Florida Medicaid Quality in Managed Care
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.
Performance Measure Specifications Manual
The following files provide the list of required performance measures for Medicaid HMO and PSNs and specifications for Agency-defined measures. These documents should be used for the July 1, 2010, performance measure submission which will represent services for calendar year 2009.
Medicaid HMO and PSN Performance Measures – July 2013 Reporting [387KB PDF] Updated 4/3/2013
Agency-Defined Performance Measure Specifications – July 2013 reporting [210KB PDF] Updated 4/3/2013
Antiretroviral Formulations [385KB PDF]
Performance Measures 2013 Report Template [43KB MS Excel] Updated 4/3/2013
Performance Measure Data Submissions for Medicaid
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.
| CY 2011 4/3/2013 | |||
| Reform | Non-Reform | ||
| Ratings [280KB PDF] |
Scores [269KB PDF] |
Ratings [339KB PDF] |
Scores [327KB PDF] |
| CY 2010 | |||
| Reform | Non-Reform | ||
| Ratings [144KB PDF] |
Scores [114KB PDF] |
Ratings [167KB PDF] |
Scores [137KB PDF] |
| 2009 | |||
| Reform | Non-Reform | ||
| Ratings | Scores | Ratings | Scores |
| 2008 | 2007 | |||||
| Reform | Non-Reform | Reform | ||||
| Ratings | Scores | Ratings | Scores | Ratings | Scores | |
| Health Plans | ||||||
| Indicator Descriptions |
Performance Measures Policy Transmittals
Year 1 - HMO - 06-06: Health Plan Performance Measures [493KB PDF]
Year 2 - HMO 08-02 and PSN 08-05: Health Plan Performance Measures [374KB PDF]
Year 3 - HMO and PSN 09-01: Health Plan Performance Measures [1.84MB PDF]
Quality Assessment and Improvement Strategies
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.
Florida Medicaid Managed Care Quality Assessment and Improvement Strategies 2011/2012 Update [1.14MB PDF]
The Agency for Health Care Administration would like to receive any comments you have about our Quality Assessment & Improvement Strategies. Please email comments to: qualityinmc@ahca.myflorida.com
To view Florida’s previous QAIS, please go to the Previous Quality Assessment and Improvement Strategies web page.
Medicaid Reform Performance Measure Selection
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.
October 6, 2006 Medicaid Reform Performance Measures Presentation [126KB PDF]
Stakeholder Comments (as of 10/25/06)
October 26, 2006 Medicaid Reform Performance Measures Workshop Presentations [100KB PDF]
Medicaid Reform Performance Measures 10/26/06 [47KB PDF]
Pfizer Health Solutions Reporting Overview 10/26/06 [471KB PDF]
External Quality Review
In compliance with federal requirements, Florida contracts with an external quality review organization 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.
Health Systems Advisory Group, Inc. (HSAG), Florida's contracted External Quality Review vendor, provides 11 categories of activity that include:- validation of performance improvement projects;
- validation of performance measures;
- review of compliance with access, structural and operations standards;
- strategic reports on consumer-reported satisfaction surveys;
- strategic reports of HEDIS Analysis;
- technical assistance on enrollee race/ethnicity and primary household language information;
- value-based purchasing methodologies;
- evaluation of AHCA's quality strategy;
- implementation of focused studies (such as adolescent well-care and identification of special health care needs);
- dissemination of information to keep key stakeholders within and outside of Medicaid involved and informed of External Quality Review work projects and tasks; and
- development of an annual technical report for submittal to the Federal Centers for Medicare and Medicaid.
These activities impact HMOs, Provider Service Networks, Prepaid Mental Health Plans, the Child Welfare Prepaid Mental Health Plan, and Nursing Home Diversion Plans.
For more information about HSAG and external quality review activities, see HSAG's Florida website at: www.myfloridaeqro.com
Children’s Quality Demonstration Grant (CHIPRA grant)
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]
Cultural Competency
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.
http://www11.georgetown.edu/research/gucchd/nccc/index.html
Florida Health Finder
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.
Related Links
Medicaid Health Maintenance Organization (HMO)
Nursing Home Diversion Program (Department of Elder Affairs) (Currently under construction)
Provider Service Network (PSN)
For more information on Florida Medicaid Quality in Managed Care, please contact:
qualityinmc@ahca.myflorida.com
