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:

Key Deliverables for 2015 - 2016
Deliverable / Activity Name Due Date
Validation of performance improvement projects (Annual Summary Report) June 10, 2016
Validation of performance measures (Annual Summary Report) November 20, 2015
Review of compliance with access, structural and operations standards May 27, 2016
Validation of encounter data May 27, 2016
Focused studies TBD
Dissemination of information to keep key stakeholders within and outside of Medicaid involved and informed of
External Quality Review work projects and tasks (Quarterly Meetings)
August 25, 2015
November 17, 2015
February 2, 2016
May 17, 2016
Completion of an Annual Technical Report February 29, 2016
Technical assistance on other activities TBD

For more information about HSAG and external quality review activities, please see HSAG's Florida website at: www.myfloridaeqro.com

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