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Petitioner compensated IHC Direct Care Plus PCPs and SCPs on
a discounted fee-for-service basis. During 1999, petitioner
applied discounts of 26 percent and 38 percent to estimated
market rate fees for PCPs and SCPs, respectively.
7. Health Choice
Petitioner’s Health Choice plan offered enrollees access to
a panel of 2,600 PCPs and SCPs along with the option to use an
independent physician or facility. Health Choice enrollees
choosing Health Choice physicians or facilities received higher
“preferred” levels of service, whereas Health Choice enrollees
choosing non-Health Choice physicians or facilities received
lower “standard” benefits.
Petitioner compensated Health Choice PCPs and SCPs on a
discounted fee-for-service basis. During 1999, petitioner
applied discounts of 23 percent and 28 percent to estimated
market rate fees for PCPs and SCPs, respectively.
8. IHC Access
Petitioner entered into a so-called risk contract9 with the
Utah Department of Health (Department), effective January 1, 1995
through June 30, 1999, under which it agreed to arrange for the
9 42 C.F.R. sec. 447.361 (2000) states: “Under a risk contract,
Medicaid payments to the contractor, for a defined scope of
services to be furnished to a defined number of recipients, may
not exceed the cost to the agency of providing those same
services on a fee-for-service basis, to an actuarially equivalent
nonenrolled population group.”
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