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Authors: Liz E. Landreth, Clinical Consultant, BSN, RN | Melinda A. Gaboury, CEO

OASIS-D Becomes OASIS-D1 Under PDGM

As a result of the upcoming Patient Driven Groupings Model (PDGM) changes in Medicare Home Health (HH), OASIS-D is now OASIS-D1. 

CMS has announced that the revised OASIS-D1 instruments will be effective January 1, 2020.  Changes to the OASIS-D data set and data collection guidance were finalized in the Calendar Year (CY) 2019 HH Final Rule, CMS 1689-FC.

Since the OASIS-D1 revisions are minor, there will not be an official revised version of the OASIS-D Guidance Manual. The CMS OASIS-D1 UPDATE document, in conjunction with the current OASIS-D Guidance Manual, will serve as OASIS-D1 guidance.

New OASIS-D1 Items

The calculation of the 432 Case-Mix Groupings under the PDGM reflects that the Functional portion of the calculation will include M1800 (Grooming) & M1033 (Risk for Hospitalization).  The current OASIS-D data set does not include these two items on the Follow-Up/Recertification (FU) OASIS. Therefore, the following OASIS items have to be collected at the time of FU prior to the PDGM implementation:

  • M1033: Risk for Hospitalization
  • M1800: Grooming

Optional OASIS-D1 Items

Several OASIS-D1 items are not required in the case-mix calculation under PDGM. As a result, CMS now regards 23 current OASIS items as optional for specific time points.

For OASIS-D1 assessments with an M0090 (Date the Assessment Is Completed) equal to January 1, 2020 or later, HHAs may enter an equal sign (=) for the items. This is a new valid response for select M items for the time points listed below (the items themselves remain unchanged).

Here’s a closer look at the items and time points when they’re optional under OASIS-D1:

Start of Care/Resumption of Care (SOC/ROC)

    • M1910 Fall Risk Assessment

Transfer (TRN) and Discharge (DC)

    • M2401(A) Intervention Synopsis: Diabetic Foot Care
    • M1051 Pneumococcal Vaccine
    • M1056 Reason Pneumococcal Vaccine Not Received

Follow-Up (FU)

    • M1021: Primary Diagnosis
    • M1023: Other Diagnosis
    • M1030: Therapies
    • M1200: Vision
    • M1242: Frequency of Pain Interfering
    • M1311: Current Number of Unhealed Pressure Ulcers at Each Stage
    • M1322: Current Number of Stage 1 Pressure Ulcers
    • M1324: Stage of Most Problematic Unhealed Pressure Ulcer that is Stageable
    • M1330: Does the Patient Have a Stasis Ulcer?
    • M1332: Current Number of Stasis Ulcer(s) That Are Observable
    • M1334: Status of Most Problematic Stasis Ulcer that is Observable
    • M1340: Does the Patient Have a Surgical Wound
    • M1342: Status of Most Problematic Surgical Wound That Is Observable
    • M1400: Short of Breath
    • M1610: Urinary Incontinence or Urinary Catheter Presence
    • M1620: Bowel Incontinence Frequency
    • M1630: Ostomy for Bowel Elimination
    • M2030: Management of Injectable Medications
    • M2200: Therapy Need

The OASIS-D1 Data Sets have been updated to reflect these changes.   

2019-2020 Transition Follow-Up/Recertification Assessments

There are very specific updated instructions for completing and transmitting Follow-Up/Recertification OASIS for patients that will be recertified during the last few days of 2019 and the recertification episode will begin January 1, 2020 and later under the new PDGM.

When the recertification is completed within the last 5 days of 2019, CMS will temporarily waive the requirement that HHAs enter the actual OASIS “Date the Assessment Is Completed” date in M0090. Instead, agencies are required to enter the M0090 date as 1/1/2020. The agency must wait to transmit the OASIS until 1/1/2020, or there will be a fatal error.

Transition Recertification Example:

  • Start of Care date: November 3, 2019
  • Recertification assessment (using OASIS-D1 Follow-Up (RF4)) is completed on December 29, 2019 (the episode is to begin January 2, 2020)
  • Report artificial M0090 date of 1/1/2020
  • Submit the OASIS to the ASAP database 1/1/2020 or later

Staying on top of the OASIS changes and compliance can be a challenge while managing patient care and daily priorities. The HPS Alliance is an exclusive resource that regularly provides participating agencies with essential tools to maintain successful operations.

Looking to enhance reimbursement and optimize operations under PDGM and OASIS-D1? Join us for our two-day home health workshop in Nashville, TN on August 8 – 9, 2019.

The workshop will be two full days of reimbursement education and regulatory updates for home health. August 9 will cover PDGM updates and best practices. Topics will focus on best episode management and process improvement practices, including referral, intake, and scheduling processes to help you more tightly manage care within the shorter 30-day payment period.

There are less than 6 months remaining to prepare for PDGM. It’s crucial for agencies to get ahead of the curve for success under PDGM. Don’t get left behind!

Sign Up for the 2019 Home Care Alliance Workshop