This new response option is no mere placeholder.
Industry experts, clinicians, and QA personnel alike have speculated about the proper use of the equal sign (=) as a response option on OASIS-D1 for the 23 items that will become optional at certain timepoints. Until now, there has been little clarification; however, CMS recently responded to an inquiry from Decision Health with a thorough explanation of exactly how and when the symbol should be utilized.
According to CMS, “The changes to the OASIS-D1 data set and data collection guidance are effective for OASIS assessments with an M0090 Date Assessment Completed of January 1, 2020 or later.”
As of that date, data collection at certain timepoints for 23 existing OASIS items will be optional, and HHAs may enter the equal sign for these items at the timepoints only to indicate the clinician and/or agency have chosen not to report the item for that assessment.
The equal sign is not the same as a skip or a dash, and you should be careful not to use it in the same way. Additionally, CMS is allowing agencies to decide whether they will use the equal sign at all.
The items and timepoints in which the equal sign is a valid response are as follows:
Start of Care/Resumption of Care (SOC/ROC)
- M1910 Fall risk Assessment
Transfer (TRN) and Discharge (DC)
- M2401a Intervention Synopsis: Diabetic Foot Care
- M1051 Pneumococcal Vaccine
- M1056 Reason Pneumococcal Vaccine not received
Follow-Up (FU)
- M1021 Primary Diagnosis
- M1023 Other Diagnoses
- M1030 Therapies
- M1200 Vision
- M1242 Frequency of Pain Interfering with Activity
- M1311 Current Number of Unhealed Pressure Ulcers at Each Stage
- M1322 Current Number of Stage 1 Pressure Injuries
- M1324 Stage of Most Problematic Unhealed Pressure Ulcer that is Stageable
- M1330 Does this patient have a Stasis Ulcer
- M1332 Current Number of Stasis Ulcers that are Observable
- M1334 Status of Most Problematic Stasis Ulcer that is Observable
- M1340 Does this patient have a Surgical Wound
- M1342 Status of the Most Problematic Surgical Wound that is Observable
- M1400 Short of Breath
- M1610 Urinary Incontinence or Urinary Catheter Presence
- M1620 Bowel Incontinence Frequency
- M1630 Ostomy for Bowel Elimination
- M2030 Management of Injectable Medications
- M2200 Therapy Need
You can find the CMS memo “OASIS-D1 Update Memorandum_Revised_May 2019” in the downloads section on the Home Health Quality Reporting website here: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/OASIS-D1-Update-Memorandum_Revised_May-2019.pdf.