What the Ohio QIP is
The nursing facility quality incentive payment is written into Ohio law at ORC 5165.26, most recently amended by HB 184 in March 2026. The Ohio Department of Medicaid sets it twice a year and prints each building's add-on, in dollars per Medicaid day, in its Provider Rate Component Data Report.
The scores are not computed from a building's own MDS. Ohio reads the quality measures CMS publishes on Care Compare. That matters for timing, which we cover below.
How the score is built
Each measure is scored the way CMS scores it for the Five-Star rating, then divided by 20. A measure worth 100 CMS points is worth 5 Ohio points; a 150-point measure is worth 7.5.
| Measure | Ohio points |
|---|---|
| Pressure ulcers (long-stay) | 5 |
| Urinary tract infection | 5 |
| Catheter inserted and left in the bladder | 5 |
| Falls with major injury | 5 |
| Ability to walk independently worsened | 7.5 |
| Need for help with daily activities increased | 7.5 |
| Antipsychotic medication (long-stay) | 7.5 |
| Clinical subtotal | 42.5 |
| Nurse staffing hours (PBJ), by quintile | up to 5 |
| Occupancy over 75% | 3 |
| Maximum | 50.5 |
Staffing pays 0, 2, 3, 4 or 5 points by where the building's case-mix-adjusted nurse staffing falls statewide. It averages four quarterly refreshes, and a missing quarter scores zero. Long-stay antipsychotic use has blended Medicare claims with the MDS since January 2026, so MDS coding alone no longer sets that rate.
The two cliffs
Payment is a straight line with two drops in it.
A measure in the lowest band scores zero
On Five-Star, the lowest band still earns 20 or 15 CMS points. In Ohio it earns nothing. So a building that slips into the bottom band on one 100-point measure loses 1.0 point for the band and another for the zero, and a 150-point measure costs 1.5.
Under the floor, every metric point goes
If a building's clinical and staffing points together fall below the 25th percentile of Ohio buildings, all of those points are zeroed. Only the occupancy points are still paid. For SFY2027 (rates in force July 2026 through June 2027) that floor is 35.75 points. Ohio strikes it once, at the July setting, and keeps it for the January recalculation. By design, roughly a quarter of Ohio buildings are under it each period.
What that looks like. A building at 37.5 metric points has one more catheter resident. The measure drops into its lowest band, the building lands at 35.5, and it is under the floor. At $1.03 a point and 50 Medicaid residents, that is about $705K a year, or about $352K for the six-month rate period it lands in.
Two smaller rules: a Special Focus Facility on CMS's table A is not paid (an SFF candidate still is), and after a change of operator a building is paid nothing, occupancy included, until the first January 1 or July 1 at least six months later.
What a point is worth
The add-on is the quality score times a value per point, paid on every Medicaid day. For SFY2027 that value is $1.03 per point per Medicaid day, down from $1.14 the year before. It moves every July, because a fixed pool is divided across the whole state's scores: when the average building scores higher, each point is worth a little less.
At $1.03, one point is worth about $376 a year for every Medicaid bed that stays full. Ohio doesn't publish Medicaid days, so any building-level dollar figure, ours included, is modeled from census.
See your building’s Ohio add-on and its distance to the floor.
When your work shows up
Ohio reads two CMS publications a year:
- July 1 setting reads CMS's June publication: the four quarters of the previous calendar year.
- January 1 recalculation reads the December publication, a four-quarter window that ends mid-year.
So the quarter ending September 2026 first counts toward the July 2027 rate. Between care and payment there are 9 to 21 months. That lag is why a spreadsheet updated from Care Compare is always looking at a year that already happened.
Corrections have a deadline too. An assessment counts only if CMS accepted it by the SNF QRP final submission deadline, about four and a half months after the quarter ends. A modification after that changes your iQIES reports but not the quarter Ohio pays on.
What moves the score
- Know your distance to the floor. If you're within two points, a single measure can decide the whole add-on. Track it by resident, not by quarter.
- Falls with major injury is Ohio's cliff measure. In our statewide build it caused most of the single-measure zeroes. Code J1900C exactly: major injury means a fracture, a dislocation, a closed head injury with altered consciousness, or a subdural hematoma.
- Staffing is worth up to 5 points, and a missing PBJ quarter scores zero. That one belongs to the administrator and payroll, not the MDS office.
- UTIs only when they meet the definition. I2300 needs both the evidence-based criteria and a physician diagnosis in the 30-day look-back.
- Fix coding before the freeze. A correction after the submission deadline doesn't reach the rate.
How SuperQM helps Ohio buildings
SuperQM scores the Ohio QIP the way the state does, from your own charting, for the quarter you're in. It shows each building's metric points against the floor, which residents are moving which measure, and what the gap is worth in dollars. When a resident is about to tip a measure into its lowest band, the right person hears about it that day.
Against ODM's January 2026 rate report, our reconstruction matches the whole score for 858 of 899 Ohio buildings. See how SuperQM works.
