Medicare and Medicaid OASIS Collection Requirements (Data collection)

OASIS Collection Requirements as Part of the CoPs for HHAs and Supporting Regulations

Documents and Forms

Document Name Document Type
Form CMS-R-245 Medicare and Medicaid OASIS Collection Requirements (Data collection) Form and Instruction
CMS-R-245 OASIS-C1 ICD-9 Attachement C Final-OASIS-C1-ICD-9-Version-Item-Set-effective-01-01-2015.pdf Form and Instruction
Attachment B.Table of Changes to OASIS-C1 to Create ICD 9 Version. 07.28.14.docx Attachment B - OASIS-C1 to OASIS-C1/ICD-9 IC Document
Attachment A OASIS C to C1 Items Timepoints and Uses 11-11-14.pdf Attachment A OASIS C to OASIS C-1 Comparison IC Document

Information Collection (IC) Details

IC Title:	Medicare and Medicaid OASIS Collection Requirements (Data collection)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 484.245 42 CFR 484.205 42 CFR 484.250 42 CFR 484.55 42 CFR 484.20

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-R-245	OASIS-C1 ICD-9	Attachement C Final-OASIS-C1-ICD-9-Version-Item-Set-effective-01-01-2015.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Home Health Agency (HHA) Outcome and Assessment Information Set (OASIS), HHS/CMS/CMSO (System # 09-70-0522)	FR Citation: 72 FR 63906

Number of Respondents: 12,014	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	17,268,890	17,268,890
Annual IC Time Burden (Hours)	15,224,141	15,224,141
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment B - OASIS-C1 to OASIS-C1/ICD-9	Attachment B.Table of Changes to OASIS-C1 to Create ICD 9 Version. 07.28.14.docx	09/03/2014
Attachment A OASIS C to OASIS C-1 Comparison	Attachment A OASIS C to C1 Items Timepoints and Uses 11-11-14.pdf	02/12/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.