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H0523	801	0	1	01	01	H0523_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H0523	801	0	1	01	01	H0523_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H0523	805	0	1	01	01	H0523_805_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H0523	805	0	1	01	01	H0523_805_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H0524	008	0	1	01	01	H0524_008_0	7	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	11	10a1;11a;11b2;4a;		13e;		2				1	11	11a;11b2;	13e;																																																																					0	0			0	0																																																																					0	0																																																																																																															2																																																																																																																																															1	01	4a;10a1;										0.00	0.00																																																							0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H0524	033	0	1	01	01	H0524_033_0	7	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	11	7d;7g;10a1;11a;11b2;4a;	1	13e;		2				1	11	11a;11b2;	13e;																																																																					0	0			0	0																																																																					0	0																																																																																																															2																																																																																																																																															1	01	4a;7d;7g;10a1;										0.00	0.00													0.00	0.00							0.00	0.00																																	0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H0524	059	0	1	01	01	H0524_059_0	7	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	11	4a;7c;7d;7g;7i;10a1;11a;11b2;	1	13e;		2				1	11	11a;11b2;	13e;																																																																					0	0			0	0																																																																					0	0																																																																																																															2																																																																																																																																															1	01	4a;7c;7d;7g;7i;10a1;										0.00	0.00											0.00	0.00	0.00	0.00							0.00	0.00					0.00	0.00																											0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H0524	061	0	1	01	01	H0524_061_0	7	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	11	7d;7g;10a1;11a;11b2;4a;	1	13e;		2				1	11	11a;11b2;	13e;																																																																					0	0			0	0																																																																					0	0																																																																																																															2																																																																																																																																															1	01	4a;7d;7g;10a1;										0.00	0.00													0.00	0.00							0.00	0.00																																	0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H0524	063	0	1	01	01	H0524_063_0	8	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	11	7d;7g;8b1;10a1;11a;11b2;4a;7c;7i;8b3;	1	13e;		2				1	11	11a;11b2;	13e;																																																																					0	0			0	0																																																																					0	0																																																																																																															2																																																																																																																																															1	01	4a;7c;7d;7g;7i;8b1;8b3;10a1;										0.00	0.00											0.00	0.00	0.00	0.00							0.00	0.00					0.00	0.00									0.00	0.00			0.00	0.00													0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H0628	001	0	1	02	01	H0628_001_0	2	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1	7f_2;	2	1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;																							10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																					10.00	10.00																																																																																																																																																																																																																																																													2			
H0628	005	0	1	02	01	H0628_005_0	3	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1	7f_2;	2	1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;																							10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																					10.00	10.00																																																																																																																																																																																																																																																													2			
H0628	017	0	1	02	01	H0628_017_0	2	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1	7f_2;	2	1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;																							10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																					10.00	10.00																																																																																																																																																																																																																																																													2			
H0628	801	0	1	01	01	H0628_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H0628	801	0	1	01	01	H0628_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H0628	802	0	1	01	01	H0628_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H0628	802	0	1	01	01	H0628_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H0630	013	0	1	01	01	H0630_013_0	10	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	11	11b2;11a;4a;4b;7c;7i;9b;10a1;8b1;		13d;		2				1	11	11a;11b2;	13d;																																																																					0	0			0	0																																																																			0	0																																																																																																																	2																																																																																																																																															1	01	4a;4b;7c;7i;8b1;9b;10a1;										0.00	0.00	0.00	0.00									0.00	0.00															0.00	0.00									0.00	0.00									0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H0630	014	0	1	01	01	H0630_014_0	10	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	11	4a;8b1;9b;10a1;11a;11b2;		13d;		2				1	11	10a1;11a;11b2;	13d;																																																																	0	0			0	0			0	0																																																																			0	0																																																																																																																	2																																																																																																																																															1	01	4a;8b1;9b;										0.00	0.00																																					0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																																					2			
H0630	015	0	1	02	01	H0630_015_0	10	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	11	4a;4b;11a;11b2;7c;7i;8b1;9b;10a1;		13d;	2	2				1	11	11a;11b2;	13d;																																																																					0	0			0	0																																																																			0	0																																																																																																																	2																																																																																																																																															1	01	4a;4b;7c;7i;8b1;9b;10a1;										0.00	0.00	0.00	0.00									0.00	0.00															0.00	0.00									0.00	0.00									0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H0630	016	0	1	02	01	H0630_016_0	10	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	11	4a;4b;7c;7i;8b1;11a;11b2;9b;10a1;		13d;	2	2				1	11	11a;11b2;	13d;																																																																					0	0			0	0																																																																			0	0																																																																																																																	2																																																																																																																																															1	01	4a;4b;7c;7i;8b1;9b;10a1;										0.00	0.00	0.00	0.00									0.00	0.00															0.00	0.00									0.00	0.00									0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H0630	025	0	1	02	01	H0630_025_0	9	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	11	4a;4b;7c;7i;8b1;9b;10a1;11a;11b2;		13d;	2	2				1	11	11a;11b2;	13d;																																																																					0	0			0	0																																																																			0	0																																																																																																																	2																																																																																																																																															1	01	4a;4b;7c;7i;8b1;9b;10a1;										0.00	0.00	0.00	0.00									0.00	0.00															0.00	0.00									0.00	0.00									0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H0630	027	0	1	01	01	H0630_027_0	11	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	11	4a;8b1;9b;10a1;11a;11b2;7a;8a2;7g;7i;8b3;7c;4b;9a2;		13d;		2				1	11	7a;7c;7g;7i;8a2;8b1;8b3;9a2;9b;10a1;11a;11b2;	13d;																	0	0			0	0									0	0					0	0							0	0	0	0			0	0			0	0	0	0							0	0			0	0			0	0																																																																			0	0																																																																																																																	2																																																																																																																																															1	01	4a;4b;										0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																																																																																			2			
H1019	001	0	1	02	01	H1019_001_0	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	006	0	1	01	01	H1019_006_0	5	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	098	0	1	01	01	H1019_098_0	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	103	1	1	01	01	H1019_103_1	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	103	2	1	01	01	H1019_103_2	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	108	0	1	01	01	H1019_108_0	8	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	113	0	1	01	01	H1019_113_0	5	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	117	0	1	01	01	H1019_117_0	5	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	124	0	1	01	01	H1019_124_0	5	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	130	0	1	01	01	H1019_130_0	5	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	147	2	1	01	01	H1019_147_2	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	151	2	1	01	01	H1019_151_2	5	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	054	0	1	01	01	H1036_054_0	5	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	062	0	1	01	01	H1036_062_0	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	065	0	1	01	01	H1036_065_0	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	077	0	1	01	01	H1036_077_0	7	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	102	0	1	01	01	H1036_102_0	7	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	209	0	1	01	01	H1036_209_0	7	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	210	0	1	01	01	H1036_210_0	8	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	213	0	1	01	01	H1036_213_0	7	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	214	0	1	01	01	H1036_214_0	7	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	230	0	1	01	01	H1036_230_0	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	233	0	1	02	01	H1036_233_0	4	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	285	0	1	01	01	H1036_285_0	8	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	291	0	1	02	01	H1036_291_0	4	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	301	0	1	01	01	H1036_301_0	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	302	0	1	01	01	H1036_302_0	5	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	304	0	1	01	01	H1036_304_0	7	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	314	0	1	01	01	H1036_314_0	8	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	315	0	1	01	01	H1036_315_0	5	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	316	0	1	01	01	H1036_316_0	5	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1099	001	0	1	02	01	H1099_001_0	4	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H1099	001	0	1	02	01	H1099_001_0	4	2	2															00100000000000										2			2	01	8a1;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8a1;																																												0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H1099	006	0	1	01	01	H1099_006_0	4	2	2															00100000000000										2			2	01	8a1;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8a1;																																												0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H1099	006	0	1	01	01	H1099_006_0	4	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H1099	009	0	1	01	01	H1099_009_0	4	2	2															00100000000000										2			2	01	8a1;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8a1;																																												0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H1099	009	0	1	01	01	H1099_009_0	4	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H1099	014	0	1	01	01	H1099_014_0	4	2	2															00100000000000										2			2	01	8a1;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8a1;																																												0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H1099	014	0	1	01	01	H1099_014_0	4	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H1099	016	0	1	01	01	H1099_016_0	3	2	2															00100000000000										2			2	01	8a1;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8a1;																																												0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H1099	016	0	1	01	01	H1099_016_0	3	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H1099	023	0	1	01	01	H1099_023_0	4	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H1099	023	0	1	01	01	H1099_023_0	4	2	2															00100000000000										2			2	01	8a1;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8a1;																																												0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H1099	024	0	1	01	01	H1099_024_0	4	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H1099	024	0	1	01	01	H1099_024_0	4	2	2															00100000000000										2			2	01	8a1;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8a1;																																												0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H1099	025	0	1	02	01	H1099_025_0	3	2	2															00100000000000										2			2	01	8a1;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8a1;																																												0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H1099	025	0	1	02	01	H1099_025_0	3	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H1099	026	0	1	01	01	H1099_026_0	4	2	2															00100000000000										2			2	01	8a1;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8a1;																																												0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H1099	026	0	1	01	01	H1099_026_0	4	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H1099	027	0	1	02	01	H1099_027_0	3	2	2															00100000000000										2			2	01	8a1;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8a1;																																												0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H1099	027	0	1	02	01	H1099_027_0	3	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H1109	801	0	1	01	01	H1109_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H1109	801	0	1	01	01	H1109_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H1109	802	0	1	01	01	H1109_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H1109	802	0	1	01	01	H1109_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H1170	002	0	1	01	01	H1170_002_0	12	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	01	7c;7g;7i;8a1;8b1;8b3;9a2;10a1;11a;11b2;4a;				2				1	01	11a;11b2;																																																																						0	0			0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7c;7g;7i;8a1;8b1;8b3;9a2;10a1;										0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00			0.00	0.00			0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H1170	008	0	1	01	01	H1170_008_0	12	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	01	4a;7c;7i;10a1;8b1;8a1;9a2;11b2;11a;8b3;				2				1	01	11a;11b2;																																																																						0	0			