Breaking News

Maryland Physicians Care (MPC) Provider Relations Representatives Maryland Physicians Care

ROI Calculator for Partnerships to Address Social Determinants of Health

ROI Forecasting Calculator for Quality Initiatives

Return on Investment Calculator (R.O.I.) for College Mental Health Services and Programs

Comprehensive Medicaid Actuarial Data (FL)

Medi-Cal Managed Care Enrollment Report

Opioid Settlement Distribution: Colorado Regions

CAQH Index Benchmarks & Time Spent on Administrative Work in Healthcare

Medi-Cal Managed Care Quality Improvement Reports (CA)

Eligibility: Contract Language (Payer v Provider) and Sample to Use

Agency: Florida Agency for Health Care Administration

Market: Florida

Line of Business: Medicaid

Market: Florida

Line of Business: Medicaid

Agency: Florida Agency for Health Care Administration

Source: Medicaid Actuarial Services

Advanced financial and statistical support relating to Capitation Rates, Risk Adjustment Models, and Payment Methodologies.

Medicaid Actuarial Services

For Institutional Reimbursement rates, please click here.

Institutional Reimbursement

For Institutional Reimbursement rates, please click here.

Medicaid Actuarial Services

This post is useful for those seeking information on Medicaid actuarial services and related rates in Florida.

  • Outlines Medicaid actuarial services provided by the Bureau, including advanced financial and statistical support for Capitation Rates, Risk Adjustment Models, and Payment Methodologies.
  • Provides information on Managed Medical Assistance (MMA), Long-Term Care (LTC), and Dental Capitation Rates for various years.
  • Includes a link to a Special Needs Plan Revenue and Expense Schedule Statement Template Tool.

Unit Responsibilities include:

  • Support of Capitation Rate Development and Adjustment
  • Management of External Actuarial Service Contracts
  • Monitoring Medicaid Program Changes
  • Trend Analysis
  • Rate Impact Analysis

Medicaid Actuarial Services

This post is useful for those seeking information on Medicaid actuarial services and related rates in Florida.

  • Outlines Medicaid actuarial services provided by the Bureau, including advanced financial and statistical support for Capitation Rates, Risk Adjustment Models, and Payment Methodologies.
  • Provides information on Managed Medical Assistance (MMA), Long-Term Care (LTC), and Dental Capitation Rates for various years.
  • Includes a link to a Special Needs Plan Revenue and Expense Schedule Statement Template Tool.

For Institutional Reimbursement rates, please click here.

SMMC Capitation Information

Managed Medical Assistance (MMA)

Long-Term Care (LTC)

Dental

Medicare Dual Eligible Special Needs Plans (D-SNPs) and Fully Liable Medicare Advantage Plans

Special Needs Plan Revenue and Expense Schedule Statement Template Tool [ excel 160.5 kB ] Effective July 1

This dataset contains the total number of Medi-Cal Managed Care enrollees based on the reported month, plan type, county, and health plan.

Medi-Cal Managed Care Enrollment Report

The Medi-Cal Managed Care Enrollment Report is a dataset that contains information about the number of people enrolled in Medi-Cal Managed Care plans based on reported month, plan type, county, and health plan. This report is an important tool for policymakers and researchers who want to better understand the state of healthcare in California.

The dataset provides valuable insights into the number of people enrolled in Medi-Cal Managed Care plans, which are designed to provide affordable healthcare to low-income Californians. By analyzing the data in the report, policymakers and researchers can identify trends in enrollment, plan type, and county-level differences in enrollment rates.

One important trend that the report highlights is the increasing popularity of Medi-Cal Managed Care plans. As of the latest reported month, the total number of people enrolled in these plans was higher than ever before, indicating that more Californians are taking advantage of these affordable healthcare options.

Another important trend is the differences in enrollment rates across different counties in California. The report shows that some counties have higher enrollment rates than others, indicating that there may be disparities in access to healthcare across the state.

Overall, the Medi-Cal Managed Care Enrollment Report is an essential resource for anyone interested in understanding the state of healthcare in California. By providing detailed information about enrollment in Medi-Cal Managed Care plans, this report can help policymakers and researchers identify areas where improvements can be made, and ensure that all Californians have access to affordable, high-quality healthcare.

Medi-Cal Managed Care Enrollment Report

The California Department of Health Care Services contracts with an external quality review organization to evaluate the care provided to Medi-Cal managed care beneficiaries in the areas of quality, access, and timeliness. Reports are available on the DHCS website, including member satisfaction surveys, encounter data validation study reports, managed care accountability sets, external quality review technical reports, plan-specific evaluation reports, health disparity reports, HEDIS® reports, MCP-specific performance evaluation reports, performance improvement project reports, and preventive services reports.

