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

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.
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