0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7c;7i;8a1;8b1;8b3;9a2;10a1;										0.00	0.00											0.00	0.00															0.00	0.00					0.00	0.00			0.00	0.00			0.00	0.00			0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H1170	009	0	1	01	01	H1170_009_0	12	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	01	7c;7g;7i;8a1;8b1;8b3;9a2;10a1;11a;11b2;4a;				2				1	01	11a;11b2;																																																																						0	0			0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7c;7g;7i;8a1;8b1;8b3;9a2;10a1;										0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00			0.00	0.00			0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H1170	011	0	1	01	01	H1170_011_0	11	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	01	4a;10a1;7c;7i;8a1;8b1;8b3;9a2;11a;11b2;				2				1	01	11a;11b2;																																																																						0	0			0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7c;7i;8a1;8b1;8b3;9a2;10a1;										0.00	0.00											0.00	0.00															0.00	0.00					0.00	0.00			0.00	0.00			0.00	0.00			0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H1170	012	0	1	01	01	H1170_012_0	11	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	01	7c;7g;7i;8a1;8b1;8b3;9a2;10a1;11a;11b2;4a;				2				1	01	11a;11b2;																																																																						0	0			0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7c;7g;7i;8a1;8b1;8b3;9a2;10a1;										0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00			0.00	0.00			0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H1170	013	0	1	02	01	H1170_013_0	11	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	01	7c;7g;7i;8a1;8b1;8b3;9a2;10a1;11a;11b2;4a;			2	2				1	01	11a;11b2;																																																																						0	0			0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7c;7g;7i;8a1;8b1;8b3;9a2;10a1;										0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00			0.00	0.00			0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H1170	014	0	1	01	01	H1170_014_0	11	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	01	7c;7g;7i;8b1;8a1;8b3;9a2;10a1;11a;11b2;4a;				2				1	01	11a;11b2;																																																																						0	0			0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7c;7g;7i;8a1;8b1;8b3;9a2;10a1;										0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00			0.00	0.00			0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H1170	015	0	1	01	01	H1170_015_0	11	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	01	10a1;4a;7c;7g;7i;8a1;8b1;8b3;9a2;11a;11b2;				2				1	01	7c;7g;7i;8a1;8b1;8b3;11a;11b2;																						0	0									0	0					0	0					0	0			0	0			0	0																	0	0			0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;9a2;10a1;										0.00	0.00																																													0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H1206	003	0	1	02	01	H1206_003_0	3	1	2															00000000001000	Long term institutionalized									1	010		2	01	7f;			2	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H1206	801	0	1	01	01	H1206_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H1206	801	0	1	01	01	H1206_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H1206	802	0	1	01	01	H1206_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H1206	802	0	1	01	01	H1206_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H1230	003	0	1	01	01	H1230_003_0	10	3	2															00110100000000										2			2	01	8a2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8a2;																																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																	2			
H1230	003	0	1	01	01	H1230_003_0	10	2	2															01000000000000										2			2	01	8a2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8a2;																																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																	2			
H1230	003	0	1	01	01	H1230_003_0	10	1	2															00000000001100	Liver Disease	Certain bleeding disorders								2			2	01	8a2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8a2;																																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																	2			
H1248	004	0	1	04	01	H1248_004_0	5	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H1248	007	0	1	04	01	H1248_007_0	5	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H1365	001	0	1	04	01	H1365_001_0	6	1	2															00000000001000	Opiate Use Disorder									2			2	01	7e1;7e2;7h1;7h2;9c1;9c2;			1	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7h1;7h2;9c1;9c2;																										0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																							0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																																	1	100.00	00100	
H1365	004	2	1	04	01	H1365_004_2	9	1	2															00000000001000	Opiate Use Disorder									2			2	01	7e1;7e2;7h1;7h2;9c1;9c2;			1	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7h1;7h2;9c1;9c2;																										0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																							0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																																	1	100.00	00100	
H1365	004	3	1	04	01	H1365_004_3	7	1	2															00000000001000	Opiate Use Disorder									2			2	01	7e1;7e2;7h1;7h2;9c1;9c2;			1	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7h1;7h2;9c1;9c2;																										0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																							0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																																	1	100.00	00100	
H1608	001	0	1	04	01	H1608_001_0	3	1	2															00000000001000	Long term institutionalized									1	010		2	01	7f;			1	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H1608	016	0	1	04	01	H1608_016_0	3	1	2															00000000001000	Long term institutionalized									1	010		2	11	7f;		7f_2;	1	1	11	7f;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7f;	7f_2;																													0.00	0.00																																																																																																			0.00	0.00																																																																																																																																																																																																																																																													2			
H1608	027	0	1	04	01	H1608_027_0	4	1	1	010	0001000000					11611	7484																	1	001		2	01	7d;7j;	2		1	1	01	7d;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				030;008;012;018;					0.00	0.00			0.00	0.00											0.00	0.00																	0.00	0.00											2			
H1608	801	0	1	04	01	H1608_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H1608	801	0	1	04	01	H1608_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H1608	802	0	1	04	01	H1608_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H1608	802	0	1	04	01	H1608_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H1609	001	0	1	02	01	H1609_001_0	3	1	2															00000000001000	Long term institutionalized									1	010		2	01	7f;			2	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H1609	801	0	1	01	01	H1609_801_0	2	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H1609	801	0	1	01	01	H1609_801_0	2	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H1609	807	0	1	01	01	H1609_807_0	2	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H1609	807	0	1	01	01	H1609_807_0	2	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H1692	801	0	1	01	01	H1692_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H1692	801	0	1	01	01	H1692_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H1692	802	0	1	01	01	H1692_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H1692	802	0	1	01	01	H1692_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H1748	010	0	1	01	01	H1748_010_0	7	1	3									01111111111111110000																1	100	Member must meet required medical criteria for coverage under this SSBCI benefit. Benefit will NOT be approved if requests are made for cosmetic purposes only.	2	01	9a1;9b;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	9a1;9b;																																																						0.00	300.00			0.00	150.00																																																																																																																																																																																																																																																																																																																																					2			
H1748	014	0	1	01	01	H1748_014_0	7	1	3									01111111111111100000																1	100	Member must meet required medical criteria for coverage under this SSBCI benefit. Benefit will NOT be approved if requests are made for cosmetic purposes only.	2	01	9a1;9b;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	9a1;9b;																																																						0.00	200.00			0.00	100.00																																																																																																																																																																																																																																																																																																																																					2			
H2056	801	0	1	01	01	H2056_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H2056	801	0	1	01	01	H2056_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H2056	802	0	1	01	01	H2056_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H2056	802	0	1	01	01	H2056_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H2172	001	0	1	02	01	H2172_001_0	8	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status.									2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																										0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7g;8b1;9a2;										0.00	0.00																					0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																							2			
H2172	002	0	1	02	01	H2172_002_0	7	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status.									2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																										0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7g;8b1;9a2;										0.00	0.00																					0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																							2			
H2172	003	0	1	02	01	H2172_003_0	9	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status.									2			2	01	4a;7g;8b1;11b2;9a2;			2	2				1	01	11b2;																																																																										0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7g;8b1;9a2;										0.00	0.00																					0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																							2			
H2172	004	0	1	02	01	H2172_004_0	8	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																										0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7g;8b1;9a2;										0.00	0.00																					0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																							2			
H2172	005	0	1	01	01	H2172_005_0	7	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status.									2			2	01	4a;7g;8b1;9a2;11b2;				2				1	01	11b2;																																																																										0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7g;8b1;9a2;										0.00	0.00																					0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																							2			
H2172	006	0	1	01	01	H2172_006_0	8	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status.									2			2	01	4a;7g;8b1;9a2;11b2;				2				1	01	11b2;																																																																										0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7g;8b1;9a2;										0.00	0.00																					0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																							2			
H2172	008	0	1	02	01	H2172_008_0	7	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																										0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7g;8b1;9a2;										0.00	0.00																					0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																							2			
H2172	009	0	1	02	01	H2172_009_0	7	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status.									2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																										0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7g;8b1;9a2;										0.00	0.00																					0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																							2			
H2172	010	0	1	02	01	H2172_010_0	7	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status.									2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																										0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7g;8b1;9a2;										0.00	0.00																					0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																							2			
H2172	011	0	1	01	01	H2172_011_0	8	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status.									2			2	01	4a;7g;8b1;9a2;11b2;				2				1	01	11b2;																																																																										0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7g;8b1;9a2;										0.00	0.00																					0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																							2			
H2172	012	0	1	02	01	H2172_012_0	8	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status.									2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																										0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7g;8b1;9a2;										0.00	0.00																					0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																							2			
H2172	013	0	1	02	01	H2172_013_0	7	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status.									2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																										0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7g;8b1;9a2;										0.00	0.00																					0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																							2			
H2172	014	0	1	02	01	H2172_014_0	7	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status.									2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																										0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;7g;8b1;9a2;										0.00	0.00																					0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																							2			
H2235	001	0	1	01	01	H2235_001_0	10	1	3									00000001000000000000																2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H2235	002	0	1	01	01	H2235_002_0	9	1	3									00000001000000000000																2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H2235	003	0	1	01	01	H2235_003_0	10	1	3									00000001000000000000																2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H2293	011	0	1	04	01	H2293_011_0	3	1	1	001					01110	251080	22525																	1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H2293	023	0	1	04	01	H2293_023_0	3	1	1	001					01110	251080	22525																	1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H2293	028	0	1	04	01	H2293_028_0	2	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H2293	029	0	1	04	01	H2293_029_0	2	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H2610	005	0	1	01	01	H2610_005_0	4	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H2610	006	0	1	01	01	H2610_006_0	5	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H2610	011	0	1	01	01	H2610_011_0	4	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H2610	015	0	1	01	01	H2610_015_0	4	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H2610	016	0	1	01	01	H2610_016_0	4	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H2610	019	0	1	01	01	H2610_019_0	4	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H2610	021	0	1	01	01	H2610_021_0	4	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H2610	023	0	1	01	01	H2610_023_0	4	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H2610	026	0	1	01	01	H2610_026_0	4	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H2610	027	0	1	01	01	H2610_027_0	4	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H2663	026	0	1	02	01	H2663_026_0	2	1	2															00000000001000	Long term institutionalized									1	010		2	11	7f;		7f_2;	2	1	11	7f;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7f;	7f_2;																													0.00	0.00																																																																																																			0.00	0.00																																																																																																																																																																																																																																																													2			
H2663	052	0	1	01	01	H2663_052_0	4	1	2															00000000001000	Long term institutionalized									1	010		2	11	7f;		7f_2;		1	11	7f;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7f;	7f_2;																													0.00	0.00																																																																																																			0.00	0.00																																																																																																																																																																																																																																																													2			
