Oasis-e Guidance Manual
Inell Krolick
The 2024 update to the Outcome and Assessment Information Set Version E (OASIS-E) Manual, and the associated Change Table, are available in the Downloads section on the OASIS Users Manuals webpage. There are no changes to the OASIS-E instrument. The changes incorporate guidance into the manual and Q&As from the CMS Quarterly Q&As dated July 2022 through October 2023.
The Centers for Medicare & Medicaid Services (CMS) wants to make clear that with this transition to OASIS-E, there is no need for the use of artificial M0090 dates. All assessments with a M0090 - Date Assessment Completed on or before December 31, 2022, including the last 5 days of 2022 must be completed with OASIS-D1. This is true even when the first day of the new certification period is on or after January 1, 2023.
The final OASIS-E instrument, effective January 1, 2023, is available in the Downloads section on the OASIS Data Sets webpage. A log of changes from the draft to final instrument and Manual is also available in the Downloads section on the OASIS Users Manuals page.
The Centers for Medicare and Medicaid Services (CMS) recently posted the draft guidance manual for the Outcome and Assessment Information Set (OASIS)-E version of the OASIS data set for certified home health agencies (CHHAs). The manual is effective Jan. 1, 2023. Members can access the manual in the Downloads section of the OASIS User Manuals webpage. The updated draft OASIS-E All Items Instrument is now available on the OASIS Data Sets webpage.
We keep saying it, the only constant is change. With CMS, if something stayed the same for too long, we'd worry. In 2023, CMS will begin to use OASIS E. We wrote about how many new items there were on OASIS E. You can read that here. In this blog, we'll highlight some of the new items and go a little more in depth with some of them. There's a few new ones and some really new concepts from previous versions of OASIS. There will certainly be a learning curve to understand some of the new items.
We always urge readers to use us as a resource and not THE source for OASIS. CMS has a lot of great information about OASIS E. Here are some helpful links for OASIS. OASIS E PDF OASIS E Guidance Manual One of our most popular articles is called OASIS Documentation for Dummies. You can read that here.
CMS uses OASIS data to track certain data. Remember, OASIS stands for Outcome and Assessment Information Set. Literally, we're providing CMS (Medicare and Medicaid) with information so it can best administer its programs. Therefore, it is imperative that we provide the most accurate information possible so that CMS has the best chance to make the best policies and decisions. We always say "Data drives decisions. Good Data Drives Great Decisions." It is especially important here.
OASIS E has several new items. 27 to be exact. However, many of the changes are simply removing an older question and replacing it with either one or more related questions but getting more information, or highlight interest in a different area. A perfect example of this is on M1040 (Race/Ethnicity). This question is removed in OASIS E, but replaced with three new questions and a 4th closely related. Those are A1005 (Ethnicity), A1010 (Race), and A1110 (Language). A1250 (Transportation) is also new. This is looking to see how transportation has impacted a patient's ability to receive care. Per OASIS Guidance Manual A1250 "Access to transportation for ongoing health care and medication access needs is essential to effective care management. Understanding patient transportation needs can help organizations assess barriers to care and facilitate connections with available community resources."
Ensuring Continuity of care is essential. These new items are related. CMS wants to ensure that reconciled medication lists are provided to the subsequent provider (because of discharge or transfer) and the patient (or family). Also, important is understanding HOW this was done. Special note: If a patient is not taking medication, this must be documented, but coded as 1.
This is a new question. CMS has asked about Vision for some time, it is only rational to think that collecting hearing data is equally important to determine safety in the home. Also, many patients can pretend to hear and understand instruction and teaching. Documenting hearing status will be helpful and paint a more accurate picture of the patient. Specific guidance from CMS regarding patients who may have cognitive impairment or other issues. "Patients who are unable to respond to a standard hearing assessment due to cognitive impairment will require alternate assessment methods. The patient can be observed in their normal environment. Do they respond (e.g., turn their head) when a noise is made at a normal level? Does the patient seem to respond only to specific noise in a quiet environment? Assess whether the patient responds only to loud noise or do they not respond at all."
