HCFA delays OASIS — but operational issues persist
HCFA delays OASIS — but operational issues persist
Last week, the Health Care Financing Administration backed off its requirement that home health agencies (HHAs) collect data using the controversial Outcome and Assessment Information Set (OASIS). A Special Alert, released April 27, effectively ended debate on the matter by announcing that HCFA has delayed the implementation of all OASIS collection and reporting requirements.
But at least one major operational question still looms: Should HHAs continue collecting these data while HCFA completes the regulation even though the rule itself is on hold?
Some HHAs that have already incorporated the OASIS questions into their comprehensive assessment say they plan to continue doing so, says Mary St. Pierre, director of regulatory affairs at the National Association for Home Care, in Washington, DC.
These HHAs claim that if they don’t use this opportunity to incorporate the OASIS questions into their comprehensive assessment, they’ll have less time to become proficient once the rule does go into effect.
When that might be, HCFA is not yet saying. But most observers believe the agency will take at least several months to address the farther-reaching concerns that Congress and others have about the dimensions of OASIS.
Others argue, however, that there’s little point in using OASIS now, since HCFA may be forced by Congress to eliminate many of the questions included in the current OASIS instrument.
"We are advising our members to continue collecting it," reports Scott Lara, Director of Government Affairs for the Home Care Association of America in Jacksonville, FL. But Lara adds that he believes the chances are good that HCFA will be forced to limit the scope of questions included in the data set. "I honestly don’t expect anything in the next couple of months," he said. "But when they do come back to it, they are going to scale it down."
What is HCFA’s advice? "Given that the instrument was designed to be useful to HHAs to assess and improve the care they furnish, they may wish to use the OASIS instrument for their own purposes," according to the Special Alert.
Linda Watts, Director of Quality Management and Health Information at Allacare in Birmingham, AL, says her company has already integrated the OASIS data into its comprehensive assessment and plans to continue using it. "We were using OASIS to do more than just collect information for the federal government," says Watts. "We were trying to improve our information on the functional health status of our patients over time."
On top of all that, legal questions persist, says Tim Pyles, JD, a partner with the law firm of Powers, Pyles, Sutter & Verville, PC in Washington, DC. For example, if HHAs do collect and submit sensitive mental health information to state agencies while the rule is suspended, are they violating state and federal laws that prohibit the disclosure of this confidential information?
"Just doing this to practice is not a very wise approach unless you really do need it for the patient’s diagnosis and treatment because patients do have rights in this area," warns Pyles. "This is particularly true if the federal government is not requiring you to collect the information and you go ahead and collect it anyway."
Mandatory collection of OASIS data by all Medicare-certified HHAs became effective earlier this year. But last week HCFA conceded that in order for this mandate to be "valid" it must first clear a several more regulatory hurdles including the Paperwork Reduction Act.
In the meantime, HCFA said it is not requiring HHAs to encode and transmit OASIS data and added that HHAs that have not met these requirements to date will not be considered out of compliance.
Confusion over the status of OASIS data collection bubbled to the surface after HCFA announced on April 7 that it had postponed the April 26 date that HHAs were supposed to start transmitting OASIS data to state agencies.
But that confusion reached fever pitch in recent days as various HCFA officials began signaling that the agency realized it had not met all regulatory requirements.
The home care industry has been protesting the size and scope of the OASIS data set for months. It argued that collection of these data should be limited strictly to Medicare patients and that HHAs should be adequately reimbursed for doing so.
Meanwhile, HCFA maintained that it developed OASIS, a hefty 19-page question set that Medicare-certified HHAs were supposed to administer to all patients, because it needed these data to improve the quality of care and ensure consistent payments rates across the country.
However, after the extent of the OASIS collection requirements were splashed across the front-page of The Washington Post in March and Congress began to weigh in against it, the pressure on HCFA started to become unbearable. That story outlined the sensitive nature of the questions patients would be asked such as suicidal tendencies and the status of their personal finances.
The timing could not have been worse for HCFA, as patient privacy legislation continues to gather speed on Capitol Hill.
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