OASIS C2

1. OASIS C2

2. Objectives • Identify changes to the OASIS question format and minor wording changes • Identify changes to guidance • Outline new questions and guidance associated with completion

3. Minor Wording Changes • Old: Since the previous OASIS • New: Since the most recent SOC/ROC assessment • Align with quality episode

4. Minor Wording Changes Longer Lookback Period

5. Format changes • Enter code box • No change to content • Many questions throughout assessment • Aligns OASIS format with MDS used in SNF July 20 2016 Q&A Question 2: We utilize an electronic medical record. Do the formatting changes added to OASIS-C2 regarding the single box entry need to be presented to the clinicians in the EMR? The end result in the extract is the same. Currently the response options are presented to the clinicians in a list with radio buttons to indication response selection. Is this acceptable? Answer 2: In the development and maintenance of OASIS-C2 Assessment user tools, Vendors are advised to reference the Data Specifications v2.20.0 (http://www.cms.gov/Medicare/Quality-Initiatives- Patient-Assessment-Instruments/OASIS/DataSpecifications.html). While the Data Specifications dictate the Assessment Instrument Items, their applicable time point(s) in the Assessment Instrument, the exact language of the Items, and each Item’s allowable response options, the Data Specifications do not dictate the format of the graphical user interface (GUI) software presentation of the Items in the Assessment Instrument. Per your example, presenting the allowable response options in the format of radio buttons in the GUI software is acceptable, and is left to the user’s discretion, as long as such modification does not impact the accuracy of the item scoring.

6. Format change example OASIS C-1 OASIS C2 Kindred Link

7. Drug Regimen Review Did a complete drug regimen review identify potential clinically significant medication issues?

8. Drug Regimen Review • Renumbering also M2005 (M2004) and M2016 (M2015)

9. Medication Reconciliation Clarified timing of response from MD as midnight of the next calendar day • Includes completion of recommended actions

10. Medication Reconciliation Clarification of Timing

11. Medication Reconciliation Change in wording to indicate HHA completed recommended actions given by physician

12. Medication Reconciliation Clarification in wording indicates that medication reconciliation is expected EACH time clinically significant issues are found – Not just at OASIS time points

13. Dash in Medication Questions • M2001 Medication Regimen Review and M2003 Medication Follow up • Dash allowed • No information available • Item cannot be assessed • Rare occurrence

14. Wound Status • All pressure ulcer questions • Now use of Arabic numbers versus Roman Numerals

15. Pressure Ulcers • Do not reverse stage a pressure ulcer. Consider the ulcer at its worst until healed. • All pressure ulcers can heal • Stage 1 no longer red/non-blanchable • Stage 2,3,4 completely covered in epithelial tissue • Once healed the wound is no longer reported as a pressure ulcer • Previously healed stage 3 or 4 that reopens at the same site is reported at its worst previous stage

16. Pressure Ulcers • Assessing clinician may report a pressure ulcer and stage without physician confirmation per OASIS guidance • Coding conventions require confirmation • Pressure ulcer covered with slough/eschar is not stageable but is observable to assess healing status • A pressure ulcer that has been debrided is still a pressure ulcer • A pressure ulcer that is treated with a muscle flap or skin graft becomes a surgical wound

17. Pressure Ulcers • If any bone, tendon or muscle or joint capsule (Stage 4 structures) is visible, the pressure ulcer should be reported as a Stage 4 pressure ulcer, regardless of the presence or absence of slough and/or eschar in the wound bed.

18. M1306 Unhealed Pressure Ulcer Healed = Closed Unhealed = Open Do not change assessment for an ulcer that increases in numerical stage within the assessment time period (5 day window)

19. M1307 Oldest stage 2 • Enter Response 1 only if the oldest Stage 2 pressure ulcer that is present at discharge was already present as a Stage 2 pressure ulcer when first assessed at the SOC/ROC. • Enter Response 2 if the oldest Stage 2 pressure ulcer that is present at discharge was NOT a Stage 2 pressure ulcer at the most recent SOC/ROC. Then, enter the date that it was identified as a Stage 2. • Do not consider suspected Stage 2 wounds that are currently not observable

20. Wound Status Answer at SOC, ROC, Recert, DC

21. Remember M1308 from OASIS C?

22. M1311 Current Number • If the pressure ulcer was unstageable at SOC/ROC, but becomes numerically stageable later, when completing the Discharge assessment, its “Present on Admission” stage should be considered the stage at which it first becomes numerically stageable. If it subsequently increases in numerical stage, do not report the higher stage ulcer as being “present at SOC/ROC” when completing the Discharge assessment. • If a pressure ulcer that is identified on the SOC date increases in numerical stage (worsens) within the assessment time frame, the initial stage of the pressure ulcer would be reported in M1311 at the SOC

23. M1311 Current Number • Multiple responses for unstagable • Non-removable dressing: Ulcer must be ‘known’ to be present in order to be counted

24. M1313 Worsening in Pressure Ulcer Status Since SOC/ROC • Question wording: • OASIS C1-ICD10 – M1309 Instructions for a – c: For Stage II, III and IV pressure ulcers, report the number that are new or have increased in numerical stage since the most recent SOC/ROC • OASIS C2 – M1313 Instructions for a-c: Indicate the number of current pressure ulcers that were not present or were at a lesser stage at the most recent SOC/ROC. If no current pressure ulcer at a given stage, enter 0.

25. M1313 Notice there are now 3 options for unstageable ulcers

26. M1313 Worsening in Pressure Ulcer • Locate all current Stage 2, 3, 4 and unstageable pressure ulcers. • Review the history of each current pressure ulcer and compare the current stage to the stage of the ulcer at SOC/ROC. • Follow the algorithm to determine if the wound is reportable as new or worsened.

