listed above, we are providing the following files:

hhb1pro.pdf - Background information on the purpose of OASIS, its history, and the use of OASIS in the context of outcome-based quality improvement. (PDF - 30K)

oascomp2.pdf - Comparison between start of care, follow-up, transfer, and discharge versions of OASIS B-1 (10/98) versus OASIS B-1 (8/2000). The purpose of this document is to provide agencies and vendors an easy way to update their forms and/or software to accommodate these changes. (This file has been updated to reflect a slight change in the discharge assessment, "Items to be used at this timepoint," on page one, right column. The rest of the document is identical.) (PDF - 176K)

For a full discussion on how OASIS items should be incorporated into assessment forms, please refer to the OASIS Implementation Manual, Chapter 7, and Appendix D, as well as sample clinical records in Appendix C.

Several general principles for integration of OASIS items must be followed when you integrate these into your comprehensive assessment. These include:

• Items in the revised clinical documentation must be exact duplicates of the OASIS items.
• All OASIS items which are appropriate for the time point must be included in the assessment documentation, though their sequence may be altered.
• Unique OASIS identification markers (M00 numbers) should be retained.
• "Skip" patterns must be carefully observed.
• The item wording variations between specific time points must be observed.
• Documentation for all disciplines who are able to complete the comprehensive assessment must follow OASIS integration guidelines.

Sample Clinical Records Incorporating the OASIS B-1 (8/2000) Data Set

The file clinreco.zip contains five sample assessment forms which incorporate the OASIS B-1 (8/2000) data items into the home health agency clinical record. They are intended to replace the sample assessment forms currently in Appendix C of the OASIS Implementation Manual (the first part of the 3-part OASIS User’s Manual). They are not official HCFA forms. Each home health agency is expected to integrate OASIS items into its comprehensive assessment form, but no specific comprehensive assessment form has been mandated or sanctioned. These forms are provided as examples of OASIS integration into clinical documentation. Once executed, the following sample assessments are available:

AS-SOC.pdf – Start of Care
AS-FU.pdf – Follow-up
AS-XFR.pdf – Transfer to Inpatient Facility
AS-DC.pdf - Discharge
AS-DH.pdf – Death at Home

The Center for Health Services Research, Denver, Colorado, developed the OASIS data set for CMS. We have recently had questions regarding permission to use the data set and are now posting the Center's permission for its use. We reproduce the body of the permission notification below and also make the document (with signatures) available at b1permit.pdf (PDF - 18K).

"RIGHT TO COPY, REPRINT, AND USE OASIS"

The Outcome and ASsessment Information Set (OASIS) is the intellectual property of the Center for Health Services Research, Denver, Colorado, and may not be copyrighted by any other party. It is our intent to permit the free use of OASIS by home care providers and related organizations, businesses, and individuals, to be incorporated into patient or client assessment forms or software. To this end we grant all such organizations or individuals the nonexclusive right to copy or reprint the contents of the OASIS and to incorporate OASIS items into printed forms, software, or other products. No royalty or use fee is required, but acknowledgment of authorship is expected *."

* "Sample acknowledgment: The Outcome and ASsessment Information Set (OASIS) is the intellectual property of the Center for Health Services Research, Denver, Colorado. It is used with permission.' "

The document is signed by the three OASIS principals.