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

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Draft Chapter 40 of the Report Guide March 2012 Agency for Health Care Administration
RICK SCOTT GOVERNOR PLAN TYPES: Better Health Care for all Floridians Draft Chapter 40 Quarterly and Annual Medical Loss Ratio Report Health plans that must submit this report: Reform HMOs Reform Capitated PSNs Reform Specialty Plan for Recipients Living with HIV/AIDS REPORT PURPOSE: ELIZABETH DUDEK SECRETARY To supply the Agency with quarterly and annual (July 1 through June 30) unaudited financial data showing Reform Medicaid medical loss ratio (MLR) information in order to comply with the Special Terms and Conditions of Florida’s Section 1115 Research and Demonstration Waiver (Project No. 11-W-002064) approved December 15, 2011. FREQUENCY & DUE DATES: Due quarterly No later than 45 days after the end of the reporting quarter. Due annually by September 15: One unaudited report using the Agency’s supplied template for the June 30 through July 1 year being reported. SUBMISSION: 1. The health plan shall submit the following in an email to the Agency Bureau of Managed Health Care (BMHC) mailbox MMCFIN@ahca.myflorida.com: For the quarterly and the annual submissions: a. The quarterly or annual MLR report using the Agency-supplied template b. A report attestation (see Chapter 2) which shall be named: MLR***YYQ#.pdf for the quarterly and MLR***YYYY-cert.pdf for the annual filing. The attestation must specifically address the accuracy and completeness of the submission. INSTRUCTIONS: 1. The Quarterly and Annual MLR template supplied by the Agency must be used to report the quarterly and annual MLR. 2. The health plan shall report the MLR for the previous July 1 through June 30 annual period. 272 7 M ah an D r i v e • M ai l S t op #1 T al l a has s ee, F L 3 23 08 Page 1 of 2 V i s i t A H C A onl i n e at A H C A . M y F l or i da. c o m
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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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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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5. 6. 7. 8. 9. local WIC office to
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Page 329 and 330: Medical Loss Ratio The following dr
Page 331 and 332: RICK SCOTT GOVERNOR Better Health C
Page 333 and 334: Plan Name: AGENCY FOR HEALTH CARE A
Page 335 and 336: DRAFT ATTESTATION OF 201_ QUARTER E
Page 337: Draft MLR Reporting Schedule Health
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Page 343 and 344: RICK SCOTT GOVERNOR Mission to Ensu
Page 345 and 346: • Obtaining data from the health
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Page 351 and 352: RICK SCOTT GOVERNOR Better Health C
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Letter to CMS - Medicaid Managed Care Policies - Agency for ...

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