Letter to CMS - Medicaid Managed Care Policies - Agency for ...

Medical Loss Ratio
The following draft amendment language was provided to the managed care provider industry on
February 17, 2012, and a conference call was held with the industry on February 27, 2012, to
discuss the changes to be included in each health plan’s Contract Attachment II, Core Contract
Provisions, Section II, General Overview, Item D., General Responsibilities of the Health Plan:
In accordance with the Florida’s Section 1115 Demonstration Special Terms and Conditions,
capitated health plans shall maintain an annual (July 1 through June 30) medical loss ratio (MLR)
of eighty-five percent (85%) for operations in the demonstration counties beginning July 1, 2012.
The health plan shall submit data to the Agency for Health Care Administration quarterly to show
ongoing compliance. The Centers for Medicare & Medicaid Services will determine the corrective
action for non-compliance with this requirement.
The draft update to the Report Guide is in the following template and draft chapter. These updated
modifications will be posted April 1, 2012, and will be effective 90 days later on July 1, 2012.
Health plans will be expected to submit quarterly and annual MLR reports using a new Agency
supplied template (see enclosed draft Chapter 40 of the Report Guide). Quarterly reports will be
due to the Agency no later than 45 days following the close of the quarter. The first Annual MLR
report, for the waiver demonstration year July 1, 2012 - June 30, 2013, is due to the Agency
September 15, 2013.
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