Care Management OASIS-C Contact: Cindy Skogen, RN (OEC) 651-201-3818, or health.oasis@state.mn.us for questions. Source: Center for Medicare and Medicaid Services Care Management

M2100 Types & Sources of Assistance Instructions to Class Care Management

M2100 Types & Sources of Assistance (cont.) (M2100) Types and Sources of Assistance: Determine the level of caregiver ability and willingness to provide assistance for the following activities, if assistance is needed. (Check only one box in each row.) Excludes HHA staff Community based services are considered as providing assistance Time period under consideration – what is known on the day of the assessment regarding the upcoming episode of care OAI Note: Need to add that Agency staff is not included as a caregiver. Need to add the time period that is under consideration. Instructions to Class Care Management

M2100 Types & Sources of Assistance (cont.) Identifies availability and ability of the caregiver(s) to provide categories of assistance needed by the patient Concerned broadly with types of assistance, not just the ones specified in other OASIS items For each row a-g, select one description of caregiver assistance CMS Q & A Question 38 M2100, Types and Sources of Assistance includes all tasks included in the broad categories included, even if there is not a specific physician’s order for the task. For example, a patient may need a caregiver’s assistance with eating, but there may very well not be a specific physician’s order for the caregiver to provide the assistance. Care Management

M2100 Types & Sources of Assistance (cont.) If patient needs assistance with any aspect of a category of assistance, E.g., needs assistance with some IADLs but not others Consider the aspect that represents the most need and the availability and ability of the caregiver(s) to meet that need Note this item is asking you to report the task with which the caregiver needs the most help. Where is the greatest need? CMS Q & A – April 2010 Question 29: When answering M2100 b, our clinicians often answer “1” – Caregivers currently provide assistance, based on the patient's “greatest need” for assistance with housekeeping and/or shopping. Please confirm if “0” is the correct response for M2100 b in situations where the patient is independent with eating, planning/ prep meals and phone use – as documented in OASIS Assessments M1780 (Feeding/Eating) = “0” (independent) and M1880 (Plan/Prep Meals) = “0” (independent) and M1890 (Phone use) = “0” (independent). We are having a problem with agency computer system not allowing us to enter “1” response to M2100 when M1780, M1880 and M1890 are all assessed as “0”. This seems contradictory to clinical guidance. Answer 29: For M2100b, IADL assistance, if more than one response applies, you are to report the response that reflects the patient's "greatest need”. In your example, the patient needs help with housekeeping and/or shopping, and with these needs met by the caregivers, the response should be "1" "Caregivers currently provide assistance". Software vendors can add edits or flags in the comprehensive assessments to aide clinicians in their consistency of data collection. An edit in the instance you described CMS OCCB Q&As – April 2010 (www.oasiscertificate.org) Page 13 of 20 may be an appropriate warning, directing the clinician to confirm the response selected, but should still allow the clinician to still choose Response "1“ when appropriate. You are encouraged to contact your software vendor in cases where provided edits are questionable. Care Management

M2100 Types & Sources of Assistance (cont.) If more than one response in a row applies, E.g., the caregiver(s) provides the assistance but also needs training or assistance Select the response that represents the greatest need “caregiver(s) needs training/supporting services to provide assistance” Care Management

M2100 Types & Sources of Assistance (cont.) “Caregiver(s) not likely to provide” means: CG(s) indicated unwillingness to provide assistance, or CG(s) physically and/or cognitively unable to provide needed care “Unclear if caregiver(s) will provide” means: CG(s) express willingness to, but their ability in question, or There is reluctance that raises questions as to whether the CG will provide the needed assistance OAI note: Explain Column 5. It is often misunderstood. Care Management

M2100 Types & Sources of Assistance (cont.) Type of Assistance No assistance needed in this area Care-giver(s) currently provide assistance Care-giver(s) need training/ supportive services to provide assistance Care-giver(s) not likely to provide assistance Unclear if Care-giver(s) will provide assistance Assistance needed, but no Care-giver(s) available a. ADL assistance (e.g., transfer/ ambulation, bathing, dressing, toileting, eating/ feeding) ⃞ 0 ⃞ 1 ⃞ 2 ⃞ 3 ⃞ 4 ⃞ 5 Instructional Guidance Instructions to Class CMS Q & A – April 2010 Question 27 The types of assistance that a foley catheter patient might need may be captured in multiple rows in M2100, Types and Sources of Assistance, as described below: • a- ADL assistance as part of toileting hygiene? - Examples: cleansing around the catheter/peri care • d- Medical procedure? Examples: insertion/removal of catheter, e.g. self cath or intermittent catheterization • e- Management of equipment? - Examples: emptying the bag, changing the bag Note that if a patient needs assistance with multiple tasks included in one of the broad categories of assistance, the response selected should be based on the area requiring the most need. Row a – ADLs include basic self-care activities such as the examples listed Care Management

