Home Health & Hospice Week

Your plummeting outcomes will be for the greater good, CMS maintains.

Home health providers hoping to see Medicare’s proposal to collect OASIS on all patients disappear were disappointed by the 2023 home health final rule, but they didn’t walk away empty handed.

The Centers for Medicare & Medicaid Services “is ending the temporary suspension of OASIS data collection on non-Medicare/non-Medicaid HHA patients. HHAs will be required to submit all-payer OASIS data for purposes of the HH Quality Reporting Program (QRP),” CMS says in a fact sheet about the rule issued Oct. 31.

However: That requirement will start “with the CY 2027 program year, with two quarters of data required for that program year,” CMS explains. “We are finalizing a phase-in period for January 1, 2025 through June 30, 2025, in which failure to submit the data will not result in a penalty,” the agency adds.

The National Association for Home Care & Hospice “requested that CMS withdraw this proposal due to the burden and cost associated with the collection,” the trade group notes in its rule analysis. “It is particularly concerning with the decrease in payment rates, the learning curve with the new OASIS-E, and the ongoing workforce crisis in home health care,” NAHC points out.

“CMS clarified that the policy would not change the current patient exemptions for OASIS, which are as follows: patients under the age of 18; patients receiving maternity services; and patients receiving only personal care, housekeeping, or chore services,” LeadingAge highlights in its rule analysis. “CMS acknowledges that the collection of the non-Medicare/non-Medicaid OASIS data could change the measure results for HHAs but CMS believes it is in the public interest to collect data on all patients,” the trade group points out.

Many HHAs and their representatives urged CMS in their proposed rule comment letters to drop this idea at a time when HHAs are still struggling with COVID-19, workforce shortages, OASIS-E’s significant changes, inflation, and more (see HHHW, Vol. XXXI, No. 32).

While CMS didn’t ditch the proposal entirely, it wasn’t completely unswayed by those comments. “We have considered the concerns raised by commenters on the burden of this new reporting requirement and, in response to those comments, will delay this requirement until the CY 2027 program year,” CMS says in the rule scheduled for publication in the Nov. 4 Federal Register.

Many agencies already collect OASIS data for all patients, CMS maintains in the rule. And having a process in place for the patients for whom they do collect will make it easier to implement collection for those for whom they currently do not, the agency says in the rule.

HHAs that complained of being handed new burdens while under reduced pay also now have a 0.7 percent increase to fund the initiative, CMS counters.

And CMS keeps OASIS data secure and confidential, which negates any privacy concerns, the agency said.

For those agencies that argued that including non-Medicare and non-Medicaid patients will significantly skew quality data “we acknowledge that the collection of non-Medicare/non-Medicaid OASIS data could change the measure results for HHAs,” CMS says. “However, we believe it is in the public’s best interest, and more representative of the quality of care provided by HHAs, to collect data on all HHA patients. We believe that the collecting and reporting of the quality data will in time improve quality for all patients regardless of payer source.”

Bottom line: “We continue to believe that the collection of all payer OASIS data will provide a more complete and accurate picture of the quality of care furnished by HHAs. We also believe that the collection of all-payer OASIS data will enable us to calculate measure rates in the HH setting that can be more meaningfully compared with rates on those same measures in the LTCH, IRF, and SNF settings,” CMS concludes.