HH RCD: Ohio Transition to Cycle 11

Published 07/07/2026

As the Review Choice Demonstration (RCD) for home health agencies (HHA) in Ohio continues, the time for Cycle 11 is approaching.

If an HHA's full affirmation rate or claim approval rate is 90% or greater for the previous six-month period, the provider may choose one of the subsequent review options:

  • Choice 1: Start or continue participating in pre-claim review (PCR) for another cycle
  • Choice 3: Selective post-payment review of a statistically valid random sample (SVRS) of claims every six months for the remainder of the demonstration
  • Choice 4: Spot Check Review of 5% of claims every six months to ensure continued compliance
     

Note: If an HHA is eligible for a subsequent review option, but does not make a selection during the selection period, the HHA will be placed in Choice 3.

If an HHA’s full affirmation rate is less than 90% for the previous six-month period, it may choose one of the initial review options:

  • Choice 1: Start or continue participating in PCR for another cycle
  • Choice 2: 100% post-payment review
     

Note: If an HHA is eligible for an initial review option, but does not make a selection during the selection period, the HHA will be placed in Choice 2.

For those options that are evaluated every six months, the claims or PCR requests reviewed during the cycle will determine the provider’s results. Providers will continue in their selected option during the calculation and selection period. The affirmation/claim approval rate calculation period occurs during the month of July 2026, with result letters being sent to HHAs by the end of July 2026. The selection period for Cycle 11 will take place from August 1, 2026, through August 16, 2026. HHAs that do not make a selection during that time period will default to either Choice 2 or Choice 3 as noted earlier in this article. 

Transition Timeline

Table 1: Transition Timeline

 

 

 

Cycle 7 Cycle 8 Cycle 9 Cycle 10 Cycle 11 Cycle 12 Cycle 13 Cycle 14
Cycle Start

01/01/24

09/01/24

05/01/25

01/01/26

09/01/26

05/01/27

01/01/28

09/01/28

Cycle End

06/30/24

02/28/25

10/31/25

06/30/26

02/28/27

10/31/27

06/30/28

02/28/29

Results Posted

07/31/24

03/31/25

11/30/25

07/31/26

03/31/27

11/30/27

07/31/28

03/30/29

Selection Start 08/01/24 04/01/25 12/01/25 08/01/26 04/01/27 12/01/27 08/01/28 04/01/29
Selection End 08/14/24 04/14/25 12/14/25 08/16/26 04/14/27 12/14/27 08/14/28 04/15/29

 As providers transition from Cycle 10 to Cycle 11, please be advised of the actions required when changing from one choice to another. 

Important Notes

  • Any claim with a date of service on or after 9/30/2019 is subject to the RCD program in Ohio
  • If your selection changes, remember that the date of submission determines which RCD selection applies to your claims, not the dates of service
Table 2
If Your
Cycle 10
Choice was:
And Your Cycle 11 Choice is: Here are the actions you will need to take:
Choice 1: PCR Choice 1: PCR
  1. Continue PCR process. Data from July and August will be included in the Cycle 11 results.
Choice 1: PCR Choice 2: Post-Payment Review
  1. Continue to submit PCR requests through 8/31/2026. Data from July and August will be included in the Cycle 11 results.

    a. Add UTN to claims if PCR was submitted (regardless if affirmed or non-affirmed)
    b. Respond to ADRs as generated
  2. As of 9/1/2026, submit final claim.

    a. Final bill will adjust, and the ADR will generate
    b. Respond to ADR

Choice 1: PCR

Choice 3: Selective Post-Payment Review

  1. Continue to submit PCR requests through 8/31/2026. Data from July and August will be included in the Cycle 11 results.

 a. Add UTN to claims if PCR was submitted (regardless if affirmed or non-affirmed)
 b. Respond to ADRs as generated

  1. As of 9/1/2026, submit final claim for payment

a. Final bill will be adjusted, and the ADR will generate
b. Respond to ADR

Choice 1: PCR

Choice 4: Spot Check

  1. Continue to submit PCR requests through 8/31/2026. Data from July and August will be included in the Cycle 11 results.

a. Add UTN to claims if PCR was submitted (regardless if affirmed or non-affirmed)
 b. Respond to ADRs as generated

  1. As of 9/1/2026, submit final claim.

a. ADR will generate
b. Respond to ADR

Choice 2: Post-Payment Review

Choice 1: PCR

  1. Continue to respond to ADRs. Data from July and August will be included in the Cycle 11 results.
  2. Begin submitting PCR requests on 9/1/2026 for any claim that will be submitted on or after 9/1/2026 with a date of service on or after 9/30/2019

    a. Add UTN to claims with PCR requests

Choice 2: Post-Payment Review

Choice 2: Post-Payment Review

  1. Continue to respond to ADRs. Data from July and August will be included in the Cycle 11 results. 

Choice 2: Post-Payment Review

Choice 3: Selective Post-Payment Review

  1. Continue to respond to ADRs. Data from July and August will be included in the Cycle 11 results. 

Choice 2: Post-Payment Review

Choice 4: Spot Check

  1. Continue to respond to ADRs. Data from July and August will be included in the Cycle 11 results. 

Choice 4: Spot Check

Choice 1: PCR

  1. Continue to respond to ADRs. Data from July and August will be included in the Cycle 11 results. 
  2. Begin submitting PCR requests on 9/1/2026 for any claim that will be submitted on or after 9/1/2026 with a date of service on or after 9/30/2019.

    a. Add UTN to claims for claims with PCR requests

Choice 4: Spot Check

Choice 2: Post-Payment Review

  1. Continue to respond to ADRs. Data from July and August will be included in the Cycle 11 results. 

Choice 4: Spot Check

Choice 3: Selective Post-Payment Review

  1. Continue to respond to ADRs. Data from July and August will be included in the Cycle 11 results. 

Choice 4: Spot Check

Choice 4: Spot Check

  1. Continue to respond to ADRs. Data from July and August will be included in the Cycle 11 results. 

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