CMS removed M1200 from OASIS D1. CMS is still interested in that information. M1200 only allowed for 3 responses. Now, B1000 allows for 5 responses. Also, B1000 mentions the ability to see in adequate light. One thing to think about is if the patient lives in a place with adequate light at all. Many patients live in older homes or apartments without many lights or windows. Further, M1200 had three choices. B1000 now has 5. This will give more accurate information. From the guidance manual: "Some patients have never learned to read or are unable to read English. In such cases, ask the patient to read numbers, such as dates or page numbers, or to name items in small pictures. Be sure to display this information in two sizes (equivalent to regular and large print)."
This is a new question. We believe it is also very helpful because many people don't speak medical terminology. It can be easy to assume that the patient same level of knowledge and training as our clinicians. We can speak fast that makes things over their head. I have to regularly go help a friend of mine read and understand medications, medical instructions, and sometimes even explain what the definition of a problem they're having is. Some doctors don't spend adequate time explaining, or perhaps a patient may have forgot what the doctor said. I know I have. CMS says "Poor health literacy is linked to lower levels of knowledge of health, worse outcomes, and the receipt of fewer preventive services, higher medical costs and rates of emergency department use." Be aware that cognitive function should be taken into consideration for this question.
This seems self-explanatory. BIMS stands for Brief Interview for Mental Status. This is a structured cognitive interview. CMS says, "A structured cognitive test is more accurate and reliable than observation alone for observing cognitive performance." This question determines if a BIMS should be conducted. Most people should have an interview. If the response is response 0 (No), then skip the BIMS items. This response should be "if the interview should not be conducted because the patient is rarely/never understood; cannot respond verbally, in writing, or using another method; or an interpreter is needed but not available." The BIMS should be attempted for all patients per CMS.
The clinician should wait about 30 seconds for a response. Some responses may be nonsensical. The guidance manual is very helpful to understand the BIMS. That can be found in Section C. Clinicians should read through this to be familiar with the process. There are contingencies to do the BIMS in written form as well.
This section details how the interview should be handled. It also is very clear that it shouldn't be changed. Use the same approach, as outlined, every time. This makes for more consistent score and assessment. The interview is conducted by having the clinician say "I am going to say three words for you to remember. Please repeat the words after I have said all three. The words are: Sock, blue, and bed. Now tell me those three words." The clinician then records the number of words repeated after the first attempt. (0,1,2,3) After the first attempt repeat the words using cues "sock, something to wear; blue, a color; bed, a piece of furniture. The clinician may repeat the words up to two more times.
The clinician will say "Please tell me what year it is right now." The answers are from 0-3. 0 is off by 5 or more years, 1 is missed by 2-5 years, 2 is missed by 1 year, and 3 is correct. The clinician will then ask "What month are we in right now?" the available responses are: 0-2. 0 means missed by greater than 1 month. 1 is Missed by 6 days to 1 month, 2 is Accurate within 5 days. The clinician will then ask "What day of the week is today?" 0, is incorrect or no answer, and 1 is correct.
The clinician will ask the patient "Let's go back to an earlier question. What were those three words that I asked you to repeat?" If the patient is unable the patient will give a clue, something to wear, a color, a piece of furniture. part A: is patient able to recall sock, 0-2. 0 unable to recall, 1- Yes, able to recall with cue, 2- Yes, no clue required. This is repeated with the words blue and bed. The clue or approach is the same with or without prompts.
The clinician will total up the scores from the previous 4 questions. If a patient refuses to answer, the clinician should mark the answer as incorrect. "The BIMS total score is highly correlated with Mini-Mental State Exam (MMSE; Folstein, Folstein, & McHugh, 1975) scores. Scores from a carefully conducted BIMS assessment where patients can hear all questions and the patient is not delirious suggest the following distributions:
The clinician will then add up all the responses from column 2 into a total score. This can be tracked over time and is important for determining mental health or change in mental health status. In addition, PHQ-2 to 9 Total Severity Score can be used to track changes in severity over time.
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