02/26/2026

ODM Clarifies How Antipsychotics will Impact QIP

The Ohio Department of Medicaid has confirmed that it will use CMS’ updated Long-Stay Antipsychotic Medication (LSAM) measure and revised cut points for purposes of the July 1, 2026 Quality Incentive Payment (QIP) rate setting. As outlined in CMS memo QSO-25-20-NH REVISED, the Centers for Medicare & Medicaid Services has incorporated Medicare Advantage encounter data and Medicaid claims data into the LSAM calculation beginning with the January 2026 Care Compare refresh. ODM will rely on the CMS four-quarter average posted on Care Compare at the time of rate setting rather than recalculating an average. Consistent with ORC 5165.26(C)(1)(c), any CMS metric changes in effect at the time of rate setting will be used.

CMS has also revised the LSAM scoring cut points, establishing new decile-based thresholds in the January 2026 update to the Five-Star Technical Users’ Guide. ODM will apply these updated cut points when assigning QIP points. Members are encouraged to review the revised CMS guidance in the QSO-25-20-NH REVISED memo here and the January 2026 Five-Star Technical Users’ Guide here. The updated LSAM cut point table is shown below for reference.