H2663	061	0	1	02	01	H2663_061_0	2	1	2															00000000001000	Long term institutionalized									1	010		2	11	7f;		7f_2;	2	1	11	7f;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7f;	7f_2;																													0.00	0.00																																																																																																			0.00	0.00																																																																																																																																																																																																																																																													2			
H2663	067	0	1	01	01	H2663_067_0	2	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H2663	805	0	1	01	01	H2663_805_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H2663	805	0	1	01	01	H2663_805_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H2663	810	0	1	01	01	H2663_810_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H2663	810	0	1	01	01	H2663_810_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H2722	002	0	1	02	01	H2722_002_0	4	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H2722	004	0	1	02	01	H2722_004_0	4	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H2722	005	0	1	02	01	H2722_005_0	4	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H2875	001	0	1	02	01	H2875_001_0	5	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H3146	001	0	1	02	01	H3146_001_0	2	1	2															00000000001000	Long term institutionalized									1	010		2	01	7f;			2	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H3146	004	0	1	02	01	H3146_004_0	3	1	2															00000000001000	Long term institutionalized									1	010		2	01	7f;			2	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H3146	006	0	1	01	01	H3146_006_0	4	1	2															00000000001000	Long term institutionalized									1	010		2	01	7f;				1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H3146	021	0	1	01	01	H3146_021_0	3	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H3146	801	0	1	01	01	H3146_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3146	801	0	1	01	01	H3146_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3146	802	0	1	01	01	H3146_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3146	802	0	1	01	01	H3146_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3152	082	0	1	01	01	H3152_082_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H3152	082	0	1	01	01	H3152_082_0	2	2	2															00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)								1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H3152	098	0	1	01	01	H3152_098_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H3152	098	0	1	01	01	H3152_098_0	2	2	2															00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)								1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H3152	801	0	1	01	01	H3152_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3152	801	0	1	01	01	H3152_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3152	804	0	1	01	01	H3152_804_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3152	804	0	1	01	01	H3152_804_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3189	001	0	1	01	01	H3189_001_0	4	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H3192	001	0	1	02	01	H3192_001_0	2	1	2															00000000001000	Long term institutionalized									1	010		2	01	7f;			2	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H3192	021	0	1	02	01	H3192_021_0	3	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		2	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H3192	801	0	1	01	01	H3192_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3192	801	0	1	01	01	H3192_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3192	802	0	1	01	01	H3192_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3192	802	0	1	01	01	H3192_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3219	801	0	1	04	01	H3219_801_0	1	1	3									01111111111111111000	At plan sponsor discretion															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H3219	801	0	1	04	01	H3219_801_0	1	2	2															01111111111000	other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H3219	802	0	1	04	01	H3219_802_0	1	1	3									01111111111111111000	At plan sponsor discretion															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H3219	802	0	1	04	01	H3219_802_0	1	2	2															01111111111000	other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H3239	017	0	1	01	01	H3239_017_0	2	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H3239	020	0	1	01	01	H3239_020_0	2	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H3239	022	0	1	01	01	H3239_022_0	2	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H3288	801	0	1	04	01	H3288_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H3288	801	0	1	04	01	H3288_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H3288	802	0	1	04	01	H3288_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H3288	802	0	1	04	01	H3288_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H3305	007	0	1	02	01	H3305_007_0	6	1	2															01000000000000										2			2	01	7f;			2	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H3305	015	0	1	02	01	H3305_015_0	7	1	2															01000000000000										2			2	01	7f;			2	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H3305	020	0	1	02	01	H3305_020_0	6	1	2															01000000000000										2			2	01	7f;			2	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H3305	022	0	1	02	01	H3305_022_0	7	1	2															01000000000000										2			2	01	7f;			2	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H3305	030	0	1	02	01	H3305_030_0	7	1	2															01000000000000										2			2	01	7f;			2	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H3312	002	0	1	01	01	H3312_002_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H3312	018	0	1	01	01	H3312_018_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H3312	062	0	1	02	01	H3312_062_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;			2	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H3312	064	0	1	01	01	H3312_064_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H3312	074	0	1	01	01	H3312_074_0	3	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H3312	079	0	1	01	01	H3312_079_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H3312	081	0	1	01	01	H3312_081_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H3312	082	0	1	01	01	H3312_082_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H3312	801	0	1	01	01	H3312_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3312	801	0	1	01	01	H3312_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3312	804	0	1	01	01	H3312_804_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3312	804	0	1	01	01	H3312_804_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3347	002	0	1	02	01	H3347_002_0	8	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H3347	009	0	1	02	01	H3347_009_0	6	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H3347	016	0	1	02	01	H3347_016_0	6	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H3388	001	0	1	01	01	H3388_001_0	6	1	3									00111111111011110000																1	011		2	01	7d;	1			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																																							2			
H3388	002	0	1	01	01	H3388_002_0	8	1	3									00111111111011110000																1	011		2	01	7d;	1			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																																							2			
H3388	004	0	1	01	01	H3388_004_0	8	1	3									00111111111011110000																1	011		2	01	7d;	1			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																																							2			
H3388	014	0	1	01	01	H3388_014_0	8	1	3									00111111111011100000																1	011		2	01	7d;	1			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																																							2			
H3597	801	0	1	01	01	H3597_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3597	801	0	1	01	01	H3597_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3597	802	0	1	01	01	H3597_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3597	802	0	1	01	01	H3597_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3748	801	0	1	01	01	H3748_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3748	801	0	1	01	01	H3748_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3748	802	0	1	01	01	H3748_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3748	802	0	1	01	01	H3748_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3832	007	0	1	04	01	H3832_007_0	5	1	2															11111111111111	Cancers	Vascular Disease	Chronic Kidney Disease	Nutrition-related disorders including obesity	Hematological Disorders					1	010		2	01	8b1;			2	2				1	01	8b1;																																																0	0																																																																																																																																																																																																															2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H3832	008	0	1	04	01	H3832_008_0	6	1	2															11111111111111	Cancers	Vascular Disease	Chronic Kidney Disease	Nutrition-related disorders including obesity	Hematological Disorders					1	010		2	01	8b1;			2	2				1	01	8b1;																																																0	0																																																																																																																																																																																																															2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H3832	009	0	1	04	01	H3832_009_0	6	1	2															11111111111111	Cancers	Vascular Disease	Chronic Kidney Disease	Nutrition-related disorders including obesity	Hematological Disorders					1	010		2	01	8b1;			2	2				1	01	8b1;																																																0	0																																																																																																																																																																																																															2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H3832	010	0	1	04	01	H3832_010_0	5	1	2															11111111111111	Cancers	Vascular Disease	Chronic Kidney Disease	Nutrition-related disorders including obesity	Hematological Disorders					1	010		2	01	8b1;			2	2				1	01	8b1;																																																0	0																																																																																																																																																																																																															2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H3832	011	0	1	04	01	H3832_011_0	8	1	2															11111111111111	Cancers	Vascular Disease	Chronic Kidney Disease	Nutrition-related disorders including obesity	Hematological Disorders					1	010		2	01	7g;8b1;8a2;			2	2				1	01	8a2;8b1;																																														0	0	0	0																																																																																																																																																																																																															2																																																																																																																																															1	01	7g;																																0.00	0.00																																																																																																																																																																																																																																																																																																																																																															2			
H3907	002	0	1	01	01	H3907_002_0	9	2	3									00000000000001000000																2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H3907	002	0	1	01	01	H3907_002_0	9	1	2															00100000000000										2			2	01	11a;				1	01	11a;		1	01	11a;																																																																						0	0																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H3907	006	0	1	01	01	H3907_006_0	10	1	2															00100000000000										2			2	01	11a;				1	01	11a;		1	01	11a;																																																																						0	0																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H3907	037	0	1	01	01	H3907_037_0	11	2	3									00000000000001000000																2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H3907	037	0	1	01	01	H3907_037_0	11	1	2															00100000000000										2			2	01	11a;				1	01	11a;		1	01	11a;																																																																						0	0																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H3907	057	1	1	01	01	H3907_057_1	11	1	3									00000000000001000000																2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H3907	057	1	1	01	01	H3907_057_1	11	2	2															00100000000000										2			2	01	11a;				1	01	11a;		1	01	11a;																																																																						0	0																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H3907	057	2	1	01	01	H3907_057_2	11	2	2															00100000000000										2			2	01	11a;				1	01	11a;		1	01	11a;																																																																						0	0																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H3907	057	2	1	01	01	H3907_057_2	11	1	3									00000000000001000000																2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H3907	057	3	1	01	01	H3907_057_3	11	1	3									00000000000001000000																2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H3907	057	3	1	01	01	H3907_057_3	11	2	2															00100000000000										2			2	01	11a;				1	01	11a;		1	01	11a;																																																																						0	0																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H3907	057	4	1	01	01	H3907_057_4	11	1	3									00000000000001000000																2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H3907	057	4	1	01	01	H3907_057_4	11	2	2															00100000000000										2			2	01	11a;				1	01	11a;		1	01	11a;																																																																						0	0																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H3907	057	5	1	01	01	H3907_057_5	11	2	2															00100000000000										2			2	01	11a;				1	01	11a;		1	01	11a;																																																																						0	0																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H3907	057	5	1	01	01	H3907_057_5	11	1	3									00000000000001000000																2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H3907	058	1	1	01	01	H3907_058_1	10	2	3									00000000000001000000																2			2	01	7e1;7e2;7j;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H3907	058	1	1	01	01	H3907_058_1	10	1	2															00100000000000										2			2	01	11a;				1	01	11a;		1	01	11a;																																																																						0	0																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H3907	058	2	1	01	01	H3907_058_2	10	1	2															00100000000000										2			2	01	11a;				1	01	11a;		1	01	11a;																																																																						0	0																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H3907	058	2	1	01	01	H3907_058_2	10	2	3									00000000000001000000																2			2	01	7e1;7e2;7j;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H3907	059	1	1	01	01	H3907_059_1	10	1	3									00000000000001000000																2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H3907	059	2	1	01	01	H3907_059_2	10	1	3									00000000000001000000																2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H3907	059	3	1	01	01	H3907_059_3	11	1	3									00000000000001000000																2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H3909	001	0	1	04	01	H3909_001_0	5	2	2															00000000010000										1	001		2	01	7d;7j;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3909	001	0	1	04	01	H3909_001_0	5	1	2															00000000001000	Breast Cancer									2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3909	007	0	1	04	01	H3909_007_0	5	2	2															00000000010000										1	001		2	01	7d;7j;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3909	007	0	1	04	01	H3909_007_0	5	1	2															00000000001000	Breast Cancer									2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3909	009	0	1	04	01	H3909_009_0	5	1	2															00000000001000	Breast Cancer									2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3909	009	0	1	04	01	H3909_009_0	5	2	2															00000000010000										1	001		2	01	7j;7d;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3909	015	0	1	04	01	H3909_015_0	4	1	2															00000000001000	Breast Cancer									2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3909	015	0	1	04	01	H3909_015_0	4	2	2															00000000010000										1	001		2	01	7d;7j;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3909	016	0	1	04	01	H3909_016_0	7	1	2															00000000001000	Breast Cancer									2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3909	016	0	1	04	01	H3909_016_0	7	2	2															00000000010000										1	001		2	01	7d;7j;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3909	017	0	1	04	01	H3909_017_0	5	2	2															00000000010000										1	001		2	01	7d;7j;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3909	017	0	1	04	01	H3909_017_0	5	1	2															00000000001000	Breast Cancer									2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3909	018	0	1	04	01	H3909_018_0	6	1	2															00000000001000	Breast Cancer									2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3909	018	0	1	04	01	H3909_018_0	6	2	2															00000000010000										1	001		2	01	7d;7j;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3916	001	0	1	04	01	H3916_001_0	4	1	3									00011110010010010000																2			2	01	11a;11b1;11b2;11c1;11c2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	11a;11b1;11b2;11c1;11c2;																																																																						0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																	1	1000.00	00100	