M2100 Types & Sources of Assistance (cont.) Type of Assistance No assistance needed in this area Care-giver(s) currently provide assistance Care-giver(s) need training/ supportive services to provide assistance Care-giver(s) not likely to provide assistance Unclear if Care-giver(s) will provide assistance Assistance needed, but no Care-giver(s) available b. IADL assistance (e.g., meals, housekeeping, laundry, telephone, shopping, finances) ⃞ 0 ⃞ 1 ⃞ 2 ⃞ 3 ⃞ 4 ⃞ 5 Instructional Guidance Instructions to Class CMS Q & A – October 2009 Question 39 A community based service, like Meals-on-Wheels, that is providing needed assistance with meals would be considered when answering M2100 and M2110. Note that if the patient needs assistance with any aspect of a category of assistance, such as IADLs, you are to consider the aspect that represents the most need and the availability and ability of the caregiver to meet that need. If the patient, who is receiving delivered meals, is also receiving other IADL assistance, the clinician must determine the IADL that requires the most need and then the availability and ability of the caregiver to meet that need. Row b – IADLs include activities associated with independent living necessary to support the ADLs such as the examples listed Care Management

M2100 Types & Sources of Assistance (cont.) Type of Assistance No assistance needed in this area Care-giver(s) currently provide assistance Care-giver(s) need training/ supportive services to provide assistance Care-giver(s) not likely to provide assistance Unclear if Care-giver(s) will provide assistance Assistance needed, but no Care-giver(s) available c. Medication administration (e.g., oral, inhaled or injectable) ⃞ 0 ⃞ 1 ⃞ 2 ⃞ 3 ⃞ 4 ⃞ 5 Instructional Guidance Instructions to Class CMS Q & A – July 2010 M2100c Question 19: How do I answer M2100 c - Medication Administration, at Discharge for a patient who has a caregiver assisting with management of oral medication but will now receive their B12 injections at the physician's office? Answer 19: M2100 Row c - Medication Administration, includes all medications, by any route administered in the home and does not include medications received at physician's offices or other locations outside the home setting. Row c – Medication administration refers to any type of medication (prescribed or OTC) and any route of administration including oral, inhalant, injectable, topical, or administration via g-tube or j-tube, etc. Care Management

M2100 Types & Sources of Assistance (cont.) Type of Assistance No assistance needed in this area Care-giver(s) currently provide assistance Care-giver(s) need training/ supportive services to provide assistance Care-giver(s) not likely to provide assistance Unclear if Care-giver(s) will provide assistance Assistance needed, but no Care-giver(s) available d. Medical procedures/ treatments (e.g., changing wound dressing) ⃞ 0 ⃞ 1 ⃞ 2 ⃞ 3 ⃞ 4 ⃞ 5 Instructional Guidance Instructions to Class CMS Q & A – October 2009 Question 37 Although T.E.D hose, prosthetic devices, orthotic devices, or other supports are considered dressing tasks for the OASIS upper and lower body dressing items, for M2100, these devices that have a medical and/or therapeutic impact should be considered Medical procedures/treatments (row d). CMS Q & A – January 2010 Question 22 The application/changing/removal of the wound dressing, including the foam and drape used with a wound VAC would constitute a "Medical procedure" as other dressing changes do. This would be considered and reported under Row d, Medical procedures. The emptying of the VAC canister or the disconnection/reconnection to the VAC for short times to allow certain activities would be considered management of the equipment and would be included under Row e, Management of equipment. Row d – Medical procedures/treatments include those ordered for purpose of improving health status Care Management

M2100 Types & Sources of Assistance (cont.) Examples: Wound care and dressing changes Range of motion exercises Intermittent urinary catheterization Postural drainage Electromodalities, etc. Care Management

M2100 Types & Sources of Assistance (cont.) Type of Assistance No assistance needed in this area Care-giver(s) currently provide assistance Care-giver(s) need training/ supportive services to provide assistance Care-giver(s) not likely to provide assistance Unclear if Care-giver(s) will provide assistance Assistance needed, but no Care-giver(s) available e. Management of Equipment (includes oxygen, IV/infusion equipment, enteral/ parenteral nutrition, ventilator therapy equipment or supplies) ⃞ 0 ⃞ 1 ⃞ 2 ⃞ 3 ⃞ 4 ⃞ 5 Instructional Guidance Instructions to Class OASIS Q & A – July 2010 M2100e Question 20: For M2100-e - Types and Sources of Assistance, Management of Equipment, are canes and walkers considered equipment? Answer 20: Yes, if the patient requires assistance with their cane or walker it would be included in M2100e. CMS is not intending to provide an exhaustive list of all medical equipment that could be used in the home health setting, but rather expects the clinician to determine what is considered medical equipment, using the examples provided in the item and good clinical judgment. Row e – Management of equipment refers to the ability to safely use medical equipment as ordered Care Management

