preauthorize costly or abused services; and inves-
tigates and refers fraudulent activities for prosecu-
tion. By recovering reimbursements from all liable
third parties, the Administration also ensures that
Medicaid is the payor of last resort.

The Administration is organized into three Di-
visions: Utilization and Eligibility Review, Health
Services Review, and Medical Assistance Recov-
eries.

MEDICAL CARE OPERATIONS
ADMINISTRATION

Joseph Davis, Acting Director

201 W. Preston St.
Baltimore 21201 Telephone: 225-5400

The Medical Care Operations Administration
develops and maintains systems for prompt and
accurate reimbursement of claims submitted by
providers of health care services. It maintains files
of approved providers of services and of Maryland
residents certified as eligible to receive services
through the Medical Assistance Program. The
Administration also manages the Maryland Phar-
macy Assistance Program. This State-funded pro-
gram helps pay for prescriptions, insulin, and cer-
tain medical supplies for low-income families and
individuals who are not eligible for Medicaid.

The Administration consists of four Divisions:
Systems and Support Services, Invoice Processing,
Programs and Liaison, and Medicaid Information
Systems.

HEALTH SYSTEMS FINANCING
ADMINISTRATION

Joseph Millstone, Acting Director

300 W. Preston St.
Baltimore 21201 Telephone: 225-1432

Formerly the Policy Administration, the Health
Systems Financing Administration was created by
the Department in 1987. The Administration re-
views and develops Medicaid policies and regula-
tions that establish eligibility criteria, define
services, detail coverage, specify limitations, and
determine reimbursement rates. In addition, it
maintains an up-to-date State Plan and obtains
federal approval for Program changes to assure
the continued availability of federal matching
funds.

The Administration works through four Divi-
sions: Long Term Care, Acute Care, Eligibility
Services, and Specialized Health Services.

LICENSING AND CERTIFICATION
ADMINISTRATION

Henry E. Schwartz, Chief

201 W. Preston St.
Baltimore 21201 Telephone: 225-5430

The Division of Licensing and Certification was
reorganized in 1986 as the Office of Licensing and
Certification Programs. In 1987, the Office was re-
formed as the Licensing and Certification Admin-
istration.

The Administration licenses all hospitals and
health-related institutions in Maryland. The Ad-
ministration also is responsible for certification
recommendations for all facilities participating in
the Medicaid and Medicare Programs. It inspects
facilities and provides consultation and education
for all health facility staffs. The Administration
initiates administrative action against those facili-
ties not in compliance with State rules and regula-
tions.

The Administration consists of three Divisions:
Survey Services, Long Term Care, and Utilization
Review.

Division of Survey Services

Vacancy, Chief
Telephone: 225-5438

The Division of Survey Services regulates health
maintenance organizations, home health agencies,
and State hospitals and correctional institutions.
The Division also surveys federal programs for
compliance with Medicare regulations. These
programs cover end-stage renal dialysis,
independent and outpatient physical therapists,
comprehensive outpatient rehabilitation facilities,
ambulatory surgical centers, rural health clinics,
and portable x-ray units.

Under the Division is the Complaint and Quali-
ty Assurance Unit. The Unit investigates all com-
plaints about any health-related facility. The Unit
also monitors the quality of nursing, sanitation
and dietary services covered by the Divisions of
Survey Services, Long Term Care, Utilization Re-
view, and Drug Control.