Medicaid Policy
Medicaid Policy
The following agencies may complete the TAM referral forms (42A, 43A and 44A) for a TAM coverage group.
An '*' denotes which agencies can complete the 45A for the General Assistance sub-group.
This list is not all inclusive. If a form is completed by an agency who is not listed below, please contact a DWS Medical Program Specialist for further guidance.
Column 1: Approved Providers
Column 2: Indicates the questions they are approved to answer (do not need all questions answered, one is sufficient)
|
Chronically Homeless |
Form 42A |
|
7th Street Treatment* |
All questions |
|
Bear River Mental Health* |
All questions |
|
Bear River Association of Governments (BRAG)
|
All questions |
| Beacon House* | All questions |
|
Central Utah Counseling* |
All questions |
|
Clinical Consultants* |
All questions |
|
Community Connection Center |
All questions |
|
Crossover Recovery Center |
All questions |
|
Davis Behavioral Health* |
All questions |
|
Division of Child and Family Services (DCFS) |
All questions |
|
First Step House - SLC* |
All questions |
|
Four Corners Community Behavioral Health* |
All questions |
|
Fourth Street Clinic – SLC* |
All questions |
|
Grace Mary Manor - SLC |
All questions |
|
Haven* |
All questions |
|
Horizon House - Cedar City* |
All questions |
|
House of Hope* |
All questions |
|
Housing Authority of Salt Lake City (HASLC) |
All questions |
|
Housing Connect |
All questions |
|
INN-Between |
All questions |
|
Iron County Care and Share |
All questions |
|
Lantern House (St. Anne’s) - Ogden |
All questions |
|
Midtown Community Health Center – Ogden* |
All questions |
|
Mountainlands Community Health Center/Mountainlands Family Health Center* |
All questions |
| My Story Matters | All questions |
|
Next Level Recovery |
All questions |
|
Northeastern Counseling Center* |
All questions |
|
Odyssey House - SLC* |
All questions |
|
Ogden Police Department |
All questions |
|
Optum Salt Lake County* |
All questions |
|
Palmer Court - SLC |
All questions |
|
Papilion Intergrated Recovery Center |
All questions |
|
Rescue Mission – SLC and Ogden |
All questions |
|
Road Home - SLC |
All questions |
|
Safe Harbor Crisis Center |
Question 3 |
|
SAIL |
All questions |
|
Salt Lake County Criminal Justice Services |
All questions |
|
Salt Lake County Division of Behavioral Health* |
All questions |
|
Salt Lake Legal Defender Association |
All questions |
|
San Juan Counseling Services* |
All questions |
|
Southwest Behavioral Health Center* |
All questions |
|
Switch Point - St. George* |
All questions |
|
Switch Point - Tooele Community Resource Center |
All questions |
|
Urban Indian Center - SLC |
All questions |
|
Utah County Dept. of Drug and Alcohol Prevention and Treatment* |
All questions |
|
Utah Harm Reduction Coalition (UHRC) |
All questions |
|
Utah Naloxone* |
Question 4 (Only question 1 on 45A) |
|
Valley Behavioral Health* |
All questions |
|
Volunteers of America (VOA)* |
All questions |
|
Wasatch Behavioral Health* |
All questions |
|
Weber Housing Authority |
All questions |
|
Weber Human Services* |
All questions |
|
Weigand Homeless Resource Center |
All questions |
|
YWCA - SLC* |
All questions |
|
Justice Involved |
Form 43A |
| Access Foundation (The) | All questions |
|
Adult Parole and Probation (AP&P) |
All questions |
|
Alpha Counseling |
All questions |
| AMP Probation | All questions |
| Ardu Recovery* | All questions |
|
Atherton Community Treatment Center |
All questions |
| Beacon House* | All questions |
|
Bear River Health Department |
All questions |
|
Bear River Mental Health |
All questions |
|
Beecon Recovery - Brigham City |
All questions |
| Beecon Recovery - Heber | All questions |
|
Bonneville Community Correctional Center |
All questions |
|
Box Elder County Sheriff's Office |
All questions |
|
Building Beginnings |
All questions |
|
Cache County Sheriff's Office |
All questions |
|
Cache Valley Recovery (CVR) |
