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

Complete the form by obtaining the required signature attesting to the accuracy of the information
as reported by the health plan. Report the 85/15 Medical Loss Ratio Template using the
instructions supplied under the 20 ___ 20 ___ Report Guide, Chapter and Exhibit of the 20 ___
20 ___ Medicaid Health Plan Contract.
The quarterly worksheet must be received by the Agency no later than 45 calendar days after the
end of the reporting quarter. The annual worksheet must be received by the Agency on or before,
but no later than close of business on September 15, 2013. Email the worksheet to
MMCFIN@ahca.myflorida.com or mail to the following address to be received by the Agency on
or before the due date:
Agency for Health Care Administration
Bureau of Managed Health Care
Attention: Hazel Greenberg, Program Administrator
2727 Mahan Drive, MSC #26
Tallahassee, Florida 32308
For questions regarding the filing of the MLR, please contact Ms. Greenberg at (850)412-4292 or
via email at Hazel.Greenberg@ahca.myflorida.com.
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