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Glossary

OASIS

The Outcome and Assessment Information Set: the standardized patient assessment a Medicare-certified home health agency collects at the start of care, resumption of care, recertification, transfer and discharge, and submits to CMS. It drives the publicly reported quality measures and the episode's payment grouping.

Also Outcome and Assessment Information Set, OASIS-E1

OASIS is the data set behind nearly every number Medicare publishes about a home health agency. The Conditions of Participation require its items inside the comprehensive assessment for every Medicare and Medicaid patient (42 CFR 484.55(b)(1)), and require the agency to transmit the completed assessment to CMS within 30 days of completing it (484.45). The current version is OASIS-E1, in use since 1 January 2025.

The time points are the start of care, resumption of care after an inpatient stay, recertification in the last five days of each sixty-day period, transfer to an inpatient facility, and discharge. Each one is a full set of items on the patient’s clinical status, function, cognition, medications, and the services used.

Two things follow from OASIS that make the records before the first visit matter. The first is that the start-of-care assessment sets the patient’s payment grouping under the Patient-Driven Groupings Model, so a diagnosis the nurse did not know about on day one is not in the grouping. The second is that the outcome measures compare the start-of-care assessment with the discharge assessment, so what is recorded at the start is the baseline the agency is measured against. An accurate baseline needs the history the hospital and the physician hold, not a reconstruction from the referral packet and the patient’s recollection.

Where it is defined

Vivlio for home healthThe face-to-face note, orders, discharge summary and medications, assembled before the first visit.

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