As Florida transitions to the next six-year Statewide Medicaid Managed Care (SMMC) program contract period, Medicaid providers should prepare for the changes taking effect on February 1, 2025. The SMMC 3.0 program will be managed by eight managed care organizations (MCOs), coordinating health care for approximately three million Medicaid recipients.

To assist providers in navigating this transition, the Agency for Health Care Administration (AHCA) has created a dedicated New SMMC Program webpage featuring a comprehensive suite of resources, including:

• Program Guides and Training Tools: Comprehensive updates on SMMC program changes and requirements, along with tailored resources designed to help providers effectively understand and implement the new program updates.
• Frequently Asked Questions: Answers to common provider concerns about the transition.
• Program Implementation Updates: Regular updates on compliance requirements and timelines.

Plan Contacts: A Key Resource

A critical tool for providers is the directory of MCO plan contacts. This directory enables direct communication with MCO representatives for a variety of needs, including:

• Contracting and Credentialing: Joining MCO networks, updating credentials, or modifying contracts.
• Claims and Reimbursement Issues: Resolving denied or delayed claims and addressing reimbursement concerns.
• Prior Authorization and Referrals: Navigating approval processes and ensuring seamless care coordination.
• Care Coordination and Case Management: Collaborating on member care plans or addressing complex patient needs.
• Member Eligibility and Benefits: Verifying member enrollment, coverage, and benefits.

Quality and Value-Based Purchasing Programs

SMMC 3.0 introduces enhanced quality and value-based purchasing (VBP) programs as mandatory components of Managed Medical Assistance (MMA) contracts. These initiatives are designed to:

• Improve health outcomes for Medicaid recipients.
• Reward providers for delivering high-quality, cost-effective care.
• Foster innovation and accountability in health care delivery.

Providers are encouraged to review the requirements and opportunities within these programs to optimize both patient outcomes and financial performance.

Next Steps

To ensure a smooth transition to SMMC 3.0:

1. Explore AHCA Resources: Visit AHCA’s New SMMC Program webpage to access guides, tools, and updates.
2. UItilize Plan Contacts: Reach out to MCO representatives for assistance with contracting, claims, or care coordination.
3. Understand Quality and VBP Programs: Familiarize yourself with program requirements to align your practices with the new quality and accountability standards.

Stay informed and take advantage of these resources to successfully navigate the transition to SMMC 3.0. For more information, visit AHCA’s webpage here.