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 |
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 |
Limitless Recovery | All questions |
MATR* |
All questions |
Midtown Community Health Center – Ogden* |
All questions |
Mountainlands Community Health Center/Mountainlands Family Health Center* |
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 |
Turning Point - Vernal* |
Questions 1, 2 and 4 |
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 |
Adult Parole and Probation (AP&P) |
All questions |
Alpha Counseling |
All questions |
Atherton Community Treatment Center |
All questions |
Bear River Health Department |
All questions |
Bear River Mental Health |
All questions |
Beecon Recovery |
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 |
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 |
First Step House - SLC |
All questions |
Four Corners Community Behavioral Health |
All questions |
Fortitude Treatment Center |
All questions |
Horizon House |
Question 2 |
House of Hope |
All questions |
Huntsman Mental Health Institute - all locations |
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 |
Limitless Recovery | All questions |
MATR |
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 |
Pomarri |
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 |
Southwest Behavioral Health Center | All questions |
State Prison (Department of Corrections) - Draper |
All questions |
Steps Recovery Centers* |
All questions |
The Other Side Academy (TOSA) | Question 4 |
True North Recovery |
All questions |
Urban Indian Center - SLC |
All questions |
U.S. Probation | All questions |
Utah County Dept. of Drug and Alcohol Prevention and Treatment | All questions |
Utah County Public Defender Association | 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 |
State Hospital |
Form 44A |
State Hospital - Provo |
All questions |