H3916	022	0	1	04	01	H3916_022_0	5	1	3									00011110010010010000																2			2	01	11a;11b1;11b2;11c1;11c2;			1	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	11a;11b1;11b2;11c1;11c2;																																																																						0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																	1	1000.00	00100	
H3928	801	0	1	01	01	H3928_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3928	801	0	1	01	01	H3928_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3928	803	0	1	01	01	H3928_803_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3928	803	0	1	01	01	H3928_803_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3931	004	0	1	02	01	H3931_004_0	4	1	1	010	0001000000					11611	7484																	1	001		2	01	7d;7j;	2		2	1	01	7d;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				008;018;012;030;					0.00	0.00			0.00	0.00											0.00	0.00																	0.00	0.00											2			
H3931	166	0	1	02	01	H3931_166_0	3	1	1	001					01110	251080	22525																	1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		2	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H3931	176	0	1	02	01	H3931_176_0	3	1	1	001					01110	251080	22525																	1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		2	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H3931	177	0	1	02	01	H3931_177_0	3	1	1	001					01110	251080	22525																	1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		2	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H3931	801	0	1	01	01	H3931_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3931	801	0	1	01	01	H3931_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3931	804	0	1	01	01	H3931_804_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3931	804	0	1	01	01	H3931_804_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3952	008	0	1	01	01	H3952_008_0	6	3	2															00000000010000										1	001		2	01	7d;7j;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3952	008	0	1	01	01	H3952_008_0	6	1	2															01010000000000										2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7f;	7f_2;																													5.00	5.00																																																																																																			5.00	5.00																																																																																																																																																																																																										008;012;					10.00	10.00			10.00	10.00																																									2			
H3952	008	0	1	01	01	H3952_008_0	6	2	2															00000000001000	Breast Cancer									2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3952	020	0	1	01	01	H3952_020_0	6	1	2															01010000000000										2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7f;	7f_2;																													5.00	5.00																																																																																																			5.00	5.00																																																																																																																																																																																																										008;012;					10.00	10.00			10.00	10.00																																									2			
H3952	020	0	1	01	01	H3952_020_0	6	3	2															00000000010000										1	001		2	01	7d;7j;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3952	020	0	1	01	01	H3952_020_0	6	2	2															00000000001000	Breast Cancer									2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3952	045	0	1	01	01	H3952_045_0	6	3	2															00000000010000										1	001		2	01	7d;7j;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3952	045	0	1	01	01	H3952_045_0	6	1	2															01010000000000										2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7f;	7f_2;																													5.00	5.00																																																																																																			5.00	5.00																																																																																																																																																																																																										008;012;					10.00	10.00			10.00	10.00																																									2			
H3952	045	0	1	01	01	H3952_045_0	6	2	2															00000000001000	Breast Cancer									2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3952	048	0	1	01	01	H3952_048_0	6	1	2															01010000000000										2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7f;	7f_2;																													5.00	5.00																																																																																																			5.00	5.00																																																																																																																																																																																																										008;012;					10.00	10.00			10.00	10.00																																									2			
H3952	048	0	1	01	01	H3952_048_0	6	2	2															00000000001000	Breast Cancer									2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3952	048	0	1	01	01	H3952_048_0	6	3	2															00000000010000										1	001		2	01	7d;7j;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3952	049	0	1	01	01	H3952_049_0	6	1	2															01010000000000										2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7f;	7f_2;																													5.00	5.00																																																																																																			5.00	5.00																																																																																																																																																																																																										012;008;					10.00	10.00			10.00	10.00																																									2			
H3952	049	0	1	01	01	H3952_049_0	6	2	2															00000000001000	Breast Cancer									2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3952	049	0	1	01	01	H3952_049_0	6	3	2															00000000010000										1	001		2	01	7j;7d;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3952	050	0	1	01	01	H3952_050_0	7	3	2															00000000010000										1	001		2	01	7d;7j;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3952	050	0	1	01	01	H3952_050_0	7	2	2															00000000001000	Breast Cancer									2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3952	050	0	1	01	01	H3952_050_0	7	1	2															01010000000000										2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7f;	7f_2;																													5.00	5.00																																																																																																			5.00	5.00																																																																																																																																																																																																										012;008;					10.00	10.00			10.00	10.00																																									2			
H3952	051	0	1	01	01	H3952_051_0	6	1	2															01010000000000										2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7f;	7f_2;																													5.00	5.00																																																																																																			5.00	5.00																																																																																																																																																																																																										008;012;					10.00	10.00			10.00	10.00																																									2			
H3952	051	0	1	01	01	H3952_051_0	6	3	2															00000000010000										1	001		2	01	7d;7j;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3952	051	0	1	01	01	H3952_051_0	6	2	2															00000000001000	Breast Cancer									2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3952	053	0	1	02	01	H3952_053_0	7	1	2															01000000000000										2			2	11	7d;7f;	2	7f_2;	2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7f;	7f_2;																													5.00	5.00																																																																																																			5.00	5.00																																																																																																																																																																																																										012;008;030;					10.00	10.00			10.00	10.00																													10.00	10.00											2			
H3952	053	0	1	02	01	H3952_053_0	7	3	2															00000000010000										1	001		2	01	7d;7j;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3952	053	0	1	02	01	H3952_053_0	7	2	2															00000000001000	Breast Cancer									2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3952	054	0	1	02	01	H3952_054_0	7	2	2															00000000001000	Breast Cancer									2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3952	054	0	1	02	01	H3952_054_0	7	3	2															00000000010000										1	001		2	01	7d;7j;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3952	054	0	1	02	01	H3952_054_0	7	1	2															01000000000000										2			2	11	7d;7f;	2	7f_2;	2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7f;	7f_2;																													5.00	5.00																																																																																																			5.00	5.00																																																																																																																																																																																																										008;030;012;					10.00	10.00			10.00	10.00																													10.00	10.00											2			
H3952	055	0	1	01	01	H3952_055_0	6	2	2															00000000001000	Breast Cancer									2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3952	055	0	1	01	01	H3952_055_0	6	3	2															00000000010000										1	001		2	01	7d;7j;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3952	055	0	1	01	01	H3952_055_0	6	1	2															01010000000000										2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7f;	7f_2;																													5.00	5.00																																																																																																			5.00	5.00																																																																																																																																																																																																										008;012;					10.00	10.00			10.00	10.00																																									2			
H3952	059	0	1	01	01	H3952_059_0	5	2	2															00000000001000	Breast Cancer									2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3952	059	0	1	01	01	H3952_059_0	5	3	2															00000000010000										1	001		2	01	7d;7j;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3952	059	0	1	01	01	H3952_059_0	5	1	2															01010000000000										2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7f;	7f_2;																													5.00	5.00																																																																																																			5.00	5.00																																																																																																																																																																																																										012;008;					10.00	10.00			10.00	10.00																																									2			
H3952	060	0	1	02	01	H3952_060_0	7	2	2															00000000001000	Breast Cancer									2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H3952	060	0	1	02	01	H3952_060_0	7	3	2															00000000010000										1	001		2	01	7d;7j;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				019;																							0.00	0.00																											2			
H3952	060	0	1	02	01	H3952_060_0	7	1	2															01010000000000										2			2	11	7d;7f;	2	7f_2;	2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7f;	7f_2;																													5.00	5.00																																																																																																			5.00	5.00																																																																																																																																																																																																										012;008;					10.00	10.00			10.00	10.00																																									2			
H3954	157	21	1	01	01	H3954_157_21	3	1	2															00100000000000										2			2	01	7d;8a1;8b1;11a;	2			2				1	01	11a;																																																																						0	0																																																																																																																																																																																									2																																																																																																																																															1	01	8a1;8b1;																																												0.00	0.00			0.00	0.00																																																																																																																																																																																																																																																																																												035;008;030;					0.00	0.00																																	0.00	0.00							0.00	0.00			2			
H3954	158	14	1	01	01	H3954_158_14	4	1	2															00100000000000										2			2	01	7d;8a1;8b1;11a;	2			2				1	01	11a;																																																																						0	0																																																																																																																																																																																									2																																																																																																																																															1	01	8a1;8b1;																																												0.00	0.00			0.00	0.00																																																																																																																																																																																																																																																																																												008;030;035;					0.00	0.00																																	0.00	0.00							0.00	0.00			2			
H3957	031	0	1	02	01	H3957_031_0	6	1	3									00011111010010010000																2			2	01	7d;8a1;11c1;11a;11b1;11b2;11c2;	1		2	2				1	01	11c1;																																																																												0	5																																																																																																																																																																																			2																																																																																																																																															1	01	7d;8a1;11a;11b1;11b2;11c1;11c2;																								10.00	10.00																			0.00	0.00																									0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																	1	1000.00	00100	
H3957	039	0	1	01	01	H3957_039_0	6	1	3									00011110010010010000																2			2	01	11a;11b1;11b2;11c1;11c2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	11a;11b1;11b2;11c1;11c2;																																																																						0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																	1	1000.00	00100	
H3957	045	1	1	02	01	H3957_045_1	6	1	3									00011110010010010000																2			2	01	11a;11b1;11b2;11c1;11c2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	11a;11b1;11b2;11c1;11c2;																																																																						0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																	1	1000.00	00100	
H3957	046	1	1	02	01	H3957_046_1	7	1	3									00011110010010010000																2			2	01	11a;11b1;11b2;11c1;11c2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	11a;11b1;11b2;11c1;11c2;																																																																						0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																	1	1000.00	00100	