M2100 Types & Sources of Assistance (cont.) Examples: Oxygen IV/infusion equipment Enteral/parenteral nutrition Ventilator therapy equipment or supplies Continuous passive motion machine Wheelchair Hoyer lift, etc. Care Management

M2100 Types & Sources of Assistance (cont.) Type of Assistance No assistance needed in this area Care-giver(s) currently provide assistance Care-giver(s) need training/ supportive services to provide assistance Care-giver(s) not likely to provide assistance Unclear if Care-giver(s) will provide assistance Assistance needed, but no Care-giver(s) available f. Supervision and safety (e.g., due to cognitive impairment) ⃞ 0 ⃞ 1 ⃞ 2 ⃞ 3 ⃞ 4 ⃞ 5 Instructional Guidance Instructions to Class Row f – Supervision and safety includes needs related to ability of patient to safely remain in the home Care Management

M2100 Types & Sources of Assistance (cont.) Row f - Includes a wide range of activities that may be necessary due to cognitive, functional, or other health deficits Calls to remind the patient to take medications In-person visits to ensure that the home environment is safely maintained Need for the physical presence of another person in the home to ensure that the patient doesn’t wander, fall, or for other safety reasons (i.e., leaving the stove burner on) OAI note – need to indicate what Row this is referencing. Care Management

M2100 Types & Sources of Assistance (cont.) Type of Assistance No assistance needed in this area Care-giver(s) currently provide assistance Care-giver(s) need training/ supportive services to provide assistance Care-giver(s) not likely to provide assistance Unclear if Care-giver(s) will provide assistance Assistance needed, but no Care-giver(s) available g. Advocacy or facilitation of patient's participation in appropriate medical care (includes transportation to or from appointments) ⃞ 0 ⃞ 1 ⃞ 2 ⃞ 3 ⃞ 4 ⃞ 5 Instructional Guidance Instructions to Class Row g – Advocacy or facilitation of patient's participation in appropriate medical care includes taking patient to medical appointments, following up with filling prescriptions, or making subsequent appointments, etc. Care Management

M2110 ADL/IADL Assistance (M2110) How often does the patient receive ADL or IADL assistance from any caregiver(s) (other than home health agency staff)? ⃞ 1 – At least daily ⃞ 2 – Three or more times per week ⃞ 3 – One to two times per week ⃞ 4 – Received, but less than weekly ⃞ 5 – No assistance received ⃞ UK – Unknown [Omit “UK” option on DC] Instructional Guidance Care Management

M2110 ADL/IADL Assistance (cont.) Identifies the frequency of the assistance provided by any non-agency caregivers with ADLs Examples: bathing, dressing, toileting, transferring, ambulating, feeding, etc. IADLs Examples: medication management, meal preparation, housekeeping, laundry, shopping, financial management Concerned broadly with ADLs and IADLs, not just the ones specified in other OASIS items Select the response that reports how often the patient receives assistance with any ADL or IADL CMS Q & A – April 2010 Question 30: Will the answer to M2110 always correlate to the M2100 Types and Sources of Assistance response? For example, if a patient needs assistance with ADLs and IADLs but the caregiver is unable/unwilling to assist with bathing and medications, would the scoring be based on the items that the patient needs the most assistance with but the caregiver is unable/unwilling to provide or would it be based on what assistance the caregiver provides regardless of patient need? Answer 30: M2100, Types and Sources of Assistance, reports the source of assistance in a number of broad categories of activities (including ADLs, IADLs, Medication administration, Equipment Management, etc.) M2110, Frequency of Assistance, only addresses ADLs and IADLs, and provides more specific information related to the frequency with which assistance is provided for these broad tasks. You are correct that in M2100 you report the response that represents the most need and the availability and ability of the caregiver to meet that need. In M2110, simply report the frequency that the patient receives assistance with any ADLs/IADLs. Because of the different approaches with these items, a logical "tie" between the two may not always be apparent. Care Management

Questions??? E-mail: health.oasis@state.mn.us Cindy Skogen, RN; Oasis Education Coordinator 651-201-3818