Florida Medicaid is committed to ensuring that health care services delivered through managed care plans are held to high standards of quality and excellence. All vendors contracted with the Agency to provide managed care services must meet specific requirements for ensuring quality both in services provided and in administrative processes involved in oversight of the plan's operations.
By accessing the information below, you may learn about the Agency's overall quality strategy and you will find additional information sources to learn more about Florida's quality initiatives.
The following files provide the list of required performance measures for Medicaid HMOs and PSNs and specifications for Agency-defined measures. These documents should be used for the July 1, 2013 performance measure submission, which represents services for calendar year 2012.
Antiretroviral Formulations [385KB PDF]
Performance Measures 2013 Report Template [43KB MS Excel]
Medicaid beneficiaries can find information to help compare the performance of Medicaid Health Plans. The Agency monitors the Medicaid Reform health plan performance through the HEDIS performance measures and Agency defined measures. The Medicaid Reform health plan contract specifies the performance measures that were to be collected and reported to the Agency annually on July 1st.
HEDIS measures are developed by the National Committee for Quality Assurance (NCQA), which is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality. NCQA develops quality standards and performance measures for a broad range of health care entities. These are the measures and standards that AHCA, like most organizations and individuals, uses to help identify opportunities for improvement.
If you would like to send us questions, comments, or suggestions please Contact Us.
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In compliance with federal regulations, the Agency for Health Care Administration (Agency) must adopt and implement a comprehensive and holistic, continuous quality improvement strategy, known as the Comprehensive Quality Strategy. The Comprehensive Quality Strategy contains all aspects of quality improvement in Medicaid, including fee-for-service populations; fee-for-service provider service networks; and capitated managed care plans, including Medicaid Reform, the Managed Medical Assistance (MMA) program, and managed long-term services and supports. The draft Comprehensive Quality Strategy requirements are outlined in Special Term and Condition #118 of the 1115 MMA Waiver (previously known as the Medicaid Reform Waiver) as approved by the Centers for Medicare and Medicaid Services on June 14, 2013.
From September 1, 2013 through September 30, 2013, the Agency solicited public input from the Medical Care Advisory Committee members, beneficiaries and other stakeholders, prior to submitting the draft Comprehensive Quality Strategy to the Centers for Medicare and Medicaid Services on October 10, 2013.
The following is a link to view the Agency’s draft Comprehensive Quality Strategy.
The Centers for Medicare and Medicaid Services (CMS) require that each state have a written strategy for assessing and improving the quality of managed care services, known as the Quality Assessment and Improvement Strategies (QAIS). Florida Medicaid's QAIS is updated annually and includes input from recipients and interested stakeholders.
On August 24, 2012, the Agency completed the 2011/2012 update to the QAIS and posted it to this web page for 30 days to allow public input from recipients and interested stakeholders prior to submitting it to Federal CMS.
On September 27, 2012, the Agency submitted the updated QAIS to Federal CMS. The QAIS update contains details regarding the significant steps the state has taken, along with its health plan partners and External Quality Review Organization, to improve the quality of health care delivered to Medicaid managed care enrollees by MCOs and PIHPs in State Fiscal Year 2011-2012. The document also outlines future plans to continue this improvement process. The following is a link to view the Agency’s QAIS 2011/2012 Update.
The Agency for Health Care Administration would like to receive any comments you have about our Quality Assessment & Improvement Strategies.
Please email comments to: email@example.com
To view Florida’s previous QAIS, please go to the Previous Quality Assessment and Improvement Strategies web page.
As part of Florida's Medicaid Reform initiative, the Agency sought to review and amend the performance measures historically required for health plans contracting with the Agency to better assess the quality and effectiveness of the health care services. Public input was sought and received from interested parties, including health care advocates, providers, and State of Florida sister agencies, culminating in the final list of adopted measures.
The links below provide documents distributed at public workshops held on October 6, 2006, and October 26, 2006. Also provided is a compilation of stakeholder comments the Agency received during the performance measures development process.
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. Beginning in 2006, the Agency for Health Care Administration contracted with Health Services Advisory Group, Inc. (HSAG), its current EQRO vendor.
HSAG is contracted to provide the following eight core categories of activities:
- Validation of performance improvement projects;
- Validation of performance measures;
- Review of compliance with access, structural and operational standards;
- Validation of encounter data;
- Focused studies;
- Dissemination of information to keep key stakeholders within and outside of Medicaid involved and informed of external quality review work projects and tasks;
- Completion of an annual technical report for submittal to the Centers for Medicare and Medicaid Services; and
- Technical assistance on other activities.
These activities impact Health Maintenance Organizations, Provider Service Networks, Prepaid Dental Health Plans, Prepaid Mental Health Plans, the Child Welfare Prepaid Mental Health Plan, Statewide Inpatient Psychiatric Program Providers, Nursing Home Diversion Plans, and Statewide Medicaid Managed Care Plans.
For more information about HSAG and external quality review activities, please see HSAG's Florida website at: www.myfloridaeqro.com
The Children’s Health Insurance Program Reauthorization Act of 2009 Section 401 (D) allows the federal Centers for Medicare and Medicaid Services (CMS) to award states grant money to improve child health outcomes over the next five years. The State of Florida with the State of Illinois submitted a proposal to federal CMS and was awarded a grant with a reduced budget. During the first nine months of the grant, the states are required to revise their Final Implementation Plan while working within their reduced budgets. Workgroups are being formed to gather expert advice for the Final Implementation Plan.
Please review the Florida-Illinois proposal package [214KB PDF] submitted to CMS for detailed information. Please note that this proposal does not include the final implementation plan and is not reflective of the reduced budget. It is subject to change upon federal CMS approval.
Please review the CHIPRA project summary [448KB PDF] for general information.
New information for providers interested in medical home projects. This work is authorized under 401(d) of the Florida Children’s Health Insurance Program Reauthorization Act. Information Calls FAQs [180KB PDF]
The Agency for Health Care Administration supports ongoing training for cultural competency in the delivery of services for all its health plans and providers. Georgetown University's National Center for Cultural Competence offers a valuable resource to organizations and individuals developing, implementing and/or evaluating a cultural competency plan.
On this website you can find information to help you compare the quality and cost performance of hospitals, ambulatory surgery centers, health plans, nursing homes, and prescription drugs. The website also lists Florida health care facilities; information on health insurance; medical care resources for the uninsured; resources for seniors; and much more.
The main topic areas to view on the Florida Health Finder website include:
Health Plans: Compare health plans on quality of care, member satisfaction, coverage areas by county, accreditation status, and claims payment performance. You can also compare monthly health plan premium rate options and find additional resources on many health insurance topics.
Hospitals and Ambulatory Surgery Centers: View performance and outcome data on selected medical conditions and procedures in these types of health care facilities.
Emergency Room Care: Read educational information about when and how to use an emergency room, what to do in a medical crisis, alternatives to emergency room care and other helpful information.
Prescription Drugs: View comparative prices at Florida pharmacies for the top 100 most prescribed drugs in Florida. You choose the county where you live and a drug you want to price. The website displays the current price for most pharmacies in your county.
For more information about Florida Health Finder, please visit the website at: http://www.floridahealthfinder.gov.
For more information on Florida Medicaid Quality in Managed Care, please contact: