OASIS delay could affect the prospective payment system

HHBR Washington Correspondent

WASHINGTON – With the possibility of delays in OASIS looming, many are asking how this might affect the development and implementation of Medicare’s prospective payment system (PPS) for home health.

"Right now, we have already computed rates based on the data set and the OASIS data from the research agencies, and we think those data are reliable enough to certainly support a proposed rule," a senior Health Care Financing Administration (HCFA; Baltimore) official told HHBR last week.

According to the official, the real question is whether or not data collected on a sample basis will be "sufficiently complete" to make up a final rule. "That is really a matter of judgment in which all sorts of factors come into play as opposed to something that can be determined analytically," said the official. Under the current PPS schedule that was included in HCFA’s PPS report to Congress earlier this year, the agency would have six to nine months of data available when it has to make its final calculations very early next year, the official added.

"Each month of delay or week of delay is a week off of that total and it becomes a judgmental issue at what point is that too little to proceed with," said the official. "But that is a judgment that hasn’t been taken yet and I don’t know when it would be taken because decisions have to be made based on the situation we are in at the time."