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.
CONTRACT YEAR 6 (2018-2019)
Category A:  Validation of Performance Improvement Projects (Section B.2, Item b., 1)
Plan-specific PIP validation reports and an annual PIP validation summary report:
71 Plan-specific PIP validation reports No later than
June 30, 2019
72 Annual PIP Validation Summary Report No later than
June 30, 2019
Category B:  Validation of Performance Measures (Section B.2, Item b., 2)
73 Annual summary report on performance measure validation activities for HMOs/PSNs/LTC plans (Calendar Year 2017) December 21, 2018
Category F:  Dissemination and Education (Section B.2, Item b., 6)
74 Quarterly Project Activity Report By the 10th of the month following
the calendar quarter end
75 Strategic Summary report of each quarterly meeting Within 30 days of the
quarterly meetings
Category G.  Annual Technical Report (Section B.2, Item b., 7)
76 Annual Technical Report February 28, 2019
Category H.  Technical Assistance on Other Activities (Section B.2, Item b., 8)
77 Annual Recommendations Tracking Report June 1, 2019
For more information about HSAG and external quality review activities, please see HSAG's Florida website at: www.myfloridaeqro.com