M2102: CMS OASIS Q&As

When completing M2102 - Types and Sources of Assistance, at the SOC/ROC, the assessing clinician will determine, to the best of their ability through observation and interview, what is known on the day of assessment regarding the ability and willingness of non-agency caregivers to provide help related to M2102f - Supervision and safety for the upcoming episode of care. For example, if the patient’s family report that they often need to provide reminders to the patient to take their medication, and to not wander out of the house, but this level of assistance has not been needed yet on the day of assessment, the assistance is reported, as it has been and is anticipated to be the ability and willingness of caregiver to meet this patient need. At Discharge, the assessing clinician is reporting what is known on the day of assessment regarding the ability and willingness of caregivers to provide assistance to the patient at the time of the discharge.

If the agency has a different provider identification number for each provider type, Medicare Skilled Home Health and Medicaid In-Home, the care provided by the staff employed by the Medicaid In-Home provider would be considered non-agency caregivers for the purpose of responding to M2102 - Types and Sources of Assistance. The entities must be separate and distinct agencies.

M1830 - Bathing addresses the patient’s ability to bathe in the shower or tub, not preference, regardless of where or how the patient currently bathes. Willingness and adherence are not the focus of the item. If assistance is needed to bathe in the shower or tub, then the level of assistance needed must be noted, and Response 1, 2, or 3 should be selected. M2102a - Types and Sources of Assistance; ADL assistance is based on the ability and willingness of the caregiver(s) (other than home health agency staff) to provide the assistance needed by the patient to perform ADLs, including bathing. The item does not specify the bathing must be in the tub or shower. In the scenario cited, the assessing clinician has determined the patient to be independent in all ADLs, including bathing. Therefore, response 0 - No assistance needed for M2102a. would be appropriate.

M2102d - Types and Sources of Assistance; Medical procedures/treatments includes but is not limited to wound care and dressing changes, along with other procedures/treatments described in the OASIS Guidance Manual Response Specific Instructions for M2102. A physician/allowed practitioner order is not required for a procedure/treatment to be considered in this response.

The types of assistance that a foley catheter patient might need may be captured in more than one row in M2102, Types and Sources of Assistance, as described below:

• •M2102a - ADL assistance as part of toileting hygiene - Examples: cleansing around the catheter/peri care
• •M2102d - Medical procedure Examples: insertion/removal of catheter, e.g., self cath or intermittent catheterization

M2102c - Types and Sources of Assistance; 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.

M2102c - Types and Sources of Assistance; Medication administration asks the clinician to determine the level of caregiver ability and willingness to provide assistance with the administration of medications by any and all routes. The broad category of Medication administration includes all tasks related to the patient's ability to self-administer all prescribed and OTC medications, by any route. Tasks included in M2020 - Management of Oral Medications and M2030 - Management of Injectable Medications as defined in current CMS guidance would be included, along with any other assistance provided/needed with any medication, by any route. The clinician must use clinical judgment to determine if the patient needs assistance with any medication and if so, describe the caregiver’s ability and willingness to provide the needed assistance. In your example, it would be correct to select Response 2 - Non-agency caregiver(s) need training/supportive services to provide assistance if the caregiver needs help to correctly fill a medication box.

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 M2102d - Types and Sources of Assistance; Medical procedures/treatment.

Response 3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance is the appropriate response for M2102 - Types and Sources of Assistance, in situations where the physician has ordered the skilled clinician perform a treatment or procedure. In this situation, the patient needs assistance and the physician/allowed practitioner has indicated by the order that it must be performed by a skilled clinician, in which case the caregiver should be considered unable to provide the needed care.

Response 4 - Assistance needed, but no non-agency caregiver(s) available means the patient has no one involved in providing any level of care to them at all. If at discharge the son was willing and able to assist with ADLS, the appropriate response for Row a would be response 1- Non-agency caregiver(s) currently provide assistance. If the son was unwilling to assist with medication administration, the appropriate responses for M2102c - Types and Sources of Assistance; Medication administration would be response 3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance because this response is defined as including situations where the caregiver is unwilling or unable to provide the needed care.

M2102, Types and Sources of Assistance, is referring to the assistance needed by the patient in the home and the availability and ability of a caregiver to meet those needs. It does not capture assistance provided to the patient outside of the home setting such as they might receive at Adult Day Care or a dialysis center. Assistance needed to transport the patient out of the home, (e.g., to/from medical appointments) is included, but services received once outside the home setting should not be considered.

Measurement of vital signs and blood glucose are considered medical procedures.

At SOC/ROC, the assessing clinician should report on M2102f - Types and Sources of Assistance; Supervision and safety what is known on the day of assessment regarding ability and willingness of caregivers to provide help for supervision and safety needs (due to cognitive impairment), for the upcoming episode of care. The assessing clinician would utilize their clinical judgment to determine the type of assistance needed by the patient, the ability and willingness of caregivers (other than home health agency staff) to provide the needed assistance, and how long the episode of care is expected to be. In the scenario described the assessing clinician knows the patient needs supervision and knows that that the children are leaving in one week. These details, along with the anticipated length of the home care episode would be considered when determining the appropriate response for M2102f. For example, the relative is staying to care for the patient for a week, and the clinician expects the home care episode to last for 5-6 weeks, using clinical judgment the assessing clinician may determine that the relative’s temporary presence should not be considered when selecting a response for M2102f. Alternatively, if the patient is only expected to receive home care services for one or two weeks before transitioning to outpatient then the assessing clinician, using their clinician judgment may determine that the relative’s temporary presence should be considered for M2102f.