August, 2000

Information Bulletin 00-20
MHC-20

Prospective Payment System

Purpose

The purpose of this informational bulletin is to alert home care providers about information needed for completion of OASIS Start of Care or Follow-Up Assessments for the Home Health Prospective Payment (HHPPS) Start-Up.

When the HHPPS becomes effective on October 1, 2000, home health agencies (HHA) must take certain actions with regard to the collection and reporting of OASIS data for their Medicare beneficiaries in order to be reimbursed under the new payment system.

Medicare patients on service prior to the October 1, 2000 effective date:

If a Medicare beneficiary is under an established Plan of Care before October 1, 2000, and the HHA has completed a Start of Care (SOC) or Follow-Up (FU) OASIS Assessment earlier than September 1, 2000, using the OASIS B-1 (10/98) data set, the HHA must complete a one-time additional FU OASIS assessment using the new OASIS B-1 (8/2000) data set and encode it using the HAVEN 4.0 software (or other HAVEN-like vendor software) any time during the month of September. This is in order to group the beneficiary for purposes of case-mix classification and will serve as the assessment necessary to accommodate the October 1, 2000 effective date for HHPPS, i.e., all SOC and FU assessments completed between September 1 and September 30 will be used to determine the payment category of the first 60-day certification period under PPS. In actuality, during HHPPS start-up only, the first certification period may span up to 90 days. This is a one-time only deviation (grace period) from the required time points for OASIS collection and reporting.

If a beneficiary is under an established Plan Of Care before October 1, 2000, and the HHA has completed a SOC or FU OASIS assessment using the new OASIS B-1 (8/2000) data set and encoded it using the HAVEN 4.0 software (or other HAVEN-like vendor software) on or after September 1, 2000, the HHA may use this assessment for the purpose of PPS start-up.

Follow-up assessments for all Medicare beneficiaries:

For all Medicare beneficiaries with a continued need for services, a FU assessment using OASIS B-1 (8/2000) must be completed during the last five days of the first HHPPS start-up certification period in order to case-mix adjust the patients' assessments for subsequent episode certification. This means that if the HHA determines the continued need for home health services into the subsequent certification period, a FU assessment must be completed during the last 5 days of the current certification period, that is, between November 25 and November 29, 2000, (day 56, 57, 58, 59, and 60 of the initial PPS certification period.) This applies to all Medicare beneficiaries, regardless of the September SOC or FU assessment date.

All new patients after October 1, 2000:

All applicable patients (not just Medicare patients) accepted for care on or after October 1 will be assessed according to the new established time points at 42 CFR 484.55, i.e., a patient whose start of care date is October 15 would be re-assessed for the need to continue services for another certification period during the last 5 days of the current 60-day certification period. In this example, the FU assessment would be conducted between 12/9/00 and 12/13/00.

Effective dates for OASIS Data Specifications, Data Set, HAVEN, and Home Health Resource Grouper (HHRG)

Until September 30

The OASIS B-1 (10/98) data set, which incorporates Data Specifications version 1.04 - Revision 1 and the encoding software, HAVEN 3.0, may be used for all OASIS assessments completed (date completed = the M0090 date) through September 30, 2000. The Home Health Resource Grouper (HHRG) that determines the case-mix from the OASIS assessment is not included in these specifications. The OASIS State-based system will accept assessment records completed through September 30, 2000 using the OASIS B-1 (10/98) data set and HAVEN 3.0 software.

On or after October 1

HHAs must use the new OASIS B-1 (8/2000) data set and the HAVEN 4.0 encoding software (or other HAVEN-like vendor software) for all patient assessments; not just Medicare beneficiaries. Any assessments completed (date completed = the M0090 date) after September 30, 2000, not using the new data set and software will be rejected by the State system.

The new OASIS B-1 (8/2000) data set, which incorporates Data Specifications 1.10 - Revision 1, and the encoding software HAVEN 4.0 (that includes the HHRG), may be used for all OASIS assessments beginning September 1, 2000, during the transition period. While the new data set and data-entry software have all the elements required to create a Health Insurance Prospective Payment System (HIPPS) code for Medicare billing, they are required for all OASIS assessments completed on or after October 1, 2000.

In order to properly submit claims for Medicare beneficiaries under the new HHPPS, HHAs must install the encoding software, HAVEN 4.0 (that includes the HHRG), or other HAVEN-like vendor software that provides for the determination of payment categories as specified in the current HCFA-defined data specifications.

If you have any questions related to this Information Bulletin, please contact:

Minnesota Department of Health
Compliance Monitoring Division
Licensing and Certification Program
85 East Seventh Place, Suite 300
St. Paul, Minnesota 55164-0900
Telephone: (651) 201-4101.

Updated Friday, March 25, 2011 at 02:55PM