Medicaid Quality

Marie Donnelly
Bureau Chief

2727 Mahan Drive
Mail Stop #38
Tallahassee, FL 32308

Phone: (850) 412-4147

The Quality Bureau provides data-driven, focused and systematic feedback on the quality of Florida’s Medicaid program to federal and state agencies, Medicaid recipients, Medicaid managed care plans, and providers. Florida’s 2014 transition from a mix of fee-for-service and managed care to mostly managed care hastened a newly-honed focus on quality: providing more comprehensive care, improving health outcomes, and reducing costs.

The Quality Bureau is responsible for the following:

Federal Reports

The State of Florida is required to furnish a written quality strategy to the federal Centers for Medicare and Medicaid Services (CMS) every three years.  This report must include a written quality strategy for assessing and improving the quality of health care and services furnished by the managed care organizations and other providers within Florida Medicaid.  The Medicaid Quality Bureau of the Agency for Health Care Administration (the Agency) is compiling a new Comprehensive Quality Strategy (CQS) report, outlining Florida Medicaid’s priorities and goals for continuous quality improvement, the performance improvement efforts that align with and promote these priorities/goals, and the quality metrics and performance targets to be used in measuring performance and improvements to provide “better health care for all Floridians”.

A draft of the 2017 Comprehensive Quality Strategy report was submitted to CMS on March 3, 2017 for approval.  A copy of the draft report is located at the following link: Comprehensive Quality Strategy Report.

Performance Evaluation and Research

Clinical Quality Review and Initiatives

Quality Performance Review and Clinical Monitoring

Utilization Management Contracts