pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	pbp_vbid_group_id	pbp_b19b_package_type	pbp_b19b_package_name	pbp_b19b_tm_vbid	pbp_b19b_states_ehc_vbd	pbp_b19b_states_ehc_vbd_d	pbp_b19b_all_dis_yn	pbp_b19b_cmb_dis_yn	pbp_b19b_cmb_dis_d	pbp_b19b_lis_vbid	pbp_b19b_enr_tar_vbid	pbp_b19b_enr_eng_vbid	pbp_b19b_states_ehc_ssbci	pbp_b19b_states_ssbci_other1	pbp_b19b_states_ssbci_other2	pbp_b19b_states_ssbci_other3	pbp_b19b_states_ssbci_other4	pbp_b19b_states_ssbci_other5	pbp_b19b_states_ehc_uf	pbp_b19b_states_uf_other1	pbp_b19b_states_uf_other2	pbp_b19b_states_uf_other3	pbp_b19b_states_uf_other4	pbp_b19b_states_uf_other5	pbp_b19b_states_uf_all_yn	pbp_b19b_states_uf_cmb_yn	pbp_b19b_states_uf_cmb_d	pbp_b19b_add_prereq_yn	pbp_b19b_add_prereq	pbp_b19b_add_prereq_d	pbp_b19b_add_nmc_bendesc_cats	pbp_b19b_add_apply_yn	pbp_b19b_add_exempt_yn	pbp_b19b_add_exempt_nmc_cats	pbp_b19b_agg_yn	pbp_b19b_agg_amt	pbp_b19b_agg_period	pbp_b19b_agg_period_d	pbp_b19b_agg_mode	pbp_b19b_agg_mode_desc	pbp_b19b_agg_nmc_bendesc_cats
H0028	007	0	1	01	01	H0028_007_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	007	0	1	01	01	H0028_007_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H0028	015	0	1	02	01	H0028_015_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H0028	015	0	1	02	01	H0028_015_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	019	0	1	01	01	H0028_019_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H0028	029	0	1	01	01	H0028_029_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H0028	030	0	1	01	01	H0028_030_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H0028	032	0	1	01	01	H0028_032_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	032	0	1	01	01	H0028_032_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H0028	035	0	1	01	01	H0028_035_0	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H0028	036	0	1	01	01	H0028_036_0	6	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	036	0	1	01	01	H0028_036_0	6	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H0028	037	0	1	01	01	H0028_037_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H0028	039	0	1	01	01	H0028_039_0	5	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H0028	039	0	1	01	01	H0028_039_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H0028	041	0	1	01	01	H0028_041_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H0028	042	0	1	01	01	H0028_042_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H0028	043	1	1	01	01	H0028_043_1	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H0028	046	0	1	01	01	H0028_046_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H0028	046	0	1	01	01	H0028_046_0	3	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H0028	051	0	1	01	01	H0028_051_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	055	0	1	02	01	H0028_055_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	056	0	1	02	01	H0028_056_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	059	0	1	01	01	H0028_059_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H0028	060	0	1	01	01	H0028_060_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	067	0	1	02	01	H0028_067_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	067	0	1	02	01	H0028_067_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H0028	070	0	1	01	01	H0028_070_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H0028	072	0	1	01	01	H0028_072_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H0028	076	0	1	01	01	H0028_076_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H0028	076	0	1	01	01	H0028_076_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	077	0	1	01	01	H0028_077_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	077	0	1	01	01	H0028_077_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H0028	078	0	1	01	01	H0028_078_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H0028	078	0	1	01	01	H0028_078_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	079	0	1	01	01	H0028_079_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H0028	079	0	1	01	01	H0028_079_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	080	0	1	01	01	H0028_080_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H0028	080	0	1	01	01	H0028_080_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0029	007	0	1	02	01	H0029_007_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0029	008	0	1	02	01	H0029_008_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0029	010	0	1	02	01	H0029_010_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0034	001	0	1	01	01	H0034_001_0	8	1	3	SSBCI-Food and Utilities										011111110111111110001001100	Chronic Hyperlipidemia	Autism Spectrum Disorder													2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0034	002	0	1	01	01	H0034_002_0	11	1	3	SSBCI - Food and Utilities										011111110111111110001001100	Chronic Hyperlipidemia	Autism Spectrum Disorder													2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0062	011	0	1	01	01	H0062_011_0	7	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0062	012	0	1	01	01	H0062_012_0	7	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0074	004	0	1	04	01	H0074_004_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0104	012	0	1	04	01	H0104_012_0	6	1	2	GA Foods																01110000001100	Vascular Disease	Autoimmune Disorders				2	1	The enrollee must be diagnosed with a minimum of two of the chronic conditions listed above.	2			13c;	1	1	13c;	2						
H0104	014	0	1	04	01	H0104_014_0	7	1	2	GA Foods																01110000001100	Vascular Disease	Autoimmune Disorders				2	1	The enrollee must be diagnosed with a minimum of two of the chronic conditions listed above.	2			13c;	1	1	13c;	2						
H0104	015	0	1	04	01	H0104_015_0	6	1	2	GA Foods																01110000001100	Vascular Disease	Autoimmune Disorders				2	1	The enrollee must be diagnosed with a minimum of two of the chronic conditions listed above.	2			13c;	1	1	13c;	2						
H0154	012	0	1	01	01	H0154_012_0	4	1	3	Healthy Food and Produce										011111111111111111111111100	Chronic Musculoskeletal Disorders	Chronic Malnutrition/Under Nutrition													2			13i1;		2		1	0.00	7		01010		13i1;
H0154	019	0	1	01	01	H0154_019_0	4	1	3	Healthy Food and Produce										011111111111111111111111100	Chronic Musculoskeletal Disorders	Chronic Malnutrition/Under Nutrition													2			13i1;		2		1	0.00	7		01010		13i1;
H0169	001	0	1	02	01	H0169_001_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0169	002	0	1	02	01	H0169_002_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0169	003	0	1	02	01	H0169_003_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0169	004	0	1	02	01	H0169_004_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0169	006	0	1	02	01	H0169_006_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0169	008	0	1	02	01	H0169_008_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0169	009	0	1	02	01	H0169_009_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0169	010	0	1	02	01	H0169_010_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0174	004	0	1	01	01	H0174_004_0	6	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0174	006	0	1	01	01	H0174_006_0	7	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0174	022	0	1	01	01	H0174_022_0	6	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0174	023	0	1	01	01	H0174_023_0	7	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0174	024	0	1	01	01	H0174_024_0	7	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0174	025	0	1	01	01	H0174_025_0	7	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0174	026	0	1	01	01	H0174_026_0	6	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0251	002	0	1	02	01	H0251_002_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0251	004	0	1	02	01	H0251_004_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0251	008	0	1	02	01	H0251_008_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0292	001	0	1	01	01	H0292_001_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H0292	002	0	1	01	01	H0292_002_0	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H0294	002	0	1	04	01	H0294_002_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H0294	027	0	1	04	01	H0294_027_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0294	048	0	1	04	01	H0294_048_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H0294	049	0	1	04	01	H0294_049_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0294	050	0	1	04	01	H0294_050_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0294	051	0	1	04	01	H0294_051_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0321	002	0	1	02	01	H0321_002_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0321	004	0	1	02	01	H0321_004_0	5	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i4;13i10;	2	1	13i1;13i4;13i10;	1	0.00	7		00010		13i1;13i10;
H0332	004	0	1	02	01	H0332_004_0	7	1	3	SSBCI Transportation										000101000011000000000000000															2			10b1;	2	2		2						
H0351	066	0	1	02	01	H0351_066_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0351	068	0	1	02	01	H0351_068_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0354	027	0	1	01	01	H0354_027_0	4	1	3	Food and Produce										000011010000000000000000000															2			13i1;		2		2						
H0363	001	0	1	01	01	H0363_001_0	4	1	3	SSBCI										011111111111111111111110000															2			13i6;13i4;14c17;10b1;13i-O1;13i-O2;		2		1	200.00	3		01000		13i6;13i-O1;13i-O2;
H0413	003	0	1	04	01	H0413_003_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	305.00	7		00010		13i1;13i10;
H0421	001	0	1	04	01	H0421_001_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0423	001	0	1	01	01	H0423_001_0	7	1	3	Package 1										011111111111111111111110000															2			13i10;13i1;13i-O1;		1	13i10;13i1;13i-O1;	2						
H0423	007	0	1	01	01	H0423_007_0	7	1	3	Package 1										011111111111111111111110000															2			13i10;13i1;13i-O1;		1	13i10;13i1;13i-O1;	2						
H0432	009	0	1	02	01	H0432_009_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0432	013	0	1	02	01	H0432_013_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0432	017	0	1	02	01	H0432_017_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H0473	003	0	1	04	01	H0473_003_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H0473	004	0	1	04	01	H0473_004_0	3	1	2	Non-Emergency Medical Transportation																00000000001100	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)				2	2		2			10b1;	1	2		2						
