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Quality Improvement & Evaluation Contracts

Cathy Cross
AHC Administrator

Quality Improvement & Evaluation Contracts Unit

Phone: (850) 412-4690

Cathy Cross
The Quality Improvement and Evaluations Contract Unit has responsibility for the management of Medicaid waiver and program evaluation and research contracts, as well as oversight and management of service-based contracts, including contracts that implement programs designed to reduce fraud and abuse in high usage programs. Other unit responsibilities include setting minimum performance standards, monitoring for contractual requirements and providing technical assistance to vendors.

Quality Management Contracts

Florida Medicaid manages quality improvement contracts to ensure that Medicaid recipients receive medically necessary, quality services in the most cost effective manner. The organizations providing quality management review services currently under contract with the Agency are Magellan Medicaid Administration, The University of South Florida, Qlarant Quality Solutions, Centric Consulting, LLC, Healthy Start, KEPRO, and The University of Florida.

Research and Evaluation Contracts

The Agency contracts with universities and other entities to conduct independent and unbiased research and evaluation projects which describe and analyze recipient, service and program characteristics.  Reports produced from the research and evaluation projects ensure Agency compliance with waiver requirements and enable the Agency to further develop clinically appropriate, fiscally responsible and effective health care policy.

Medicaid Managed Care External Quality Review

In compliance with federal requirements, Florida contracts with an external quality review organization (EQRO) to provide a quality review of its Medicaid managed care programs.  The purpose of external quality review is to assess and improve managed care organizations and prepaid inpatient health plans' strengths and weaknesses with respect to the quality, timeliness, and access to Medicaid health care services.

Quality Improvement & Evaluation Contracts Team

Agency for Health Care Administration
2727 Mahan Drive, Mail Stop #38
Tallahassee, Florida 32308-5403
Phone: (850) 412-4003
Fax: (850) 414-1721