OASIS Related Definitions

2202.1 - OASIS Related Definitions (Rev. 125, Issued: 10-31-14, Effective: 10-31-14, Implementation: 10-31-14) OASIS – Outcome and Assessment Information Set - Scientifically tested data items developed for the purpose of measuring outcomes (and patient risk factors that affect outcomes) for HHA patients. These data items alone do not constitute a comprehensive assessment; they must be collected as part of the assessment process at various time points during a patient’s admission to an HHA. CMSnet (formerly known as Medicare Data Communications Network-MDCN) - A private communications network CMS purchased to ensure the security of OASIS and Minimum Data Set (MDS) data transmissions to the state. This system replaces the previous process of direct dial-up by public telephone lines to the SA and reflects the latest technology available for securing the privacy of data during transmission. In addition to increased security, another benefit of the CMSnet is that it is provided at no cost to the HHAs. HHAs may also apply for a CMSnet user identification and password for each of their branches for direct transmissions from their branches. Use of the CMSnet allows for all data submitted to the CMS OASIS State System to be encrypted during the transmission process precluding any unauthorized sources from intercepting identifiable data. Similarly, data reports, which are sent by the OASIS State System to the HHA across the CMSnet, are also automatically encrypted and decoded. This network encryption occurs automatically when the HHA uses the CMSnet and requires no special action on the part of the HHA other than using browser software that supports industry standard encryption. Comprehensive Assessment - An assessment of a patient’s condition that accurately and completely reflects the patient’s current health status at the time of the evaluation. This assessment must identify the patient’s continuing need for home care and must meet the patient’s medical, nursing, rehabilitative, social, and discharge planning needs. An HHA must include the collection of specific OASIS data items at specific time points during a patient’s admission as part of its comprehensive assessment process for all adult Medicare and Medicaid patients receiving skilled care unrelated to pregnancy or delivery. The specific OASIS items associated with each assessment time point are summarized in each version of the OASIS data set. The required OASIS data set and its time point related versions include (1) Start of Care (SOC)/Resumption of Care (ROC), (2) Follow-up, (3) Transfer, and (4) Discharge. HHAs must use the most current version of the OASIS. The most current version of OASIS is available on the OASIS Web site. Encode - To enter OASIS data into a computer using the Home Assessment and Validation Entry (HAVEN) software (provided by CMS) or other HAVEN-like software (developed by private vendors). HAVEN-like software must meet CMS’ data and edit specification requirements. Encryption - A system to translate plain text into scrambled code. Encryption offers a higher level of security when electronically transmitting information. The sender “locks” the data before transmitting. The receiver “unlocks” the data upon receipt. HAVEN – Home Assessment and Validation Entry - A software program provided by CMS, free of charge, for use by HHAs to encode their OASIS data and save as electronic files for electronic transmission to the SA. The HAVEN software automatically applies date range and consistency checks according to CMS’ published data specifications, which serve as an electronic safety net to preclude the transmission of erroneous or inconsistent information. Header Record - Contains basic information that identifies the HHA submitting OASIS data, as well as, contact persons and telephone numbers to be used in the event the file is in error. Initial Assessment - The HHA’s first visit to the patient after referral. In the absence of a specified start of care date, the initial visit is the first visit made to the patient within 48 hours of the referral. If the physician specifies a particular start of care date, then the initial visit is the date specified by the physician and includes performance of the skilled care ordered. In accordance with the regulations, the initial visit must be made by a registered nurse except for therapy-only cases, in which the initial assessment visit can be made by a qualified therapist. Incorporate/Integrate - Incorporating/integrating the OASIS data items into an agency’s assessment process means replacing similar questions on the agency’s existing assessment tool with the corresponding OASIS data items. Agencies must merge the OASIS data items into their existing assessment process rather than simply appending them without considering which OASIS items could replace similar items on the agency’s assessment tool. Simply appending the OASIS items adds time to the assessment process and renders it burdensome and duplicative. Since the OASIS items are not intended to constitute a complete comprehensive assessment, agencies should gather other pertinent assessment information not included in the OASIS data items in order to create a comprehensive assessment. Except as required to meet other Federal, State, or accreditation standards, agencies are at liberty to determine what other information they require as part of the comprehensive assessment. Late Assessment - An assessment transmitted after the specific time frames defined in the regulations. 42 CFR 484.20(a) requires the HHA to transmit the assessment within 30 days of completing the assessment. Masking - A term used to describe software that conceals individually identifiable data elements. When required, HHAs will mask these data elements prior to transmission and keep the masked identifiers and the original data in their records. Private Pay assessments are no longer accepted by the State System. If M0150 items 1, 2, 3 and 4 are all equal to ‘0’ unchecked, the state system rejects the record. Any private pay assessment entered into HAVEN will be marked as ‘Complete’ and is excluded from the export process in HAVEN. Outcome - Changes in a patient’s health status between two or more time points. Outcome-Based Quality Improvement (OBQI) - Performance improvement based on outcome measurement and reporting. Outcome-Based Quality Monitoring (OBQM) Reports - The OBQM reports include the agency patient-related characteristics report and potentially avoidable events outcome reports. Overdue OASIS - OASIS assessments not received by the OASIS System within the specific time frames defined by the regulations. (See also Late Assessment.) Process Based Quality Improvement (PBQI) - Evaluating or investigating the use of specific best care processes (such as conducting falls risk assessments or providing drug education) by reviewing the care provided to determine any needed changes in care delivery. Quality Improvement and Evaluation System (QIES) - An online system that supports the CMS mission and initiatives to improve the quality of care for Medicare beneficiaries (Providers: Skilled Nursing Home, Home Health Agencies, as well as State Survey Agencies). (Includes CASPER, MDS, OASIS, RAVEN, HAVEN, and ASPEN). Reason For Assessment (RFA) - Reason for conducting the assessment, e.g., Start of Care (SOC), Resumption of Care (ROC), and Follow-Up found in M0100. Resumption of Care (ROC) – The day that care resumes after an inpatient stay. The HHA must complete an OASIS assessment and obtain the necessary physician change orders reflecting the change in the treatment approach in the patient’s plan of care. The ROC is to be done within 48 hours of the patient’s return home. If the physician’s order requests that the HHA resume care at a point later than 48 hours or if the patient refuses a visit within this 48-hour period, a note to this effect should be documented in the patient’s chart for future reference. Significant Change in Condition (SCIC) - A SCIC is defined as a significant change in the patient’s condition during a 60-day episode that was not envisioned in the original plan of care. While this no longer creates a new case-mix for payment, the HHA must complete an OASIS assessment and obtain the necessary physician change orders reflecting the significant change in the treatment approach in the patient’s plan of care. The SCIC relates to the OASIS data set “other” Follow-Up (RFA5). Start of Care (SOC) – The day care begins after the referral is received. SOC currently relates to the “first billable visit.” The “first billable visit” approach was selected largely because of the Medicare payment requirements and the fact that the first billable visit defines SOC and start of the episode for Medicare purposes. Time Points - Specific times during an episode of care when collection of OASIS data items is required as part of a comprehensive assessment. They are start of care, resumption of care, recertification, follow-up, and transfer to an inpatient facility, death at home, and discharge from agency. Trailer Record - Indicates the end of the submission file. The trailer record includes a count of the total records in the file, including the header and trailer records.