H3957	047	1	1	01	01	H3957_047_1	6	1	3									00011110010010010000																2			2	01	11a;11b1;11b2;11c1;11c2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	11a;11b1;11b2;11c1;11c2;																																																																						0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																	1	1000.00	00100	
H3957	047	3	1	01	01	H3957_047_3	6	1	3									00011110010010010000																2			2	01	11a;11b1;11b2;11c1;11c2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	11a;11b1;11b2;11c1;11c2;																																																																						0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																	1	1000.00	00100	
H3957	048	0	1	01	01	H3957_048_0	6	1	3									00011110010010010000																2			2	01	11a;11b1;11b2;11c1;11c2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	11a;11b1;11b2;11c1;11c2;																																																																						0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																	1	1000.00	00100	
H3959	001	0	1	02	01	H3959_001_0	3	1	1	010	0001000000					11611	7484																	1	001		2	01	7d;7j;	2		2	1	01	7d;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				012;008;018;030;					0.00	0.00			0.00	0.00											0.00	0.00																	0.00	0.00											2			
H3959	002	0	1	02	01	H3959_002_0	4	1	1	010	0001000000					11611	7484																	1	001		2	01	7d;7j;	2		2	1	01	7d;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				030;018;008;012;					0.00	0.00			0.00	0.00											0.00	0.00																	0.00	0.00											2			
H3959	033	0	1	02	01	H3959_033_0	3	1	1	001					01110	251080	22525																	1	010		2	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1	7f_2;	2	1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;																							10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																					10.00	10.00																																																																																																																																																																																																																																																													2			
H3959	039	0	1	02	01	H3959_039_0	3	1	1	010	0001000000					11611	7484																	1	001		2	01	7d;7j;	2		2	1	01	7d;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				018;030;012;008;					0.00	0.00			0.00	0.00											0.00	0.00																	0.00	0.00											2			
H3959	052	0	1	02	01	H3959_052_0	3	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1	7f_2;	2	1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;																							10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																					10.00	10.00																																																																																																																																																																																																																																																													2			
H3959	803	0	1	01	01	H3959_803_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3959	803	0	1	01	01	H3959_803_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3959	804	0	1	01	01	H3959_804_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H3959	804	0	1	01	01	H3959_804_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H4004	062	0	1	01	01	H4004_062_0	8	1	1	001					10000	43126	41603																	2			2	01	11a;11b1;11b2;				2				1	01	11a;11b1;11b2;																																																																						0	0	0	0	0	0																																																																																																																																																																																					2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		1	130.00	00010	
H4004	068	0	1	01	01	H4004_068_0	7	1	1	001					10000	3915	3781																	2			2	11	11a;11b1;11b2;16a;		16c1;16c4;16c6;16c7;		2				1	11	11a;11b1;11b2;16a;	16c1;16c4;16c6;16c7;																																																																					0	0	0	0	0	0																											0	0																																																																																																									0	0					0	0			0	0	0	0																																			2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		1	120.00	00010	
H4004	069	0	1	01	01	H4004_069_0	7	1	1	001					10000	2913	2808																	2			2	01	11a;11b1;11b2;16a;				2				1	01	11a;11b1;11b2;16a;																																																																						0	0	0	0	0	0																											0	0																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		1	263.00	00010	
H4141	015	0	1	01	01	H4141_015_0	4	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H4141	017	5	1	01	01	H4141_017_5	4	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		2	01	3-1;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	3-1;		0.00	0.00																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H4141	023	0	1	01	01	H4141_023_0	4	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H4152	022	0	1	02	01	H4152_022_0	7	1	1	001					01110	3170	2709																	1	010		2	11	1a;1b;2;3-1;3-4;4a;4b;7b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7k;8b1;9a1;9a2;9b;9c1;9c2;10a1;10a2;11a;11b1;11b2;11c2;15-2;15-3;17a;18a;	1	7f_2;	2	2				1	01	11a;11b1;11b2;11c2;15-2;15-3;																																																																						10	10	10	10	10	10			10	10																			0	10	0	10																																																																																																																																																											2																																																																																																																																															1	11	3-1;3-4;4a;4b;7b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7k;8b1;9a1;9a2;9b;9c1;9c2;10a1;10a2;17a;18a;	7f_2;	10.00	10.00					10.00	10.00	50.00	50.00	0.00	0.00							0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			0.00	0.00					75.00	75.00					0.00	150.00	150.00	150.00	0.00	150.00	0.00	0.00	0.00	0.00			100.00	100.00	100.00	100.00																																			0.00	0.00			0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																													2			
H4461	022	0	1	01	01	H4461_022_0	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H4461	038	0	1	01	01	H4461_038_0	5	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H4523	020	0	1	01	01	H4523_020_0	2	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H4523	021	0	1	01	01	H4523_021_0	3	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H4523	024	0	1	01	01	H4523_024_0	2	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H4523	027	0	1	01	01	H4523_027_0	3	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H4523	801	0	1	01	01	H4523_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H4523	801	0	1	01	01	H4523_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H4523	802	0	1	01	01	H4523_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H4523	802	0	1	01	01	H4523_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H4620	001	0	1	04	01	H4620_001_0	4	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H4711	801	0	1	01	01	H4711_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H4711	801	0	1	01	01	H4711_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H4711	802	0	1	01	01	H4711_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H4711	802	0	1	01	01	H4711_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H4835	801	0	1	01	01	H4835_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H4835	801	0	1	01	01	H4835_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H4835	802	0	1	01	01	H4835_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H4835	802	0	1	01	01	H4835_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H4982	801	0	1	01	01	H4982_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H4982	801	0	1	01	01	H4982_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H4982	802	0	1	01	01	H4982_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H4982	802	0	1	01	01	H4982_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H5042	009	0	1	04	01	H5042_009_0	9	1	3									00111111111011110000																1	011		2	01	7d;	1		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																																							2			
H5042	012	0	1	04	01	H5042_012_0	6	1	3									00111111111011110000																1	010		2	01	7d;	1		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																																							2			
H5042	014	0	1	04	01	H5042_014_0	9	1	3									00111111111011110000																1	011		2	01	7d;	1		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																																							2			
H5050	004	0	1	01	01	H5050_004_0	4	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	01	7c;7g;7i;8b1;9a2;9b;10a1;11a;11b2;4a;4b;				2				1	01	11a;11b2;																																																																						0	0			0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;4b;7c;7g;7i;8b1;9a2;9b;10a1;										0.00	0.00	0.00	0.00									0.00	0.00									0.00	0.00					0.00	0.00									0.00	0.00							0.00	0.00	0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H5050	009	0	1	01	01	H5050_009_0	4	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	01	7c;7g;7i;8b1;9a2;9b;10a1;11a;11b2;4a;4b;				2				1	01	11a;11b2;																																																																						0	0			0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;4b;7c;7g;7i;8b1;9a2;9b;10a1;										0.00	0.00	0.00	0.00									0.00	0.00									0.00	0.00					0.00	0.00									0.00	0.00							0.00	0.00	0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H5050	013	0	1	01	01	H5050_013_0	4	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	01	7c;7g;7i;8a1;9a2;9b;10a1;11a;11b2;4a;4b;8b1;				2				1	01	11a;11b2;																																																																						0	0			0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;4b;7c;7g;7i;8a1;8b1;9a2;9b;10a1;										0.00	0.00	0.00	0.00									0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00							0.00	0.00	0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H5050	022	0	1	01	01	H5050_022_0	5	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	01	7c;7g;7i;8a1;9a2;10a1;11a;11b2;4a;4b;8b1;9b;				2				1	01	11a;11b2;																																																																						0	0			0	0																																																																																																																																																																																					2																																																																																																																																															1	01	4a;4b;7c;7g;7i;8a1;8b1;9a2;9b;10a1;										0.00	0.00	0.00	0.00									0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00							0.00	0.00	0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H5178	002	0	1	01	01	H5178_002_0	5	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5211	001	0	1	02	01	H5211_001_0	9	1	3									00001111000001000000																1	001		2	01	7h1;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7h1;																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																																													2			
H5211	001	0	1	02	01	H5211_001_0	9	2	2															00000000001000	Meets clinical criteria, hospital care in home based on health status.									2			2	01	1a;			2	2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																							2			
H5211	002	0	1	02	01	H5211_002_0	6	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status.									2			2	01	1a;			2	2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																							2			
H5211	002	0	1	02	01	H5211_002_0	6	2	3									00001111000001000000																1	001		2	01	7h1;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7h1;																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																																													2			
H5211	003	0	1	02	01	H5211_003_0	5	2	3									00001111000001000000																1	001		2	01	7h1;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7h1;																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																																													2			
H5211	003	0	1	02	01	H5211_003_0	5	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status.									2			2	01	1a;			2	2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																							2			
H5211	004	0	1	02	01	H5211_004_0	6	2	3									00001111000001000000																1	001		2	01	7h1;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7h1;																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																																													2			
H5211	004	0	1	02	01	H5211_004_0	6	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status.									2			2	01	1a;			2	2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																							2			
H5211	012	0	1	02	01	H5211_012_0	11	2	3									00001111000001000000																1	001		2	01	7h1;8a2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7h1;8a2;																																		0.00	0.00											0.00	0.00																																																																																																																																																																																																																																																																																																																																																	2			
H5211	012	0	1	02	01	H5211_012_0	11	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status.									2			2	01	1a;			2	2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																							2			
H5216	142	2	1	04	01	H5216_142_2	4	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	242	0	1	04	01	H5216_242_0	7	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	243	0	1	04	01	H5216_243_0	9	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	257	0	1	04	01	H5216_257_0	4	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	277	0	1	04	01	H5216_277_0	4	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	317	0	1	04	01	H5216_317_0	3	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	347	0	1	04	01	H5216_347_0	4	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	362	0	1	04	01	H5216_362_0	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	369	0	1	04	01	H5216_369_0	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	391	0	1	04	01	H5216_391_0	4	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	400	0	1	04	01	H5216_400_0	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	1000.00	10000	Purchases must be coordinated by a Care Manager on the member's behalf
H5216	401	0	1	04	01	H5216_401_0	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	402	0	1	04	01	H5216_402_0	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	413	0	1	04	01	H5216_413_0	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	1000.00	10000	Purchases must be coordinated by a Care Manager on the member's behalf
H5216	416	0	1	04	01	H5216_416_0	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	419	0	1	04	01	H5216_419_0	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	444	0	1	04	01	H5216_444_0	5	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	446	0	1	04	01	H5216_446_0	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	447	0	1	04	01	H5216_447_0	6	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5262	001	0	1	01	01	H5262_001_0	7	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						0	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	003	0	1	01	01	H5262_003_0	7	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	004	0	1	01	01	H5262_004_0	4	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	005	0	1	01	01	H5262_005_0	4	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	007	0	1	01	01	H5262_007_0	6	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	008	0	1	01	01	H5262_008_0	6	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	009	0	1	01	01	H5262_009_0	4	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	010	0	1	01	01	H5262_010_0	4	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	011	0	1	01	01	H5262_011_0	6	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	012	0	1	01	01	H5262_012_0	6	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	013	0	1	01	01	H5262_013_0	5	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	018	0	1	01	01	H5262_018_0	6	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	019	0	1	01	01	H5262_019_0	6	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	020	0	1	01	01	H5262_020_0	4	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	021	0	1	01	01	H5262_021_0	6	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	023	0	1	01	01	H5262_023_0	6	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	024	0	1	01	01	H5262_024_0	6	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	025	0	1	01	01	H5262_025_0	4	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	026	0	1	01	01	H5262_026_0	6	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5262	027	0	1	01	01	H5262_027_0	4	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5302	022	0	1	01	01	H5302_022_0	2	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1	7f_2;		1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;																							10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																					10.00	10.00																																																																																																																																																																																																																																																													2			
