Mission
Statement
The
Division of Health Care Financing provides
access to quality, cost-effective health
care for eligible Utahns.
Division
Director and Assistant Directors -
Michael Deily, 538-6406 - Michael Hales ,
538-6965 and Brenda Bryant, 538-6136
Bureau
of Eligibility Services - Robert Knudson,
538-6416 or Jacky Stokes, 538-6418
The
Bureau of Eligibility Services (BES) is responsible
for eligibility policy and determining eligibility.
(DWS and DHS also make some eligibility determinations
under contract with the Division.) The staff
members determine eligibility for nursing home
residents, families, including pregnant women,
children and other Medicaid only clients. They
also determine eligibility for CHIP and PCN
enrollees. The Bureau has staff stationed throughout
the State in hospitals, local offices of DWS,
Community Health Centers, some local health
departments and Salt Lake and Ogden Agencies
on Aging.
Additionally,
the Bureau has responsibility to manage the
Health Clinics of Utah and the Family Dental
Plan (FDP). The Health Clinics provide direct
medical services at three clinic sites, and
the FDP operates dental clinics that service
Medicaid, PCN and CHIP patients.
Bureau
of Managed Health Care - Julie Olson, 538-6303
The
main objective of the Bureau of Managed Health
Care (BMHC) is to provide Medicaid clients
with the choice of health care delivery programs
(primary care physician or HMO) in order to
enable them to make an informed choice regarding
primary care providers. This includes both
physical and mental health plans. This Bureau
also monitors the performance of the capitated
health maintenance organization programs under
Medicaid and prepaid mental health programs.
This Bureau also administers children’s
initiatives, including the CHEC Program and
the community-based Travis C. Waiver for technology
dependent children.
Bureau
of Financial Services - Kent Roner, 538-6433
or Bruce Wood, 538-6442
This
Bureau is responsible for coordinating internal
and external audits to monitor the Medicaid
service programs, providers, and all Third
Party Liability (TPL) activity. Budget forecasting
and preparation, appropriation requests, monitoring
of program and administration expenditures
and federal reporting are also performed by
the Bureau.
Bureau
of Medicaid Operations - Paula McGuire, 538-6573
The
Bureau of Medicaid Operations’ (BMO)
main objectives are the accurate and expeditious
processing of claims submitted for covered
services on behalf of eligible beneficiaries
and training of providers regarding allowable
Medicaid expenditures and billing practices.
The general responsibilities of this Bureau
include receipt processing and adjudication
of medical claims; publishing all provider
manuals, training providers concerning allowable
Medicaid expenditures and billing practices;
and being the single point of telephone contact
for information about client eligibility, claims
processing, and general questions about the
Medicaid Program.
Bureau
of Coverage and Reimbursement Policy - Blake
Anderson, 538-9925
General
responsibilities of the Bureau of Coverage
and Reimbursement Policy (BCRP) include policy
development, interpretation and implementation
planning. These responsibilities focus on scope
of service. Other functions of this Bureau
are utilization management, prior authorization
of appropriate services, post-payment reviews
and program integrity.
Information
Technology Unit - Dennis Tingey, 538-6677
The
Information Technology Unit (ITU) is responsible
for development and maintenance of the Medicaid
Management Information System (MMIS) and for
the Division’s overall information technology
development plan. The administration of the
Data Warehouse system is coordinated from the
ITU.
Bureau
of Long Term Care - Tonya Keller, 538-9136
The
Bureau of Long Term Care (BLTC) is responsible
for home and community based services policy
and oversight. It coordinates all long-term
care (LTC) issues in the Division. It has the
lead for the Long-Term Care Managed Care Program
and other LTC initiatives.
Bureau
of Access - Nathan Checketts, 538-6043
The
Bureau of Access (BOA) is responsible for administering
the Children’s Health Insurance Program
(CHIP), the Primary Care Network (PCN), and
the Covered at Work (CAW) Program.
11/10/2005
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