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

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esidency requirements and the residency positions funded by the plans are active providers of care to Medicaid and uninsured patients. ** (c) Prior to final determination of the medical loss ratio for any period, a plan may contribute to a designated state trust fund for the purpose of supporting Medicaid and indigent care and have the contribution counted as a medical expenditure for the period. * Please provide a copy of the first and last page of any capitated provider/subcontractor contract if reporting capitation paid to providers/subcontractors. ** Please provide an attestation from the graduate medical education institutions that the funding amount is sufficient to sustain the position(s) for the number of years necessary to complete the residency requirements and the residency positions funded are active providers of care to Medicaid and uninsured patients (included Medicaid provider identification numbers). Page 4 of 4
DRAFT ATTESTATION OF 201_ QUARTER ENDING _______ HEALTH CARE COVERED SERVICES QUARTERLY MEDICAL LOSS RATIO (USE THE FOLLOWING HEADING FOR THE ANNUAL ATTESTATION) DRAFT ATTESTATION OF 201_ - 20__ HEALTH CARE COVERED SERVICES ANNUAL MEDICAL LOSS RATIO I, , CEO/President of (Health Plan), do hereby swear or affirm that the expenditure information reported for the provision of health care covered services is true and correct to the best of my knowledge and belief. Subscribed and sworn to before me this day of _, 20 . Signature Date (Print Name) Affix Corporate Stamp: Page 5 of 4
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Attachment I Special Term and Condi
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Attachment II Special Term and Cond
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RICK SCOTT GOVERNOR 272 7 Mah an Dr
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• Encounter data • Systems issu
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Appendix A How to Become a Florida
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How to Become a Florida Medicaid He
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Appendix B MCO Application Checklis
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4 5 6 7 8 9 10 Service Level(s) are
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19 b. Total number of employees; AP
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APPLICATION ITEM 25 3. In the past
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32 33 34 35 36 APPLICATION ITEM 10.
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APPLICATION ITEM C. Criminal Backgr
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APPLICATION ITEM 43 13. For medical
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46 47 APPLICATION ITEM 16. Indicate
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49 APPLICATION ITEM 19. Describe in
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51 52 53 54 55 56 APPLICATION ITEM
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Attachment III Special Term and Con
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RICK SCOTT GOVERNOR Regulatory Auth
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e. Complete a credentialing review
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RICK SCOTT GOVERNOR Regulatory Auth
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Compliance Monitoring Tool with Spe
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Standard I: Care Management/Continu
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Results for Standard I Care Managem
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Standarrd II: Utilizatio on Managem
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Standard III: Eligibility, Enrollme
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Standard IV: Enrollee Services & En
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Results for Standard IV Enrollee Se
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Standard V: Provider Credentialing
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Standard VI: Provider Services CONT
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Standard VI: Provider Services CC-
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Standard VI: Provider Services CONT
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Standard VII: Provider Contracting
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AGENCY FOR HEALTHCARE ADMINISTRATIO
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Standard VIII: Quality Improvement
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Results for Standard IX Medical Rec
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Standard X: Access and Availability
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Results for Standard X Access and A
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Standard XI: Grievances and Appeals
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Standard XII: Administration and Ma
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Results for Standard XII Administra
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Standard XIII: Community Outreach C
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Results for Standard XIII Community
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Standard XIV: Covered Services AGEN
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Standard XV: Immunizations, Pregnan
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Vendor Name: Review Period: Date of
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Agency For Health Care Administrati
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File # Case ID # Agency For Health
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File # Case ID # 1 2 3 4 5 6 7 8 9
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13 14 15 Agency For Health Care Adm
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f. Posting of the Agency Summary of
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Name: Review Period: Date of Review
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Page 331 and 332: RICK SCOTT GOVERNOR Better Health C
Page 333: Plan Name: AGENCY FOR HEALTH CARE A
Page 337 and 338: Draft MLR Reporting Schedule Health
Page 339 and 340: RICK SCOTT GOVERNOR PLAN TYPES: Bet
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Page 349 and 350: Attachment VI Special Term and Cond
Page 351 and 352: RICK SCOTT GOVERNOR Better Health C
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