H0523	074	0	1	02	01	H0523_074_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	45.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0523	801	0	1	01	01	H0523_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H0523	801	0	1	01	01	H0523_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H0523	805	0	1	01	01	H0523_805_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H0523	805	0	1	01	01	H0523_805_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H0524	008	0	1	01	01	H0524_008_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;		2		2						
H0524	032	0	1	01	01	H0524_032_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;		2		2						
H0524	033	0	1	01	01	H0524_033_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;		2		2						
H0524	039	0	1	01	01	H0524_039_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;		2		2						
H0524	059	0	1	01	01	H0524_059_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;		2		2						
H0524	060	0	1	01	01	H0524_060_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;		2		2						
H0524	061	0	1	01	01	H0524_061_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;		2		2						
H0524	062	0	1	01	01	H0524_062_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;		2		2						
H0524	063	0	1	01	01	H0524_063_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;		2		2						
H0543	214	0	1	02	01	H0543_214_0	5	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H0543	217	0	1	02	01	H0543_217_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H0543	218	0	1	02	01	H0543_218_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H0543	219	0	1	02	01	H0543_219_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H0543	226	0	1	02	01	H0543_226_0	5	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H0543	239	0	1	01	01	H0543_239_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;		1	13i1;	1	0.00	7		00010		13i1;
H0543	240	0	1	01	01	H0543_240_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;		1	13i1;	1	0.00	7		00010		13i1;
H0543	241	0	1	01	01	H0543_241_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;		1	13i1;	1	0.00	7		00010		13i1;
H0543	242	0	1	01	01	H0543_242_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;		1	13i1;	1	0.00	7		00010		13i1;
H0543	246	0	1	01	01	H0543_246_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;		1	13i1;	1	0.00	7		00010		13i1;
H0543	249	0	1	02	01	H0543_249_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H0544	004	0	1	02	01	H0544_004_0	4	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i10;13i2;	2	2		2						
H0544	010	0	1	02	01	H0544_010_0	4	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i10;13i2;	2	2		2						
H0544	014	0	1	02	01	H0544_014_0	4	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i10;13i2;	2	2		2						
H0544	015	0	1	02	01	H0544_015_0	4	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;13i2;	2	2		2						
H0544	019	0	1	02	01	H0544_019_0	4	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i10;13i2;	2	2		2						
H0544	020	0	1	02	01	H0544_020_0	4	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;13i2;	2	2		2						
H0544	062	0	1	02	01	H0544_062_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;	2	2		2						
H0571	001	0	1	01	01	H0571_001_0	9	1	3	OTC and Food/Produce										000000000000000000000001000	Chronic Hypertension														1	001		13i1;13b;		2		1	10.00	7		00010		13b;13i1;
H0571	005	0	1	01	01	H0571_005_0	9	1	3	OTC and Food/Produce										011111111111111111111111000	Chronic Hypertension														1	001		13i1;13b;		2		1	55.00	7		00010		13b;13i1;
H0571	007	0	1	01	01	H0571_007_0	10	1	3	OTC and Food/Produce										000000000000000000000001000	Chronic Hypertension														1	001		13i1;13b;		2		1	20.00	7		00010		13b;13i1;
H0571	010	0	1	01	01	H0571_010_0	9	1	3	OTC and Food/Produce										000000000000000000000001000	Chronic Hypertension														1	001		13i1;13b;		2		1	20.00	7		00010		13b;13i1;
H0571	011	0	1	01	01	H0571_011_0	10	1	3	OTC and Food/Produce										000000000000000000000001000	Chronic Hypertension														1	001		13i1;13b;		2		1	20.00	7		00010		13b;13i1;
H0609	037	0	1	02	01	H0609_037_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H0609	042	0	1	02	01	H0609_042_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H0609	043	0	1	02	01	H0609_043_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H0609	047	0	1	02	01	H0609_047_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H0609	049	0	1	02	01	H0609_049_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H0609	052	0	1	02	01	H0609_052_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0609	058	0	1	02	01	H0609_058_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H0609	062	0	1	02	01	H0609_062_0	5	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H0609	065	0	1	02	01	H0609_065_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0609	072	0	1	02	01	H0609_072_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H0609	076	0	1	02	01	H0609_076_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H0624	001	0	1	02	01	H0624_001_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0624	006	0	1	02	01	H0624_006_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0628	001	0	1	02	01	H0628_001_0	4	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	005	0	1	02	01	H0628_005_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	012	0	1	01	01	H0628_012_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	013	0	1	01	01	H0628_013_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	017	0	1	02	01	H0628_017_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	018	0	1	01	01	H0628_018_0	5	1	3	SSBCI Pkg										010001100010011100000000000															1	001		13i6;		1	13i6;	2						
H0628	031	0	1	01	01	H0628_031_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	032	0	1	01	01	H0628_032_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	033	0	1	01	01	H0628_033_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	034	0	1	01	01	H0628_034_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	035	0	1	01	01	H0628_035_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	036	0	1	01	01	H0628_036_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	037	0	1	01	01	H0628_037_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	038	0	1	01	01	H0628_038_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	039	0	1	01	01	H0628_039_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	040	0	1	01	01	H0628_040_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	041	0	1	01	01	H0628_041_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	801	0	1	01	01	H0628_801_0	2	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H0628	801	0	1	01	01	H0628_801_0	2	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H0629	001	0	1	01	01	H0629_001_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H0629	002	0	1	01	01	H0629_002_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H0629	003	0	1	01	01	H0629_003_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H0629	004	0	1	01	01	H0629_004_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H0630	013	0	1	01	01	H0630_013_0	5	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13e;		2		2						
H0630	014	0	1	01	01	H0630_014_0	5	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13e;		2		2						
H0630	015	0	1	02	01	H0630_015_0	5	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13e;	2	2		2						
H0630	016	0	1	02	01	H0630_016_0	6	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13e;	2	2		2						
H0630	025	0	1	02	01	H0630_025_0	5	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13e;	2	2		2						
H0630	027	0	1	01	01	H0630_027_0	5	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13e;		2		2						
H0710	030	0	1	04	01	H0710_030_0	6	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H0710	037	0	1	04	01	H0710_037_0	6	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H0710	057	0	1	04	01	H0710_057_0	6	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H0712	005	0	1	02	01	H0712_005_0	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0712	029	0	1	01	01	H0712_029_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0738	001	0	1	01	01	H0738_001_0	6	1	3	Package 1										000011111100011010000001000	Connective Tissue Disease														2			13i1;13i10;13i3;		1	13i1;13i3;13i10;	1	104.00	7		01010		13i1;13i3;13i10;
H0764	001	0	1	04	01	H0764_001_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H0783	004	0	1	01	01	H0783_004_0	2	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H0885	001	0	1	04	01	H0885_001_0	5	1	3	SSBCI Package 1										000011010000010000000000000															2			13b;13i1;	1	1	13b;13i1;	1	20.00	5		00010		13b;13i1;
H0885	002	0	1	04	01	H0885_002_0	5	1	3	Package 1										000011010000010000000000000															2			13b;13i1;	1	1	13b;13i1;	1	30.00	5		00010		13b;13i1;
H0885	003	0	1	04	01	H0885_003_0	5	1	3	Package 1										000011010000010000000000000															2			13b;13i1;	1	1	13b;13i1;	1	30.00	5		00010		13b;13i1;
H0885	005	0	1	04	01	H0885_005_0	5	1	3	Package 1										000011010000010000000000000															2			13b;13i1;	1	1	13i1;13b;	1	25.00	5		00010		13b;13i1;
H0885	006	0	1	04	01	H0885_006_0	5	1	3	Package 1										000011010000010000000000000															2			13b;13i1;	1	1	13i1;13b;	1	25.00	5		00010		13b;13i1;
H0885	007	0	1	04	01	H0885_007_0	5	1	3	SSBCI Package 1										000011010000010000000000000															2			13b;13i1;	1	1	13b;13i1;	1	20.00	5		00010		13b;13i1;
H0885	008	0	1	04	01	H0885_008_0	5	1	3	Package 1										000011010000010000000000000															2			13b;13i1;	1	1	13b;13i1;	1	30.00	5		00010		13b;13i1;
H0885	009	0	1	04	01	H0885_009_0	5	1	3	SSBCI Package 1										000011010000010000000000000															2			13b;13i1;	1	1	13b;13i1;	1	20.00	5		00010		13b;13i1;
H0885	010	0	1	04	01	H0885_010_0	4	1	3	SSBCI Package 1										000011010000010000000000000															2			13i1;	1	1	13i1;	1	100.00	5		00010		13i1;
H0885	011	0	1	04	01	H0885_011_0	4	1	3	SSBCI Package 1										000011010000010000000000000															2			13i1;	1	1	13i1;	1	100.00	5		00010		13i1;
H0907	001	0	1	02	01	H0907_001_0	4	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;	2	2		2						
H0907	003	0	1	02	01	H0907_003_0	4	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;	2	2		2						
H0908	001	0	1	02	01	H0908_001_0	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0908	006	0	1	02	01	H0908_006_0	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0908	007	0	1	02	01	H0908_007_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0908	008	0	1	02	01	H0908_008_0	14	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0913	013	0	1	01	01	H0913_013_0	7	1	3	SSBCI OTC										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H0963	001	0	1	01	01	H0963_001_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H0963	001	0	1	01	01	H0963_001_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0976	001	0	1	01	01	H0976_001_0	10	1	3	Food-Utilities, Non-med Transport and Home Mod										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;13i10;13i5;13i3;		1	13i1;13i4;13i3;13i5;13i10;	2						
H0976	002	0	1	01	01	H0976_002_0	9	1	3	Food-Utilities, Non-med Transport and Home Mod										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;13i10;13i5;13i3;		1	13i1;13i4;13i10;13i3;13i5;	2						
H0978	002	0	1	01	01	H0978_002_0	7	1	3	Food and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i1;13i4;		2		2						
H0978	010	0	1	01	01	H0978_010_0	7	1	3	Food, Utilities and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i1;13i4;13i10;		1	13i1;13i4;13i10;	2						
H0982	002	0	1	01	01	H0982_002_0	13	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i-O1;13i1;13i3;13i4;13i10;		2		1	225.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	007	0	1	01	01	H0982_007_0	12	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	50.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	008	0	1	01	01	H0982_008_0	10	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	50.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	009	0	1	01	01	H0982_009_0	10	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	50.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	010	0	1	01	01	H0982_010_0	10	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i-O1;13i10;13i1;13i3;13i4;		2		1	200.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	012	0	1	01	01	H0982_012_0	10	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	215.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	013	0	1	01	01	H0982_013_0	10	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	200.	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	016	0	1	01	01	H0982_016_0	9	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	100.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	017	0	1	01	01	H0982_017_0	9	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	75.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	018	0	1	01	01	H0982_018_0	9	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	75.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	019	0	1	01	01	H0982_019_0	9	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	100.	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	020	0	1	01	01	H0982_020_0	9	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	50.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	021	0	1	01	01	H0982_021_0	9	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	100.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	022	0	1	01	01	H0982_022_0	9	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	50.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	023	0	1	01	01	H0982_023_0	10	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	200.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	024	0	1	01	01	H0982_024_0	9	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	50.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	025	0	1	01	01	H0982_025_0	10	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	200.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	026	0	1	01	01	H0982_026_0	9	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	75.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	027	0	1	01	01	H0982_027_0	9	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	200.	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	028	0	1	01	01	H0982_028_0	9	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	75.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	030	0	1	01	01	H0982_030_0	9	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	50.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	031	0	1	01	01	H0982_031_0	9	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	80.	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	032	0	1	01	01	H0982_032_0	9	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	75.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	033	0	1	01	01	H0982_033_0	9	1	3	Healthy Living Allowance										011111111111111111111111000	Chronic hypertension														2			13i1;13i3;13i4;13i10;13i-O1;		2		1	75.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H1019	001	0	1	02	01	H1019_001_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H1019	001	0	1	02	01	H1019_001_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1019	006	0	1	01	01	H1019_006_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	006	0	1	01	01	H1019_006_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1019	023	0	1	01	01	H1019_023_0	6	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	043	0	1	02	01	H1019_043_0	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H1019	057	0	1	02	01	H1019_057_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	057	0	1	02	01	H1019_057_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H1019	065	0	1	01	01	H1019_065_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	073	0	1	01	01	H1019_073_0	6	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	094	0	1	01	01	H1019_094_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	103	1	1	01	01	H1019_103_1	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1019	103	1	1	01	01	H1019_103_1	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	103	2	1	01	01	H1019_103_2	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	103	2	1	01	01	H1019_103_2	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1019	104	1	1	01	01	H1019_104_1	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	104	2	1	01	01	H1019_104_2	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	109	0	1	01	01	H1019_109_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13b;13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;18c;		2		1	300.00	3		00010		13b;13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;18c;
H1019	109	0	1	01	01	H1019_109_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	113	0	1	01	01	H1019_113_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1019	113	0	1	01	01	H1019_113_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	118	0	1	01	01	H1019_118_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	118	0	1	01	01	H1019_118_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13b;13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;18c;		2		1	420.00	3		00010		13b;13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;18c;
H1019	121	0	1	01	01	H1019_121_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13b;13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;18c;		2		1	300.00	3		00010		13b;13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;18c;
H1019	121	0	1	01	01	H1019_121_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	123	0	1	01	01	H1019_123_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13b;13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;18c;		2		1	420.00	3		00010		13b;13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;18c;
H1019	123	0	1	01	01	H1019_123_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	124	0	1	02	01	H1019_124_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H1019	124	0	1	02	01	H1019_124_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	2		1	920.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1019	130	0	1	02	01	H1019_130_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	2		1	800.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1019	130	0	1	02	01	H1019_130_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H1019	132	0	1	01	01	H1019_132_0	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	134	0	1	01	01	H1019_134_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	135	0	1	02	01	H1019_135_0	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H1019	136	0	1	01	01	H1019_136_0	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	138	0	1	01	01	H1019_138_0	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	139	0	1	01	01	H1019_139_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	144	0	1	01	01	H1019_144_0	6	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	144	0	1	01	01	H1019_144_0	6	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	146	0	1	01	01	H1019_146_0	6	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	147	1	1	01	01	H1019_147_1	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	147	2	1	01	01	H1019_147_2	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1019	147	2	1	01	01	H1019_147_2	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	148	0	1	01	01	H1019_148_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	148	0	1	01	01	H1019_148_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	149	0	1	01	01	H1019_149_0	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	150	0	1	01	01	H1019_150_0	6	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	150	0	1	01	01	H1019_150_0	6	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	151	1	1	01	01	H1019_151_1	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	151	2	1	01	01	H1019_151_2	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	151	2	1	01	01	H1019_151_2	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	860.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1019	152	0	1	01	01	H1019_152_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	153	0	1	01	01	H1019_153_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	154	0	1	01	01	H1019_154_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1019	154	0	1	01	01	H1019_154_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1032	202	0	1	01	01	H1032_202_0	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1032	240	0	1	01	01	H1032_240_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1032	241	0	1	01	01	H1032_241_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1032	242	0	1	01	01	H1032_242_0	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1032	243	0	1	01	01	H1032_243_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1032	244	1	1	01	01	H1032_244_1	10	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1032	244	2	1	01	01	H1032_244_2	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1032	245	1	1	01	01	H1032_245_1	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1032	245	2	1	01	01	H1032_245_2	10	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1036	025	0	1	01	01	H1036_025_0	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	044	0	1	01	01	H1036_044_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	054	0	1	01	01	H1036_054_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	054	0	1	01	01	H1036_054_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	062	0	1	01	01	H1036_062_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	062	0	1	01	01	H1036_062_0	3	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	065	0	1	01	01	H1036_065_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	065	0	1	01	01	H1036_065_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	068	0	1	01	01	H1036_068_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	074	0	1	01	01	H1036_074_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	077	0	1	01	01	H1036_077_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	102	0	1	01	01	H1036_102_0	5	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	119	0	1	01	01	H1036_119_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	121	0	1	01	01	H1036_121_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	121	0	1	01	01	H1036_121_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	143	0	1	01	01	H1036_143_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	146	0	1	01	01	H1036_146_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	157	0	1	01	01	H1036_157_0	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	167	0	1	01	01	H1036_167_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	209	0	1	01	01	H1036_209_0	5	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	210	0	1	01	01	H1036_210_0	5	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	213	0	1	01	01	H1036_213_0	5	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	214	0	1	01	01	H1036_214_0	5	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	217	0	1	01	01	H1036_217_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	222	0	1	01	01	H1036_222_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	222	0	1	01	01	H1036_222_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H1036	226	0	1	01	01	H1036_226_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	229	0	1	01	01	H1036_229_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	229	0	1	01	01	H1036_229_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	230	0	1	01	01	H1036_230_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	230	0	1	01	01	H1036_230_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	234	0	1	01	01	H1036_234_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	234	0	1	01	01	H1036_234_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	235	0	1	01	01	H1036_235_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H1036	235	0	1	01	01	H1036_235_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	236	0	1	01	01	H1036_236_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	265	1	1	01	01	H1036_265_1	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	265	2	1	01	01	H1036_265_2	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	266	0	1	01	01	H1036_266_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	269	0	1	01	01	H1036_269_0	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	270	0	1	01	01	H1036_270_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	279	0	1	01	01	H1036_279_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	280	0	1	01	01	H1036_280_0	6	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	285	0	1	01	01	H1036_285_0	5	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	290	0	1	01	01	H1036_290_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	292	0	1	01	01	H1036_292_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	297	0	1	01	01	H1036_297_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	297	0	1	01	01	H1036_297_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	298	0	1	01	01	H1036_298_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	299	0	1	01	01	H1036_299_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	299	0	1	01	01	H1036_299_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	300	0	1	01	01	H1036_300_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	300	0	1	01	01	H1036_300_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	301	0	1	01	01	H1036_301_0	3	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	301	0	1	01	01	H1036_301_0	3	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	302	0	1	01	01	H1036_302_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	302	0	1	01	01	H1036_302_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	304	0	1	01	01	H1036_304_0	5	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	305	0	1	01	01	H1036_305_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	306	0	1	01	01	H1036_306_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	307	0	1	01	01	H1036_307_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	308	0	1	01	01	H1036_308_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	310	0	1	01	01	H1036_310_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	310	0	1	01	01	H1036_310_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	311	0	1	01	01	H1036_311_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	311	0	1	01	01	H1036_311_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	312	0	1	01	01	H1036_312_0	6	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	312	0	1	01	01	H1036_312_0	6	