Home Health & Hospice Week

The pandemic is still hitting agencies hard, agencies tell CMS.

Medicare is backtracking on its pledge to hold off the burdensome new OASIS update until after the COVID-19 Public Health Emergency ends, and home health agencies aren’t happy about it.

So say many commenters on the 2022 home health proposed rule. The final rule is expected out very soon.

Recap: Last year, the Centers for Medicare & Medicaid Services bumped OASIS-E from its Jan. 1, 2021 start date to give agencies a break during the COVID-19 PHE. “HHAs will be required to use OASIS-E … beginning with discharges and transfers on January 1st of the year that is at least 1 full calendar year after the end of the COVID-19 PHE,” CMS said in an interim final rule published in the May 8, 2020 Federal Register. When CMS began making noises about OASIS-E training this past spring, a CMS representative assured AAPC in April that the agency planned to stick to that timeline (see HCW by AAPC, Vol. XXX, No. 15).

In the proposed rule, CMS changes its tune. “We are proposing to revise the compliance date” for OASIS-E to “January 1, 2023, which is a two-year delay from this original compliance date finalized in the CY 2020 HH PPS final rule,” CMS notes in the proposed rule published in the July 7 Federal Register. The new date “balances the support that HHAs needed during much of the COVID-19 PHE as CMS provided flexibilities to support HHAs along with the need to collect this important data,” according to the rule.

A chunk of the OASIS-E changes involve adding data collection on Social Determinants of Health including race. “The PHE’s disproportionate impact on minority populations demonstrates the importance of analyzing this impact and the needs for these populations to improve quality of care within HHAs, especially during a public health emergency,” CMS adds in the rule.

“HHAs now have the administrative capacity to attend trainings, train their staff, and work with their vendors to incorporate the updated assessment instrument, the OASIS–E into their operations,” CMS maintains. “Based upon the processes adopted by HHAs … the flexibilities afforded to HHAs since the beginning of the COVID-19 PHE, and the importance of the data to the HH QRP, it would be appropriate to modify the compliance date finalized in IFC–2,” the agency continues.

The majority of agencies and their representatives who touched on this topic in their comment letters do not seem to agree. “Our member hospitals and HHAs continue to be significantly challenged by the ongoing COVID-19 pandemic,” the California Hospital Association’s Megan Howard says in the trade group’s comment letter. “Throughout California, health care providers at all levels are facing a resurgence of COVID-19 cases and hospital admissions. We expect the PHE to continue at least through the end of this calendar year, and likely into 2022,” Howard tells CMS.

“At the same time, we are beginning to understand some of the long-term disruptions caused by the duration of the pandemic, such as significant reductions in workforce,” Howard points out. “As providers strive to meet their communities’ immediate for both COVID-19 and non-COVID-19-related care, their ability to implement new operational requirements will remain limited.”

It’s not like adopting OASIS-E is routine or simple. “Implementing these new measures will require HHAs to dedicate significant resources to educating and training staff to use the updated version of the data set, the OASIS-E version, which CMS recognized when it originally delayed implementation,” Howard stresses.

“In general, we support the inclusion of [Standardized Patient Assessment Data Element] categories but are concerned about the extensive reporting obligation associated with an expanded OASIS-E,” cautions Laura Friend with the West Virginia Council of Home Care Agencies in the trade group’s comment letter. “CMS should consider the overall burden associated with reporting via these mechanisms,” Friend urges.

“Agencies face the significant task of learning new software functionality in addition to the new elements of OASIS-E itself and incorporating all of this into their policies and practices,” details Josh Lamkin with Medical Information Technology Inc. in the vendor’s comment letter. Plus, “significant work is required for software vendors to program for OASIS-E,” Lamkin stresses.

Instead: “We ask that CMS aggressively evaluate the OASIS-E data set and implement a limitation for the maximum number of assessment items that can be included at any given time,” says David Totaro with BAYADA Home Health Care in the chain’s comment letter. Further, “we challenge CMS to re-examine existing regulations that are no longer applicable in the PDGM payment model, specifically the Therapy Reassessment requirement, and begin a targeted approach to eliminate administrative burden and outdated cost-saving methodologies,” Totaro says.

Many asked for the same. “OASIS-E … already contains hundreds of reporting items and sums to 31 pages,” highlights Joanne Cunningham with the Partnership for Quality Home Healthcare in the lobbying group’s letter. “SPADES categories should ultimately be included, but only if CMS moves to remove other elements and diminish the burden faced by providers in managing the OASIS-E,” Cunningham exhorts.

“As a general rule, the Partnership is not opposed to new reporting fields,” Cunningham adds. But “as new elements are added, other items that may be less valid in a patient assessment should be retired to keep the OASIS-E process from expanding, unmanageably, without limitation,” she tells CMS.

More Time, Firm Dates Needed

If CMS decides to go ahead with OASIS-E in January 2023, it should at least give HHAs and their vendors sufficient time to get ready, multiple commenters urge. “We … implore CMS to release the OASIS-E spec as soon as possible in 2021 so all parties can have as much time as possible to prepare,” Lamkin says.

HHAs will have “to dedicate significant resources to educating and training staff to use the updated version of the data set, the OASIS-E version, which CMS recognized when it originally delayed implementation,” Howard observes. Releasing an updated draft of the OASIS-E and associated training education in early 2022 will “not provide sufficient time for HHAs to operationalize the updated OASIS-E, including training staff and working with vendors to incorporate the updated assessment instrument into their operations, while continuing to respond to the ongoing pandemic,” Howard worries.

There are at least some silver linings in forging ahead with OASIS-E, according to nurse and coding and oasis specialist Rhonda Crawford with 31-state chain AccentCare Inc. The specific implementation date “will greatly benefit our training efforts and OASIS-E readiness plans during 2022,” Crawford says in her comment letter.

In fact, Crawford would like to see that specificity expanded. She asks CMS for a specific date for the updated OASIS-E tool, related OASIS-E Guidance Manual, and corresponding OASIS question-and-answer set as well.

“Having authoritative guidance to support a new version of the OASIS dataset is vital to data accuracy,” Crawford emphasizes. “Please make it a priority to publish the OASIS-E Guidance Manual and updated static OASIS Q&A set concurrently with the release of the updated instrument (or as soon afterward, as feasible),” she asks.

Note: The 2022 proposed rule is online at www.govinfo.gov/content/pkg/FR-2021-07-07/pdf/2021-13763.pdf. Draft OASIS-E data specs are online at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/DataSpecifications.