All questions |
| Cedar Ridge Recovery | All questions |
|
Central Utah Counseling |
All questions |
|
Clinical Consultants |
All questions |
|
Collective Recovery Center |
All questions |
|
Community Connection Center |
All questions |
|
Crossover Recovery Center |
All questions |
|
Courts - Any federal, state, county, city or tribal mental health/drug court throughout the state. Defenders office with any court. |
Questions 2, 3 and 4 |
|
Davis Behavioral Health |
All questions |
|
Division of Child and Family Services |
All questions |
|
Division of Juvenile Justice and Youth Services (JJYS) |
All questions |
| Eos Serenity Lodge | All questions |
|
First Step House - SLC |
All questions |
| Fortitude Treatment Center | All questions |
|
Four Corners Community Behavioral Health |
All questions |
| Golden Steps Recovery* | All questions |
| Helping Hearts Recovery* | All questions |
|
High Desert Counseling*
|
All questions |
| Hope Rising* | All questions |
|
Horizon House |
Question 2 |
|
House of Hope |
All questions |
|
Huntsman Mental Health Institute - all locations |
All questions |
| I Am Recovery* | All questions |
|
J Walker Sober Living & IOP |
All questions |
|
Jails – By County: Beaver, Cache, Davis, Garfield, Kane, Millard, SLC, Tooele, Utah, Weber. Includes county agencies working with the jails. |
Question 1 |
|
Judicial Supervision Services |
All questions |
|
Liberty Addiction Recovery Centers |
All questions |
| My Story Matters | All questions |
|
Next Level Recovery |
All questions |
|
New Season Treatment Center - Bountiful |
All questions |
|
Northeastern Counseling Center |
All questions |
|
Northern Utah Community Correctional Center |
All questions |
|
Odyssey House – SLC |
All questions |
|
Optum Salt Lake County |
All questions |
|
Orange Street Community Correctional Center |
All questions |
|
Papilion Integrated Recovery Center |
All questions |
| Phoenix Rising | All questions |
|
Pomarri |
All questions |
| Premier Counseling* | All questions |
|
Psychiatric and Behavioral Solutions (PBS) |
All questions |
| Recovery Innovations International (RI) | All questions |
| Renaissance Ranch Treatment Centers | All questions |
| Riverton Family Life Center (Also known as Foundation for Family Life and MentorWorks) | All questions |
| Salt Lake County Criminal Justice Services | All questions |
| Salt Lake County Division of Behavioral Health | All questions |
| Salt Lake Legal Defender Association | All questions |
| San Juan Counseling Center | All questions |
| Sanpete County Sheriff's Office | All questions |
| SOL Recovery Community |
All questions
|
| Southwest Behavioral Health Center | All questions |
|
State Prison (Department of Corrections) - Draper |
All questions |
|
Steps Recovery Centers* |
All questions |
|
The Next Right Thing
|
All questions |
| The Other Side Academy (TOSA) | Question 4 |
| Timpanogos Community Treatment Center | All questions |
|
True North Recovery |
All questions |
| Turning Point Centers* | All questions |
| Upper Mesa Recovery* | All questions |
|
Urban Indian Center - SLC |
All questions |
| U.S. Probation | All questions |
| Utah Case Management | All questions |
| Utah County Dept. of Drug and Alcohol Prevention and Treatment | All questions |
| Utah County Public Defender Association | All questions |
| Utah Harm Reduction Coalition | All questions |
| Valley Behavioral Health | All questions |
| Wasatch Behavioral Health | All questions |
|
Washington County Court Support Services |
All questions |
|
Weber County Correctional Facility (WCCF) |
All questions |
|
Weber County Sheriffs Kiesel Facility |
All questions |
|
Weber Human Services |
All questions |
| Weber Public Defender Group | All questions |
|
State Hospital |
Form 44A |
|
State Hospital - Provo |
All questions |
|
General Assistance |
Form 45A |
| Bonneville Family Practice | All questions |
| Comprehensive Treatment Center (CTC) - Taylorsville | All questions |