H5302	809	0	1	01	01	H5302_809_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H5302	809	0	1	01	01	H5302_809_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H5302	810	0	1	01	01	H5302_810_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H5302	810	0	1	01	01	H5302_810_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H5361	001	0	1	04	01	H5361_001_0	5	1	2															00000000001000	Breast Cancer									2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H5361	002	0	1	04	01	H5361_002_0	5	1	2															00000000001000	Breast Cancer									2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H5361	003	0	1	04	01	H5361_003_0	5	1	2															00000000001000	Breast Cancer									2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H5361	004	0	1	04	01	H5361_004_0	5	1	2															00000000001000	Breast Cancer									2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	8b2;																																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																													2			
H5521	013	0	1	04	01	H5521_013_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H5521	016	0	1	04	01	H5521_016_0	2	1	2															00000000001000	Long term institutionalized									1	010		2	01	7f;			1	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H5521	040	0	1	04	01	H5521_040_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H5521	081	0	1	04	01	H5521_081_0	3	1	2															00000000001000	Long term institutionalized									1	010		2	01	7f;			1	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H5521	086	0	1	04	01	H5521_086_0	2	1	2															00000000001000	Long term institutionalized									1	010		2	01	7f;			1	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H5521	157	0	1	04	01	H5521_157_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H5521	170	0	1	04	01	H5521_170_0	2	1	2															00000000001000	Long term institutionalized									1	010		2	01	7f;			1	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H5521	277	0	1	04	01	H5521_277_0	2	2	2															00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H5521	277	0	1	04	01	H5521_277_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H5521	302	0	1	04	01	H5521_302_0	4	1	1	001					01110	251080	22525																	1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H5521	364	0	1	04	01	H5521_364_0	4	1	1	001					01110	251080	22525																	1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H5521	365	0	1	04	01	H5521_365_0	2	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1	7f_2;	1	1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;																							10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																					10.00	10.00																																																																																																																																																																																																																																																													2			
H5521	399	0	1	04	01	H5521_399_0	3	1	1	001					01110	251080	22525																	1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H5521	474	0	1	04	01	H5521_474_0	3	1	1	001					01110	251080	22525																	1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H5521	496	0	1	04	01	H5521_496_0	4	1	1	001					01110	251080	22525																	1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H5521	500	0	1	04	01	H5521_500_0	3	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H5521	502	0	1	04	01	H5521_502_0	2	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H5521	511	0	1	04	01	H5521_511_0	2	2	2															00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H5521	511	0	1	04	01	H5521_511_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H5521	512	0	1	04	01	H5521_512_0	2	1	2															00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H5521	512	0	1	04	01	H5521_512_0	2	2	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H5521	514	0	1	04	01	H5521_514_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H5521	514	0	1	04	01	H5521_514_0	2	2	2															00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H5521	520	0	1	04	01	H5521_520_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H5521	521	0	1	04	01	H5521_521_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H5521	522	0	1	04	01	H5521_522_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H5521	536	0	1	04	01	H5521_536_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H5521	537	0	1	04	01	H5521_537_0	2	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H5521	543	0	1	04	01	H5521_543_0	3	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
H5521	550	0	1	04	01	H5521_550_0	2	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H5521	551	0	1	04	01	H5521_551_0	3	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H5521	598	0	1	04	01	H5521_598_0	2	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H5521	801	0	1	04	01	H5521_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	801	0	1	04	01	H5521_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	802	0	1	04	01	H5521_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	802	0	1	04	01	H5521_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	805	0	2	04	01	H5521_805_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	805	0	2	04	01	H5521_805_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	806	0	2	04	01	H5521_806_0	1	1	3									01111111111111111000	other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	806	0	2	04	01	H5521_806_0	1	2	2															01111111111000	other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	809	0	1	04	01	H5521_809_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	809	0	1	04	01	H5521_809_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	810	0	1	04	01	H5521_810_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	810	0	1	04	01	H5521_810_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	812	0	1	04	01	H5521_812_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	812	0	1	04	01	H5521_812_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	814	0	2	04	01	H5521_814_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	814	0	2	04	01	H5521_814_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	815	0	2	04	01	H5521_815_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	815	0	2	04	01	H5521_815_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	816	0	2	04	01	H5521_816_0	1	1	3									01111111111111111000	other CMS chronic Conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	816	0	2	04	01	H5521_816_0	1	2	2															01111111111000	Other CMS chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	817	0	1	04	01	H5521_817_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	817	0	1	04	01	H5521_817_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	818	0	2	04	01	H5521_818_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	818	0	2	04	01	H5521_818_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	819	0	1	04	01	H5521_819_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	819	0	1	04	01	H5521_819_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	820	0	1	04	01	H5521_820_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	820	0	1	04	01	H5521_820_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	821	0	1	04	01	H5521_821_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	821	0	1	04	01	H5521_821_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	822	0	1	04	01	H5521_822_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	822	0	1	04	01	H5521_822_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	823	0	2	04	01	H5521_823_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	823	0	2	04	01	H5521_823_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	824	0	2	04	01	H5521_824_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	824	0	2	04	01	H5521_824_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	825	0	1	04	01	H5521_825_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	825	0	1	04	01	H5521_825_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	826	0	2	04	01	H5521_826_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	826	0	2	04	01	H5521_826_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	827	0	2	04	01	H5521_827_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	827	0	2	04	01	H5521_827_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	828	0	2	04	01	H5521_828_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	828	0	2	04	01	H5521_828_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	829	0	1	04	01	H5521_829_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	829	0	1	04	01	H5521_829_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	830	0	2	04	01	H5521_830_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	830	0	2	04	01	H5521_830_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	831	0	1	04	01	H5521_831_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	831	0	1	04	01	H5521_831_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	832	0	1	04	01	H5521_832_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	832	0	1	04	01	H5521_832_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	833	0	1	04	01	H5521_833_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	833	0	1	04	01	H5521_833_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	834	0	1	04	01	H5521_834_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	834	0	1	04	01	H5521_834_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	835	0	2	04	01	H5521_835_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	835	0	2	04	01	H5521_835_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	836	0	1	04	01	H5521_836_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	836	0	1	04	01	H5521_836_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	837	0	1	04	01	H5521_837_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5521	837	0	1	04	01	H5521_837_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	001	0	1	04	01	H5522_001_0	3	1	1	010	0001000000					11611	7484																	1	001		2	01	7d;7j;	2		1	1	01	7d;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				018;008;012;030;					0.00	0.00			0.00	0.00											0.00	0.00																	0.00	0.00											2			
H5522	002	0	1	04	01	H5522_002_0	3	1	1	010	0001000000					11611	7484																	1	001		2	01	7d;7j;	2		1	1	01	7d;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				018;030;012;008;					0.00	0.00			0.00	0.00											0.00	0.00																	0.00	0.00											2			
H5522	005	0	1	04	01	H5522_005_0	3	1	1	010	0001000000					11611	7484																	1	001		2	01	7d;7j;	2		1	1	01	7d;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7j;																																								0.00	0.00																																																																																																																																																																																																																																																																																																				018;008;012;030;					0.00	0.00			0.00	0.00											0.00	0.00																	0.00	0.00											2			
H5522	013	0	1	04	01	H5522_013_0	3	1	1	001					01110	251080	22525																	1	010		2	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1	7f_2;	1	1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;																							10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																					10.00	10.00																																																																																																																																																																																																																																																													2			
H5522	802	0	1	04	01	H5522_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	802	0	1	04	01	H5522_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	803	0	1	04	01	H5522_803_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	803	0	1	04	01	H5522_803_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	808	0	2	04	01	H5522_808_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	808	0	2	04	01	H5522_808_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	809	0	2	04	01	H5522_809_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	809	0	2	04	01	H5522_809_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	810	0	1	04	01	H5522_810_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	810	0	1	04	01	H5522_810_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	811	0	1	04	01	H5522_811_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	811	0	1	04	01	H5522_811_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	813	0	2	04	01	H5522_813_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	813	0	2	04	01	H5522_813_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	814	0	2	04	01	H5522_814_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	814	0	2	04	01	H5522_814_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	815	0	1	04	01	H5522_815_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	815	0	1	04	01	H5522_815_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	816	0	1	04	01	H5522_816_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	816	0	1	04	01	H5522_816_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	817	0	2	04	01	H5522_817_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	817	0	2	04	01	H5522_817_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	818	0	2	04	01	H5522_818_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	818	0	2	04	01	H5522_818_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	819	0	1	04	01	H5522_819_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	819	0	1	04	01	H5522_819_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	820	0	1	04	01	H5522_820_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	820	0	1	04	01	H5522_820_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	821	0	1	04	01	H5522_821_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	821	0	1	04	01	H5522_821_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	822	0	2	04	01	H5522_822_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	822	0	2	04	01	H5522_822_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	823	0	1	04	01	H5522_823_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	823	0	1	04	01	H5522_823_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	824	0	2	04	01	H5522_824_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	824	0	2	04	01	H5522_824_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	825	0	2	04	01	H5522_825_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	825	0	2	04	01	H5522_825_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	826	0	2	04	01	H5522_826_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	826	0	2	04	01	H5522_826_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	827	0	2	04	01	H5522_827_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	827	0	2	04	01	H5522_827_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	828	0	1	04	01	H5522_828_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	828	0	1	04	01	H5522_828_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	829	0	2	04	01	H5522_829_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	829	0	2	04	01	H5522_829_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	830	0	1	04	01	H5522_830_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	830	0	1	04	01	H5522_830_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	831	0	1	04	01	H5522_831_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	831	0	1	04	01	H5522_831_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	832	0	1	04	01	H5522_832_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	832	0	1	04	01	H5522_832_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	833	0	1	04	01	H5522_833_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	833	0	1	04	01	H5522_833_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	834	0	2	04	01	H5522_834_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	834	0	2	04	01	H5522_834_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	835	0	1	04	01	H5522_835_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	835	0	1	04	01	H5522_835_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	836	0	1	04	01	H5522_836_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5522	836	0	1	04	01	H5522_836_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5525	036	0	1	04	01	H5525_036_0	4	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5525	050	0	1	04	01	H5525_050_0	4	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5525	083	0	1	04	01	H5525_083_0	4	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5533	003	0	1	04	01	H5533_003_0	9	2	3									00000000000001000000																2			2	01	7e1;7e2;7j;			1	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H5533	003	0	1	04	01	H5533_003_0	9	1	2															00100000000000										2			2	01	11a;			1	1	01	11a;		1	01	11a;																																																																						0	18																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5533	005	0	1	04	01	H5533_005_0	9	2	3									00000000000001000000																2			2	01	7e1;7e2;7j;			1	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H5533	005	0	1	04	01	H5533_005_0	9	1	2															00100000000000										2			2	01	11a;			1	1	01	11a;		1	01	11a;																																																																						0	0																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5533	008	0	1	04	01	H5533_008_0	9	1	3									00000000000001000000																2			2	01	7e1;7e2;7j;			1	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H5533	011	0	1	04	01	H5533_011_0	10	1	3									00000000000001000000																2			2	01	7e1;7e2;7j;			1	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H5533	013	0	1	04	01	H5533_013_0	12	1	3									00000000000001000000																2			2	01	7e1;7e2;7j;			1	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H5533	015	1	1	04	01	H5533_015_1	11	1	3									00000000000001000000																2			2	01	7e1;7e2;7j;			2	1	01	7e1;7e2;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H5533	015	2	1	04	01	H5533_015_2	12	1	3									00000000000001000000																2			2	01	7e1;7e2;7j;			1	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H5533	015	3	1	04	01	H5533_015_3	12	1	3									00000000000001000000																2			2	01	7e1;7e2;7j;			1	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H5533	015	4	1	04	01	H5533_015_4	12	1	3									00000000000001000000																2			2	01	7e1;7e2;7j;			1	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H5533	017	1	1	04	01	H5533_017_1	10	1	3									00000000000001000000																2			2	01	7e1;7e2;7j;			1	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H5533	017	2	1	04	01	H5533_017_2	10	1	3									00000000000001000000																2			2	01	7e1;7e2;7j;			1	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7j;																										15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																							2			
