Quality Improvement & Evaluation Contracts
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 contractual requirements, and providing technical assistance to vendors.
Quality Management Contracts
Florida Medicaid’s quality improvement contracts ensure that Medicaid recipients receive medically necessary and quality services in the most cost-effective manner. The entities providing quality management review services currently under contract with the Agency are:
- Magellan Health Care QIO, LLC
- Qlarant Quality Solutions, Inc.
- Healthy Start MomCare Network, Inc.
- Kepro Acquisitions, LLC
- eQ Health Solutions, LLC
- Myers and Stauffer, LC.,
- The University of Florida
- Netsmart Technologies, Inc., and
- Area Agencies on Aging
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. The entities providing research and evaluation services currently under contract with the Agency are:
- University of Florida
- University of Florida, ICHP
- Florida State University
- Florida Medical Schools Quality Network
Medicaid Managed Care External Quality Review
In compliance with federal requirements, Florida contracts with an external quality review organization (EQRO) to conduct a comprehensive, independent quality review of its Medicaid managed care programs. The purpose of the external quality review is to drive health care quality improvement and identify the health plans' strengths and weaknesses with respect to the quality, timeliness, and access to Medicaid health care services. The Agency’s current vendor for this contract is Health Services Advisory Group, Inc. (HSAG).
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
