Performance Measure Data Submissions for Medicaid
Indicator Descriptions

These are a set of measures used to report the performance of health plans. Medicaid Beneficiaries can use this information to compare health plans and determine the relative value of care offered by managed care health plans. The measures allow the users to understand how well health plans achieve results that matter, such as, how effective and accessible is the care delivered.


Adolescent Well Care

The percentage of enrolled members 12-21 years of age who had at least one comprehensive well-care visit with a PCP or OB/GYN practitioner during the measurement year.

Adult BMI Assessment

The percentage of members 18-74 years of age who had an outpatient visit and who had their body mass index documented during the measurement year or the year prior.

Adults' Access to Preventive/Ambulatory Health Services - ages 20-44

The percentage of members 20 - 44 years of age who had an ambulatory or preventive care visit.

Adults' Access to Preventive/Ambulatory Health Services - ages 45-64

The percentage of members 45-64 years of age who had an ambulatory or preventive care visit.

Adults' Access to Preventive/Ambulatory Health Services - ages 65+

The percentage of members 65 years and older who had an ambulatory or preventive care visit.

Adults' Access to Preventive/Ambulatory Health Services Total

The percentage of members 20 years and older who had an ambulatory or preventive care visit.

Annual Dental Visits – Total

The percentage of members age 2-21 who had at least one dental visit during the measurement year.

Antidepressant Medication Management - Effective Acute Phase Treatment

The percentage of members 18 years of age and older who were diagnosed with a new episode of major depression and remained on antidepressant medication for at least 84 days.

Antidepressant Medication Management - Effective Continuation Phase Treatment

The percentage of members 18 years of age and older who were diagnosed with a new episode of major depression and remained on antidepressant medication for at least 180 days.

Breast Cancer Screening

The percentage of women 40-69 years of age who had a mammogram to screen for breast cancer.

Cervical Cancer Screening

The percentage of women 24-64 with one or more Pap tests during the measurement year or the two years prior to the measurement year.

Childhood Immunization Status - Combination 2

Children who received four DTaP; three IPV; one MMR; two Hib; three hepatitis B; and one VZV vaccination on or before the child's second birthday.

Childhood Immunization Status - Combination 3

Children who received all antigens listed in Combination 2 and four pneumococcal conjugate vaccinations on or before the child's second birthday.

Comprehensive Diabetes - Eye Exam

A retinal or dilated eye exam by an eye care professional was done during the measurement year OR a negative retinal exam was done by an eye professional in the year prior to the measurement year.

Comprehensive Diabetes - Good Control

The most recent HbA1c level is <8.0%.

Comprehensive Diabetes - HbA1C Poor Control (Inverse Measure)

The most recent HbA1C level is >9.0% or is missing or was not done during the measurement year.

Comprehensive Diabetes - HbA1C Testing

HbA1C test was performed during the measurement year.

Comprehensive Diabetes - LDL Screening

An LDL-C test was performed during the measurement year.

Comprehensive Diabetes - LDL-C Control

The most recent LDL-C level performed during the measurement year is <100 mL.

Comprehensive Diabetes – Nephropathy

A urine microalbumin test was done during the measurement year OR there is evidence of nephropathy during the measurement year.

Controlling Blood Pressure – Total   

The number of members with hypertension whose most recent BP is <140/90.

Follow-Up after Hospitalization for Mental Illness - 7 Day

The percentage of discharges for members 6 years and older who were hospitalized for a mental health disorder and who had an outpatient visit, an intensive outpatient encounter, or a partial hospitalization with a mental health practitioner within 7 days.

Follow-Up after Hospitalization for Mental Illness - 30 Day

The percentage of discharges for members 6 years and older who were hospitalized for a mental health disorder and who had an outpatient visit, an intensive outpatient encounter, or a partial hospitalization with a mental health practitioner within 30 days.

Follow-Up Care for Children Prescribed ADHD Medication - Continuation and Maintenance

The percentage of members 6-12 years of age with an ambulatory prescription dispensed for ADHD medication, who remained on the prescription for 210 days, had one follow-up visit in the initiation phase and two follow-up visits within 9 months after initiation phase ended.

Follow-Up Care for Children Prescribed ADHD Medication - Initiation Phase

The percentage of members 6-12 years of age with an ambulatory prescription dispensed for ADHD medication, who had one follow-up visit with practitioner with prescribing authority during 30 days.

Frequency of HIV Disease Monitoring Lab Tests - CD4

The percentage of enrollees with HIV who received greater than or equal to 3 CD4 tests during the calendar year.

Frequency of HIV Disease Monitoring Lab Tests - VL

The percentage of enrollees with HIV who received greater than or equal to 3 viral load tests during the calendar year.

Highly Active Anti-Retroviral Treatment

The percentage of enrollees with AIDS who were prescribed HAART.

Immunization for Adolescents - Combination 1

The percentage of adolescents 13 years of age who had meningococcal and Tdap/Td.

Lead Screening in Children

Children who received one or more capillary or venous lead blood tests for lead poisoning by their second birthday.

Lipid Profile Annually

The percentage of members 18 to 85 years of age who had a diagnosis of hypertension and who had a lipid profile during the measurement year that includes total cholesterol, HDL, and triglycerides.

Persistence of Beta-Blocker Treatment After a Heart Attack

Percentage of members 18 and older who were hospitalized with a diagnosis of AMI and who received beta-blockers for 6 months after discharge.

Prenatal Care

The percentage of deliveries that received a prenatal care visit as a member of the plan in the first trimester OR within 42 days of enrollment in the plan.

Prenatal Care Frequency - Greater than 81% of Visits

The percentage of Medicaid deliveries that received greater than 81% of expected prenatal visits.

Postpartum Care

The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery.

Readmission Rate (Inverse Measurement)

The percentage of enrollees who were hospitalized for a mental health diagnosis and were discharged to the community from an acute care facility and were readmitted for a mental health diagnosis within 30 days.

Use of Angiotensin-Converting Enzyme (ACE) Inhibitors/ Angiotensin Receptor Blockers (ARB) Therapy

The percentage of members 18 years and older during the measurement year who were diagnosed with congestive heart failure, and who have at least one prescription filled for ACE inhibitors or ARBs during the measurement year.

Use of Appropriate Medications for People with Asthma – Total

The percentage of members 5-56 years of age during the measurement year who were identified as having persistent asthma and who were appropriately prescribed medication during the measurement year.

Well-Child 0 Visits (Inverse Measure)

The percentage of children who turned 15 months old during the measurement year who had zero well-child visits with a PCP.

Well-Child 6+ Visits

The percentage of children who turned 15 months old during the measurement year who had six or more well-child visits with a PCP.

Well-Child Visits in the Third, Fourth, Fifth, & Sixth Years of Life

The percentage of members 3-6 years of age who received one or more well-child visits with a PCP during the measurement year.

For more information on Florida Medicaid Quality in Managed Care, please contact:

qualityinmc@ahca.myflorida.com