Health Care Policy, Finance, and Regulation
oversees the principal health regulatory functions
of the Department and provides leadership and
guidance for the Department's financing, regula-
tory and licensing programs. This entails oversight
of regulatory functions of the State Health Services
Cost Review Commission, the State Health Re-
sources Planning Commission, and the Maryland
Health Care Access and Cost Commission; compli-
ance with regulations and standards of the Medical
Care Finance and Compliance Administration and
the Licensing and Certification Administration;
payments for services through the Program Systems
and Operations Administration; and financing and
policy of the Medical Care Policy Administration.
With the assistance of the Policy and Health
Statistics Administration, the Deputy Secretary de-
velops recommendations for the Secretary of
Health and Mental Hygiene to modify and shape
the role of the Department. The Deputy Secretary
helps define health problems, evaluates Depart-
ment programs, and develops data on federal and
other external trends so as to advise the Secretary
on program emphasis and Department direction.
The Deputy Secretary plans, directs, and evalu-
ates the Medical Assistance Program (Medicaid). The
Medical Assistance Program provides access to health
care for categorically and medically needy residents
throughout Maryland. Health care includes hospital
inpatient and outpatient services, laboratory and X-
ray services, nursing facility services, physician serv-
ices, and home health care. Additional health care is
available as indicated in the Medical Assistance State
Plan. The Program is implemented by the Medical
Care Finance and Compliance Administration, the
Program Systems and Operations Administration,
and the Medical Care Policy Administration.
Health care expenses of the Medical Assistance
Program are federally matched on a 50/ 50 basis
for approximately 90 percent of the recipients. For
the remaining 10 percent, services are funded to-
tally by State and local funds (Code Health—Gen-
eral Article, sees. 15-101 through 15-128).
Under the Deputy Secretary are three administra-
tions: Medical Care Finance and Compliance; Medical
Care Policy; and Program Systems and Operations.

MEDICAL CARE FINANCE &
COMPLIANCE ADMINISTRATION

Lawrence P. Triplett, Director
Kenneth S. Smoot, Deputy Director
Diane C. Herr, Deputy Director

201 West Preston St., Room 200
Baltimore, MD 21201—2399 (410) 767-5204

The Medical Care Finance and Compliance Ad-
ministration began in 1975 as the Medical Care

Compliance Administration. In November 1993,
the Administration merged with the Office of Ad-
ministration and Finance to form the Medical Care
Finance and Compliance Administration. By devel-
oping and implementing procedures to monitor
and control the delivery of health care services, the
Administration assures that benefits of the Medical
Assistance Program (Medicaid) are used effectively.
The Administration designs computer applications
to detect aberrant practices; administers systems to
require preauthorization for certain services; and
investigates and refers fraud for prosecution. By
recovering reimbursements from all liable third
parties, the Administration also ensures that Medi-
caid is the payor of last resort.
The Administration has nine divisions: Acute
Care Services; Adjunct Services; Administrative
Services; Audit; Budget; Long-Term Care; Medical
Assistance Recoveries; Provider Reimbursement;
and Utilization and Eligibility Review.

DIVISION OF ACUTE CARE SERVICES
Stanley H. Freedman, Chief
(410)767-1722

Established in 1987, the Division of Acute Care
Services reviews and monitors the use of acute care
services provided by general and special hospitals,
physicians, and clinics reimbursed by the Medical
Assistance Program.

DIVISION OF ADJUNCT SERVICES
Janet G. Freeze, Acting Chief
(410) 767-1743

The Division of Adjunct Services was organized
in 1976. The Division controls and monitors serv-
ices provided to recipients of the Medical Assistance
Program and the Pharmacy Assistance Program.
These services cover ambulance and wheelchair
vans; dental care; durable medical equipment and
disposable supplies; hearing aids; laboratory; oxy-
gen; pharmacy; physical therapy; podiatry; and vi-
sion care. The Division also contracts with the
Maryland Pharmacists Association and the Center
on Drugs and Public Policy of the University of
Maryland System to review drug use.
The Division develops and implements policies,
guidelines, standards, and procedures to assure that
providers of health care services comply with federal
and State laws, regulations, plans, and policies. For
the Medical Assistance Program, the Division
monitors and evaluates services and the degree to
which they are used; and designs, develops, and
implements standards and mechanisms for detect-
ing fraud or misuse of the Program. Generally,
providers who misuse the Program are required to
reimburse funds. Cases of suspected fraud are re-
ferred to the Medicaid Fraud Control Unit of the
Office of the Attorney General.