HHA Attestation for OASIS Submission Exemption

OASIS Submission is required for HHAs participating in the Medicare and/or Medicaid programs under 42 CFR §484.20 (G320), a federal condition of participation. OASIS does not apply to HHAs meeting certain exemption requirements.  In an effort to facilitate submission compliance monitoring, AHCA requests the following attestation be submitted annually, or updated upon changes in exemption status.

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* Agency Information

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* Exemption Statements: This HHA provides ONLY Care and services for patients

  Applies to my agency
under the age of 18
receiving  prenatal, antepartum and postpartum maternity services.
receiving unskilled care, personal care, housekeeping or chore services.
for whom Medicare or Medicaid insurance is not billed (includes traditional fee-for-service or HMO/Managed Care
I understand OASIS submission is required, if none of the above four criteria apply. 

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* Attested by:

Questions regarding this attestation should be directed to FLQIES_HELP@ahca.myflorida.com.