OASIS-D changes are coming at home health agencies (HHAs) fast and furious with a January 1, 2019 implementation date. The main reason for revising OASIS-D is to increase standardization across post-acute care (PAC) settings, and enable calculation of standardized, cross-setting quality measures (QMs), pursuant to the provisions of the IMPACT Act. This standardization involves SPADEs (standardized patient assessment data elements), which are questions and response options that are identical across all four PAC assessment instruments, and include identical standards and definitions.
As we mentioned in our OASIS-D blog in August, several items will be deleted come January. However, in this blog we will focus on the additions, not the deletions. We will provide high level information regarding the new GG items in particular.
Section GG – Functional Abilities and Goals
The intent of assessment item, GG0100, is to deal with the patient’s usual ability regarding everyday activities, prior to the current illness, exacerbation or injury. The time point items are completed at start of care (SOC) and at resumption of care (ROC). The response-specific instructions include interviewing the patient or family members. However, another option is to review the patient’s clinical records describing the patient’s prior functioning as related to everyday activities.
When coding, Codes 1-3 can be used, but there two new codes also:
- Code 8: Unknown, if the patient’s usual ability prior to the current illness, exacerbation or injury is unknown.
- Code 9: Not Applicable, if the activity was not applicable to the patient prior to the current illness, exacerbation or injury.
Also, A dash is a valid response for this item. However, CMS expects the use of a dash as a rare occurrence.
- Coding Tip: If no information about the patient’s ability is available after attempts have been made to interview the patient and/or family members, and after reviewing the patient’s clinical record, then use code 8 – Unknown.
Assessment item, GG0110, identifies the patient’s use of devices and aids immediately prior to the current illness, exacerbation, or injury to align treatment goals. Like GG0100, the time point items are completed at SOC and at ROC. The response-specific instructions include interviewing the patient and/or family members or reviewing the patient’s clinical record describing use of prior devices and aids. When coding, check all devices that apply, which may include a manual wheelchair, a motorized wheelchair and/or scooter, a mechanical lift, a walker, or orthotics/prosthetics. However, if the patient did use any of these listed devices or aids immediately prior to the current illness, exacerbation, or injury, then item Z, none of the above, should be checked. A dash can be a valid response too, but it should be used rarely.
The intent of assessment item, GG0130, is to identify the patient’s ability to perform the listed self-care activities, and discharge goal(s). Unlike the other GG items described above, the time points completed for GG0130 include start of care, resumption of care, follow-up, and discharge from agency – not to an inpatient facility. The response-specific instructions include the preferred method of direct observation, but reviewing reports from the patient, clinicians, care staff, and/or family members is another acceptable option. When possible, CMS advocates a multidisciplinary approach to patient assessment.
- Coding Tip: Assessment item, GG0130B, deals with Oral Hygiene. If a patient does not perform oral hygiene during home visit, then determine the patient’s abilities based on performance of similar activities during the assessment, or on the patient and/or caregiver report.
The final new GG assessment item, GG0170, deals with mobility. It identifies the patient’s ability to perform the listed mobility activities, and discharge goal(s). Similar to GG0130, the time points completed include SOC, ROC, follow-up and discharge from agency – not to an inpatient facility. Also similar to GG0130, response-specific instructions include the preferred method of direct observation, but reviewing reports from the patient, clinicians, care staff, and/or family members is also acceptable.
With the busy schedules of home health staff, it is often difficult for them to find time to review the CMS OASIS Guidance Manual. 5 Star Consultants has a better option for bringing your team up to speed. We offer a pre-recorded webinar on the OASIS-D changes titled “OASIS-D: Be Prepared for New, Detailed Assessment Items”. This session is led by Sharon Litwin, a Senior Managing Partner and Founder of 5 Star Consultants, LLC, and a renowned speaker at state and national conferences. The 90-minute webinar will cover the upcoming changes in detail, making it easy for your team to be informed before the January 1, 2109 effective date. To learn more, please contact us at [email protected] or 866-428-4040.