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. 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 submission to the Centers for Medicare and Medicaid Services; and
- Technical assistance on other activities.
For more information about HSAG and external quality review activities, please see HSAG's Florida website at: https://www.hsag.com/myfloridaeqro
Agency Contact: Breanna O’Neal