H5591	005	0	1	02	01	H5591_005_0	6	1	2															00000000001000	Opiate Use Disorder									2			2	01	7e1;7e2;7h1;7h2;9c1;9c2;			1	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7h1;7h2;9c1;9c2;																										0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																							0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																																	1	100.00	00100	
H5591	006	1	1	02	01	H5591_006_1	6	1	2															00000000001000	Opiate Use Disorder									2			2	01	7e1;7e2;7h1;7h2;9c1;9c2;			1	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7h1;7h2;9c1;9c2;																										0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																							0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																																	1	100.00	00100	
H5591	006	2	1	02	01	H5591_006_2	6	1	2															00000000001000	Opiate Use Disorder									2			2	01	7e1;7e2;7h1;7h2;9c1;9c2;			1	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7h1;7h2;9c1;9c2;																										0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																							0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																																	1	100.00	00100	
H5591	009	0	1	02	01	H5591_009_0	6	1	2															00000000001000	Opiate Use Disorder									2			2	01	7e1;7e2;7h1;7h2;9c1;9c2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7h1;7h2;9c1;9c2;																										0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																							0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																																	1	100.00	00100	
H5591	015	1	1	02	01	H5591_015_1	6	1	2															00000000001000	Opiate Use Disorder									2			2	01	7e1;7e2;7h1;7h2;9c1;9c2;			1	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7h1;7h2;9c1;9c2;																										0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																							0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																																	1	100.00	00100	
H5591	015	2	1	02	01	H5591_015_2	6	1	2															00000000001000	Opiate Use Disorder									2			2	01	7e1;7e2;7h1;7h2;9c1;9c2;			1	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7e1;7e2;7h1;7h2;9c1;9c2;																										0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																							0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																																	1	100.00	00100	
H5593	801	0	1	01	01	H5593_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H5593	801	0	1	01	01	H5593_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H5593	802	0	1	01	01	H5593_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H5593	802	0	1	01	01	H5593_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H5619	054	0	1	02	01	H5619_054_0	7	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5619	135	0	1	01	01	H5619_135_0	4	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5619	157	0	1	01	01	H5619_157_0	4	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5619	173	0	1	01	01	H5619_173_0	3	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5793	019	0	1	02	01	H5793_019_0	3	1	3									01111111111111111100	Hyperlipidemia	Hypertension														1	010		2	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1	7f_2;	2	1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;																							10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																					10.00	10.00																																																																																																																																																																																																																																																													2			
H5793	801	0	1	01	01	H5793_801_0	2	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H5793	801	0	1	01	01	H5793_801_0	2	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H5793	802	0	1	01	01	H5793_802_0	2	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H5793	802	0	1	01	01	H5793_802_0	2	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H5826	006	0	1	01	01	H5826_006_0	3	2	2															00100000000000										2			2	01	7d;11a;	2			2				1	01	11a;																																																																						0	0																																																																																																																																																																																									2																																																																																																																																															1	01	11a;																																																																						0.00	0.00																																																																																																																																																																																																																																																																						030;																																							0.00	0.00											2			
H5826	006	0	1	01	01	H5826_006_0	3	3	2															00010000000000										2			2	01	7d;	2			2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																				008;					0.00	0.00																																													2			
H5826	006	0	1	01	01	H5826_006_0	3	1	2															01000000000000										2			2	01	7d;17a;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																				023;012;									0.00	0.00																					0.00	0.00																			2			
H5826	009	0	1	01	01	H5826_009_0	4	3	2															00010000000000										2			2	01	7d;	2			2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																				008;					0.00	0.00																																													2			
H5826	009	0	1	01	01	H5826_009_0	4	2	2															00100000000000										2			2	01	7d;11a;	2			2				1	01	11a;																																																																						0	0																																																																																																																																																																																									2																																																																																																																																															1	01	11a;																																																																						0.00	0.00																																																																																																																																																																																																																																																																						030;																																							0.00	0.00											2			
H5826	009	0	1	01	01	H5826_009_0	4	1	2															01000000000000										2			2	01	7d;17a;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																				023;012;									0.00	0.00																					0.00	0.00																			2			
H5826	010	0	1	01	01	H5826_010_0	4	1	2															01000000000000										2			2	01	7d;17a;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																				023;012;									0.00	0.00																					0.00	0.00																			2			
H5826	010	0	1	01	01	H5826_010_0	4	3	2															00010000000000										2			2	01	7d;	2			2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																				008;					0.00	0.00																																													2			
H5826	010	0	1	01	01	H5826_010_0	4	2	2															00100000000000										2			2	01	7d;11a;	2			2				1	01	11a;																																																																						0	0																																																																																																																																																																																									2																																																																																																																																															1	01	11a;																																																																						0.00	0.00																																																																																																																																																																																																																																																																						008;					0.00	0.00																																													2			
H5938	001	0	1	01	01	H5938_001_0	16	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	30.00																																																																																																																																																																																																																																																																																							2			
H5938	006	0	1	01	01	H5938_006_0	12	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	20.00																																																																																																																																																																																																																																																																																							2			
H5938	008	0	1	01	01	H5938_008_0	10	1	2															01000000000000										2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	30.00																																																																																																																																																																																																																																																																																							1	30.00	00100	
H5938	802	0	1	01	01	H5938_802_0	3	1	2															01000000000000										2			2	01	17a;				2				1	01	17a;																																																																																																								0	20																																																																																																																																																							2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5938	803	0	1	01	01	H5938_803_0	3	1	2															01000000000000										2			2	01	17a;				2				1	01	17a;																																																																																																								0	20																																																																																																																																																							2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5938	804	0	1	01	01	H5938_804_0	3	1	2															01000000000000										2			2	01	17a;				2				1	01	17a;																																																																																																								0	20																																																																																																																																																							2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5938	805	0	1	01	01	H5938_805_0	3	1	2															01000000000000										2			2	01	17a;				2				1	01	17a;																																																																																																								0	20																																																																																																																																																							2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H5959	009	0	1	04	01	H5959_009_0	5	1	2															00000000101110	history of joint & muscle pain	urinary incontinance	osteoarthritis							1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7i;																																						0.00	0.00																																																																																																																																																																																																																																																																																																																																																									2			
H5959	010	1	1	04	01	H5959_010_1	6	1	2															00000000101110	history of Joint & muscle pain	Urinary incontinence	Osteoarthritis							1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7i;																																						0.00	0.00																																																																																																																																																																																																																																																																																																																																																									2			
H5959	010	2	1	04	01	H5959_010_2	6	1	2															00000000101110	history of joint & muscle pain	urinary incontinance	osteoarthritis							1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7i;																																						0.00	0.00																																																																																																																																																																																																																																																																																																																																																									2			
H5959	011	0	1	04	01	H5959_011_0	5	1	2															00000000101110	history of joint & muscle pain	urinary inconrinance	osteoarthritis							1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7i;																																						0.00	0.00																																																																																																																																																																																																																																																																																																																																																									2			
H5959	012	0	1	04	01	H5959_012_0	3	1	2															00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis							1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7i;																																						0.00	0.00																																																																																																																																																																																																																																																																																																																																																									2			
H5959	013	1	1	04	01	H5959_013_1	3	1	2															00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis							1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7i;																																						0.00	0.00																																																																																																																																																																																																																																																																																																																																																									2			
H5959	013	2	1	04	01	H5959_013_2	3	1	2															00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis							1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7i;																																						0.00	0.00																																																																																																																																																																																																																																																																																																																																																									2			
