In the rural areas choosing a primary care provider or MCO is voluntary and Medicaid clients may remain with traditional fee for service. The program is administered by the Utah Department of Health, Division of Health Care Financing.
Enrollment is voluntary in the rural areas.
The State arranges for an annual independent, external review of the quality of services delivered under each MCO contract with the State. The entity which provides the annual external quality review is not part of the State government, and is not a managed care organization or an association of managed care organizations. The entity is HealthInsight, the federally-designated Peer Review Organization for Utah. Utah beneficiaries living in the four urban counties must enroll in an MCO, while beneficiaries living in rural counties have the choice of the MCO or PCCM model. The MCO will provide all primary care services and referral for all necessary speciality services for the Medicaid population.