Utah Office of Inspector General is created by statute to conduct oversight of the Utah Medicaid program. The office’s oversight focuses on all aspects of the Utah Medicaid program to include traditional Medicaid, referred to sometimes as Fee-For-Service (FFS) Medicaid, and the Managed Care system, known as Managed Care Organizations (MCOs). Managed care is a Medicaid delivery system in which the Utah Department of Health contracts with MCOs to provide Medicaid covered services to enrolled members.
There are three types* of MCOs in the Utah Medicaid system:
1. Physical Health Care: An MCO that provides physical health care services is known as an Accountable Care Organization (ACO).
2. Behavioral Health Care: An MCO that provides behavioral health services is known as a Prepaid Mental Health Plan (PMHP).
3. Dental Services: An MCO that provides dental services is called a Dental Plan.
To learn more about MCOs and how the Utah OIG conducts oversight of the managed care system, please contact us at: UtahOIG@utah.gov or mpi@utah.gov.
* These MCO’s type were obtained from Medicaid’s Section I General Information Manual. Other federal and or state governments might further define what constitutes an MCO. For purposes of this news article we utilized the general definition of an MCO.
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