Outline

  • Introduction: Purpose of the DHCS external quality review organization
  • Available Reports:
    • Member Satisfaction Surveys
    • Encounter Data Validation Study Reports
    • Managed Care Accountability Sets/External Accountability Sets
    • External Quality Review Technical Reports and Plan-Specific Evaluation Reports
    • Health Disparity Reports
    • HEDIS® Reports
    • MCP-Specific Performance Evaluation Reports
    • Performance Improvement Project Reports
    • Preventive Services Report
  • Conclusion: Summary of available reports and their purpose.

In accordance with federal requirements, the California Department of Health Care Services (DHCS) contracts with an external quality review organization (EQRO) to conduct external quality reviews and evaluate the care provided to beneficiaries by Medi-Cal managed care health plans (MCPs) in the areas of quality, access, and timeliness. The EQRO presents these external quality review activities, results, and assessments in reports that help DHCS and Medi-Cal MCPs understand where to focus resources to further improve the quality of care.

Medi-Cal Managed Care Quality Strategy Reports

The Medi-Cal Managed Care Quality Strategy Reports are DHCS’ written strategy for assessing and improving the quality of managed care services offered by all Medi-Cal MCPs.

Member Satisfaction Surveys (CAHPS® Surveys)

Each Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey report aggregates the results of CAHPS® surveys, which ask Medi-Cal managed care beneficiaries to evaluate their experiences with their health care health care providers.

Encounter Data Validation Study Reports

Encounter Data Validation (EDV) Study Reports examine the completeness and accuracy of the encounter data submitted to DHCS by the MCPs.

Managed Care Accountability Sets / External Accountability Sets

The Managed Care Accountability Sets (MCAS) / External Accountability Set (EAS) is a set of performance measures that DHCS selects for annual reporting by Medi-Cal MCPs.

External Quality Review Technical Reports and Plan-Specific Evaluation Reports

The EQRO annually prepares an independent external quality review technical report that analyzes and evaluates aggregated information on the health care services provided by Medi-Cal MCPs. As part of the external quality review technical report, the EQRO prepares a plan-specific evaluation report of each of MCP.

Access these reports on the Medi-Cal Managed Care External Quality Review Technical Reports with Plan-Specific Evaluation Reports.

Health Disparity Reports

The Health Disparity Reports identify and understand health disparities affecting California’s Medi-Cal managed care members and are based on focused studies conducted annually by the EQRO. The reports analyze Managed Care Accountability Set (MCAS) measure results reported by Medi-Cal managed care plans (MCPs) for various demographic categories.

HEDIS® Reports

The Healthcare Effectiveness Data and Information Set (HEDIS®) Aggregate Report, also referred to as Performance Measurement Reports, provides performance rates of MCPs during a reporting year and trending using previous years’ data. The report also compares plan-specific and aggregated rates to national benchmarks.

MCP-Specific Performance Evaluation Reports

The MCP-Specific Performance Evaluation Reports are also referred to as Plan-Specific Performance Evaluation Reports.

Access these reports on the Medi-Cal Managed Care Quality Improvement Reports webpage

Performance Measures and HEDIS® Reports

Access Medi-Cal Managed Care’s annual performance measure, External Accountability Set, on the Medi-Cal Managed Care Quality Improvement Reports webpage.

The following performance measure results are also available on our website:

Performance Improvement Project Reports

Plan-Specific Performance Evaluation Reports

Plan-Specific Performance Evaluation Reports are also referred to as MCP-Specific Performance Evaluation Reports.

Access the reports on the  Medi-Cal Managed Care Quality Improvement Reports: External Quality Review Technical Reports and Plan-Specific Evaluation Reports.

Quality Improvement Project Reports

Quality Improvement Project (QIP) Reports are available on the Medi-Cal Managed Care Quality Improvement Reports: Quality Improvement Project Reports webpage.

Technical Reports

Technical Reports are available on the Medi-Cal Managed Care Quality Improvement Reports: External Quality Review Technical Reports webpage.

Preventive Services Report

The 2021 Preventive Services Report and Executive Summary assist with identifying and monitoring appropriate utilization of preventive services for children in Medi-Cal Managed Care.

The 2020 Preventive Services Report and Addendum assesses the provision of preventive services by pediatric Medi-Cal managed care members.

The Birth Count Query System is a highly useful online tool provided by the Florida Department of Health. It offers a plethora of data on birth counts in Florida, and can be accessed easily through this link: https://www.flhealthcharts.gov/FLQUERY_New/Birth/Count.

This comprehensive tool is an excellent resource for researchers and analysts who are interested in delving deeper into birth trends in Florida. The system provides data that is updated regularly, offering a wealth of information on birth counts across different areas of the state, as well as various demographics. By using this system, researchers and analysts can gain valuable insights into the factors that affect birth rates in Florida, and can make informed decisions based on the data provided by the tool. Additionally, the system can also be used to identify areas where further research is needed, helping to drive innovation in the field of birth rate analysis.

%d bloggers like this: