Version 1.2 Revised 7/20/2025

Quality Measures Included in the Quality Incentive Calculations

The following quality measures are included in Ohio's Quality Incentive Payment calculations:

  • Antipsychotic Medication (L)

  • Catheter Inserted/Left in Bladder (L)

  • Falls with Major Injury (L)

  • UTI (L)

  • Pressure Ulcers (L)

  • Move Independently Worsens (L)

  • Increased ADL Help (L)

  • Total Nursing Staff per Resident per Day (Adjusted)

  • Occupancy Percentage

How is the Quality Incentive Payment Calculated?

Ohio’s Quality Incentive Payment for MDS QMs is calculated using real time QM Scores calculated by DatAlign for chs.care for the four-quarter rolling period ending with the current quarter to simulate how current performance would impact reimbursement. The Occupancy Percentage is calculated based on a rolling 12-month period ending with the most recent complete month.

Points Assignment

Ohio’s QIP points are calculated by dividing the CMS 5-star Quality Measure cut points by 20. For the Occupancy QM, an occupancy percentage of less than 75% results in a 0-point allocation, while a percentage greater than 75% results in a 3-point allocation.

Below is the range of points for the various QMs:

  • Antipsychotic Medication (L): 0-5 points

  • Catheter Inserted/Left in Bladder (L): 0-5 points

  • Falls with Major Injury (L): 0-5 points

  • UTI (L): 0-5 points

  • Pressure Ulcers (L): 0-7.5 points

  • Independence in Movement Worsened (L): 0-7.5 points

  • Increased ADL Help (L): 0-7.5 points

  • Total Nursing Staff: 0-5 points

  • Occupancy: 0-3 points

From Points to Dollars and Cents

The Quality Incentive Payment is calculated using the following formula:

Per diem Quality Payment rate × Points × Number of Medicaid days in the period

  • Per diem Quality Payment rate: $1.20

  • Number of Medicaid days in the period: The sum of the days of care in the period for patients whose primary payer is Medicaid.

References


Version 1.2 Revised 7/20/2025