Performance Measure Data Submissions for Medicaid

The Agency monitors the Medicaid health plans’ performance through a combination of HEDIS, Adult and Child Core Set, and Agency-defined performance measures. These can be used to compare the performance of Medicaid health plans.

HEDIS measures are developed by the National Committee for Quality Assurance (NCQA), which is a private, not-for-profit organization dedicated to improving health care quality. NCQA develops quality standards and performance measures for a broad range of health care entities. These are the measures and standards that AHCA, like most managed care organizations, uses to help identify opportunities for improvement.

Adult[ ] and Child Core Set[ ] measures are developed by the Centers for Medicare & Medicaid Services (CMS), which is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer the Medicaid program.

Agency-defined measures are developed by the Agency for Health Care Administration and are used for areas of focus for which no national measures are available. The Agency posts separate technical specifications manuals for

Managed Medical Assistance (MMA) [ 183.7 kB ]

and

Long-term Care (LTC) [ 375.4 kB ]

for health plans to use when calculating these measures.