27. M1313 – Algorithm

28. M1313 Worsening in Pressure Ulcer • Dash is available as response • No information available • Item could not be assessed • Possibly when a patient is unexpectedly transferred, discharged or dies before assessment could be completed • Rare occurrence

29. M1340 Surgical Wound • If a pressure ulcer is surgically closed with a flap or graft it is no longer reported as a pressure ulcer. It should be reported as a surgical wound until healed. If the flap or graft fails, it should continue to be considered a surgical wound until healed.

30. Other Guidance Changes

31. M0090 Date Assessment Completed • If the clinician needs to follow-up, off site, with the patient’s family or physician in order to complete an OASIS or non-OASIS portion of the comprehensive assessment, M0090 should reflect the date that last needed information is collected. • If the original assessing clinician gathers additional information during the SOC 5-day assessment time frame that would change a data item response, the M0090 date would be changed to reflect the date the information was gathered and the response change was made.

32. M1017 Diagnoses Requiring Treatment • A diagnosis reported in M1011 – Inpatient Diagnosis may also be reported in M1017 if within the 14 days prior to the SOC/ROC date the condition was • new or exacerbated, • required changes in the treatment regimen • AND the patient was discharged from an inpatient facility where the condition was actively treated.

33. M1046 Influenza Vaccine • Response 8 includes when assessing clinician is unable to determine whether the patient received the influenza vaccination.

34. Day Counting • Last 14 days at discharge • Use M0090 • M0090 date is day 0 and the day immediately prior to M0090 date is day 1 • OASIS items • M1600 • M1710 • M1720

35. M1740 Cognitive Symptoms • Behaviors reported could be identified by a formal diagnosis and/or determined by the assessing clinician to be associated with a significant neurological, developmental, behavioral and/or psychiatric disorder.

36. M1840 Toilet Transferring • In the absence of a toilet in the home, the assessing clinician would need to determine if the patient is able to use a bedside commode (Response 2), or if unable to use a bedside commode, if he is able to use a bedpan/urinal independently (Response 3). If the patient is not able to use the bedside commode or bedpan/urinal as defined in the responses • If such equipment is not present in the home to allow assessment, then Response 4 – totally dependent in toileting would be appropriate.

38. New Questions • M1028 – Active Diagnoses – Comorbidities – Co-existing Conditions • Peripheral vascular disease (PVD) and Peripheralartery disease (PAD) • ICD10 code categories • I70 - fourth digit of 2, 3, 4, 5, 6, 7, 9, • I73 • Diabetes • ICD10 code categories E08, E09, E10, E11, E13

39. NEW M1028 Active Diagnoses • Physician (or other allowed party) confirmed • Direct relationship • To the patient’s current functional, cognitive, mood or behavior status; medical treatments; nurse monitoring; or risk of death at the time of assessment • Do not include resolved diagnoses • Use of dash

40. New Questions • M1060 – Height and Weight • Standard mathematical rounding • < .4 – round down • > .5 – round up • In accordance with company policy and standard of practice • Cannot use: • Patient reported • Weight from another setting • Use of dash if no information is available • Our assessment

41. M1028 Active Diagnoses

42. M1060 Height and Weight

43. NEW GG0170C Mobility

44. MDS MDS is used to assess patients in a SNF

45. GG0170C Mobility • Assessment • Observation • Safe • With or without assistive devices • Performance varies

46. GG0170C Mobility • Discharge goal • Use 6 point scale • Do not use 07, 09 or 88 • In collaboration with patient and caregiver • Can be more or less independent • Use of dash

47. GG0170C Response Options • Enter 06 – Independent, if the patient completes the activity by him/herself with no human assistance • Enter 05 – Setup or clean-up assistance, if the caregiver SETS UP or CLEANS UP; patient completes activity. Caregiver assists only prior to or following the activity, but not during the activity. For example, the patient requires assistance putting on a shoulder sling prior to the transfer, or requires assistance removing the bedding from off his/her lower body to get out of bed. • Enter 04 – Supervision or touching assistance, if the caregiver must provide VERBAL CUES or TOUCHING/ STEADYING assistance as patient completes activity. Assistance may be required throughout the activity or intermittently. For example, the patient requires verbal cueing, coaxing, or general supervision for safety to complete activity; or patient may require only incidental help such as contact guard or steadying assist during the activity.

48. GG0170C Response Options • Enter 03 – Partial/moderate assistance, if the caregiver must provide LESS THAN HALF the effort. Caregiver lifts, holds, or supports trunk or limbs, but provides less than half the effort. • Enter 02 – Substantial/maximal assistance, if the caregiver must provide MORE THAN HALF the effort. Caregiver lifts or holds trunk or limbs and provides more than half the effort. • Enter 01 – Dependent, if the caregiver must provide ALL of the effort. Patient is unable to contribute any of the effort to complete the activity; or the assistance of two or more caregivers is required for the patient to complete the activity.

49. GG0170C Response Options • If the patient does not attempt the activity and a caregiver does not complete the activity for the patient, report the reason the activity was not attempted. • Enter 07 – Patient refused, if the patient refused to complete the activity. • Enter 09 – Not Applicable, if the patient did not perform this activity prior to the current illness, exacerbation, or injury. • Code 88 – Not attempted due to medical condition or safety concerns, if the activity was not attempted due to medical condition or safety concerns. • If no information is available or assessment is not possible for reason other than above, enter a dash (“–“) for 1-SOC/ROC Performance.

50. GG0170C Examples • The patient pushes up from the bed to get himself from a lying to a seated position. The caregiver must provide steadying (touching) as the patient scoots himself to the edge of the bed and lowers his feet onto the floor.