H5959	014	1	1	04	01	H5959_014_1	6	1	2															00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis							1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7i;																																						0.00	0.00																																																																																																																																																																																																																																																																																																																																																									2			
H5959	014	2	1	04	01	H5959_014_2	6	1	2															00000000101110	history of joint & muscle pain	urinary incontinance	osteoarthritis							1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7i;																																						0.00	0.00																																																																																																																																																																																																																																																																																																																																																									2			
H5959	015	0	1	04	01	H5959_015_0	4	1	2															00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis							1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7i;																																						0.00	0.00																																																																																																																																																																																																																																																																																																																																																									2			
H5959	016	0	1	04	01	H5959_016_0	4	1	2															00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis							1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7i;																																						0.00	0.00																																																																																																																																																																																																																																																																																																																																																									2			
H5959	018	0	1	04	01	H5959_018_0	5	1	2															00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis							1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7i;																																						0.00	0.00																																																																																																																																																																																																																																																																																																																																																									2			
H5959	801	0	1	04	01	H5959_801_0	3	1	2															00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis							1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7i;																																						0.00	0.00																																																																																																																																																																																																																																																																																																																																																									2			
H5959	807	0	1	04	01	H5959_807_0	3	1	2															00000000101110	history of Joint & muscle pain	urinary incontinence	osteoarthritis							1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7i;																																						0.00	0.00																																																																																																																																																																																																																																																																																																																																																									2			
H5959	808	0	1	04	01	H5959_808_0	3	1	2															00000000101110	history of joint & muscle pain	urinary incontinance	osteoarthritis							1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7i;																																						0.00	0.00																																																																																																																																																																																																																																																																																																																																																									2			
H5959	809	0	1	04	01	H5959_809_0	3	1	2															00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis							1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7i;																																						0.00	0.00																																																																																																																																																																																																																																																																																																																																																									2			
H6200	001	0	1	04	01	H6200_001_0	4	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6200	002	0	1	04	01	H6200_002_0	4	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6200	003	0	1	04	01	H6200_003_0	4	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6200	004	0	1	04	01	H6200_004_0	4	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6200	005	0	1	04	01	H6200_005_0	4	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6200	006	0	1	04	01	H6200_006_0	4	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6200	007	0	1	04	01	H6200_007_0	4	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6200	009	0	1	04	01	H6200_009_0	4	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6200	010	0	1	04	01	H6200_010_0	4	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6453	013	1	1	02	01	H6453_013_1	6	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6453	013	2	1	02	01	H6453_013_2	5	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6453	013	3	1	02	01	H6453_013_3	5	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6453	013	4	1	02	01	H6453_013_4	5	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6453	013	5	1	02	01	H6453_013_5	5	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6453	017	1	1	02	01	H6453_017_1	6	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6453	017	2	1	02	01	H6453_017_2	5	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6453	018	1	1	02	01	H6453_018_1	6	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6453	018	2	1	02	01	H6453_018_2	5	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6453	020	1	1	02	01	H6453_020_1	5	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6453	020	2	1	02	01	H6453_020_2	5	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H6622	061	0	1	02	01	H6622_061_0	4	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H6727	001	0	1	04	01	H6727_001_0	6	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H7149	801	0	1	01	01	H7149_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H7149	801	0	1	01	01	H7149_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H7149	802	0	1	01	01	H7149_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H7149	802	0	1	01	01	H7149_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H7163	002	0	1	02	01	H7163_002_0	4	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H7163	004	0	1	02	01	H7163_004_0	4	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H7163	005	0	1	02	01	H7163_005_0	4	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H7220	012	0	1	01	01	H7220_012_0	5	1	3									00000000010000001110	CKD3	CKD4	CKD5													1	011		2	01	7d;12;	2			2				1	01	12;																																																																																0	0																																																																																																																																																																															2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																															018;																					0.00	0.00																													2			
H7301	013	0	1	04	01	H7301_013_0	2	1	2															00000000001000	Long term institutionalized									1	010		2	01	7f;			1	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H7301	022	0	1	04	01	H7301_022_0	3	1	1	001					01110	251080	22525																	1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																								10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																			2			
H7301	801	0	1	04	01	H7301_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H7301	801	0	1	04	01	H7301_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H7301	803	0	1	04	01	H7301_803_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H7301	803	0	1	04	01	H7301_803_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H7646	001	0	1	02	01	H7646_001_0	6	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H7646	002	0	1	02	01	H7646_002_0	6	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H7646	004	0	1	02	01	H7646_004_0	6	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H7646	005	0	1	02	01	H7646_005_0	6	1	2															01000000000000										2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																							2			
H8145	069	0	1	09	04	H8145_069_0	3	1	3									01111111111111111000	Chronic Obstructive Pulmonary Disease (COPD)															1	001		2	01	3-1;			1	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	3-1;		0.00	0.00																																																																																																																																																																																																																																																																																																																																																																																													1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H8332	801	0	1	01	01	H8332_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H8332	801	0	1	01	01	H8332_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H8332	802	0	1	01	01	H8332_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H8332	802	0	1	01	01	H8332_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H8649	801	0	1	01	01	H8649_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H8649	801	0	1	01	01	H8649_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H8649	803	0	1	01	01	H8649_803_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H8649	803	0	1	01	01	H8649_803_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																													2			
H9003	001	0	1	02	01	H9003_001_0	9	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	11	4a;7c;7g;7i;8a1;8b1;10a1;11a;11b2;		13e;	2	2				1	11	11a;11b2;	13e;																																																																					0	0			0	0																																																																					0	0																																																																																																															2																																																																																																																																															1	01	4a;7c;7g;7i;8a1;8b1;10a1;										0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00																	0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H9003	006	0	1	02	01	H9003_006_0	9	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	11	4a;7c;7g;7i;8a1;8b1;10a1;11a;11b2;		13e;	2	2				1	11	11a;11b2;	13e;																																																																					0	0			0	0																																																																					0	0																																																																																																															2																																																																																																																																															1	01	4a;7c;7g;7i;8a1;8b1;10a1;										0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00																	0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H9003	009	0	1	02	01	H9003_009_0	10	1	2															00000000001000	Meets clinical criteria, hospital care in home based on health status									2			2	11	7c;7g;7i;8a1;8b1;10a1;11a;11b2;4a;		13e;	2	2				1	11	11a;11b2;	13e;																																																																					0	0			0	0																																																																					0	0																																																																																																															2																																																																																																																																															1	01	4a;7c;7g;7i;8a1;8b1;10a1;										0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00																	0.00	0.00																																																																																																																																																																																																																																																																																																																													2			
H9431	801	0	1	04	01	H9431_801_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H9431	801	0	1	04	01	H9431_801_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H9431	802	0	1	04	01	H9431_802_0	1	1	3									01111111111111111000	Other CMS defined chronic conditions															1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H9431	802	0	1	04	01	H9431_802_0	1	2	2															01111111111000	Other CMS defined chronic conditions									1	001		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H9615	007	0	1	04	01	H9615_007_0	7	1	2															01000000000000										2			2	01	7f;			2	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H9615	008	0	1	04	01	H9615_008_0	7	1	2															01000000000000										2			2	01	7f;			2	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H9615	010	0	1	04	01	H9615_010_0	7	1	2															01000000000000										2			2	01	7f;			2	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H9615	012	0	1	04	01	H9615_012_0	7	1	2															01000000000000										2			2	01	7f;			2	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H9615	015	0	1	04	01	H9615_015_0	7	1	2															01000000000000										2			2	01	7f;			2	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H9615	015	0	1	04	01	H9615_015_0	7	2	2															00010000000000										2			2	01	7d;	2		1	2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																				008;					0.00	0.00																																													2			
H9615	018	0	1	04	01	H9615_018_0	7	1	2															01000000000000										2			2	01	7f;			2	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H9615	020	0	1	04	01	H9615_020_0	7	1	2															01000000000000										2			2	01	7f;			2	1	01	7f;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7f;																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																																	2			
H9834	001	0	1	01	01	H9834_001_0	6	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H9834	003	0	1	01	01	H9834_003_0	6	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H9834	004	0	1	01	01	H9834_004_0	4	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H9834	005	0	1	01	01	H9834_005_0	4	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
H9834	006	0	1	01	01	H9834_006_0	6	1	2															01000000000000										2			2	01	11a;				2				1	01	11a;																																																																						10	10																																																																																																																																																																																									2																																																																																																																																															2																																																																																																																																																																																																																																																																																																																																																																																																		2			
R6694	006	0	1	31	11	R6694_006_0	3	2	2															00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
R6694	006	0	1	31	11	R6694_006_0	3	1	2															11000000001111	Chronic and disabling mental health conditions	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic musculoskeletal or metabolic conditions	Autoimmune, chronic lung or neurologic disorders	Chronic alcohol and other drug dep, End-stage liver disease or ESRD					1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																															1	01	7a;7j;																		0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																							2			