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	313	0	1	01	01	H1036_313_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	313	0	1	01	01	H1036_313_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	314	0	1	01	01	H1036_314_0	5	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	315	0	1	01	01	H1036_315_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	315	0	1	01	01	H1036_315_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	316	0	1	01	01	H1036_316_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	316	0	1	01	01	H1036_316_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	317	0	1	01	01	H1036_317_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	317	0	1	01	01	H1036_317_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H1036	320	0	1	01	01	H1036_320_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H1036	320	0	1	01	01	H1036_320_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	324	0	1	01	01	H1036_324_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	324	0	1	01	01	H1036_324_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H1036	325	0	1	01	01	H1036_325_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H1036	325	0	1	01	01	H1036_325_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	326	0	1	01	01	H1036_326_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	326	0	1	01	01	H1036_326_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H1036	328	0	1	01	01	H1036_328_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	328	0	1	01	01	H1036_328_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H1036	329	0	1	01	01	H1036_329_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	329	0	1	01	01	H1036_329_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H1036	331	0	1	01	01	H1036_331_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	333	0	1	01	01	H1036_333_0	3	1	2	Non-Emergency Medical Transportation																00000000001000	End Stage Renal Disease (ESRD)								2			10b1;		2		2						
H1036	335	2	1	02	01	H1036_335_2	4	1	2	Non-Emergency Medical Transportation																00000000001000	End Stage Renal Disease (ESRD)								2			10b1;	1	2		2						
H1036	336	0	1	01	01	H1036_336_0	3	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	336	0	1	01	01	H1036_336_0	3	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	337	0	1	01	01	H1036_337_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	337	0	1	01	01	H1036_337_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	338	0	1	01	01	H1036_338_0	3	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	338	0	1	01	01	H1036_338_0	3	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1036	339	0	1	01	01	H1036_339_0	3	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	340	0	1	01	01	H1036_340_0	3	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1036	341	0	1	01	01	H1036_341_0	3	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H1045	012	0	1	01	01	H1045_012_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1045	018	0	1	01	01	H1045_018_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;		1	13i1;	1	0.00	7		00010		13i1;
H1045	038	0	1	01	01	H1045_038_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1045	039	0	1	02	01	H1045_039_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1045	048	1	1	02	01	H1045_048_1	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H1045	048	2	1	02	01	H1045_048_2	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H1045	048	3	1	02	01	H1045_048_3	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H1045	048	4	1	02	01	H1045_048_4	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H1045	061	0	1	01	01	H1045_061_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1045	063	0	1	02	01	H1045_063_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1045	064	0	1	01	01	H1045_064_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1045	065	0	1	02	01	H1045_065_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1109	801	0	1	01	01	H1109_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1109	801	0	1	01	01	H1109_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H1109	802	0	1	01	01	H1109_802_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1109	802	0	1	01	01	H1109_802_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H1112	006	0	1	02	01	H1112_006_0	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1112	033	0	1	02	01	H1112_033_0	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1112	046	0	1	02	01	H1112_046_0	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1112	047	0	1	02	01	H1112_047_0	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1112	048	0	1	02	01	H1112_048_0	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1170	002	0	1	01	01	H1170_002_0	6	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;		2		2						
H1170	002	0	1	01	01	H1170_002_0	6	2	3	Healthy Food Card										011111110011111110000000000															2			13i1;		2		2						
H1170	008	0	1	01	01	H1170_008_0	6	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;		2		2						
H1170	008	0	1	01	01	H1170_008_0	6	2	3	Healthy Food Card										011111110011111110000000000															2			13i1;		2		2						
H1170	009	0	1	01	01	H1170_009_0	6	2	3	Healthy Food Card										011111110011111110000000000															2			13i1;		2		2						
H1170	009	0	1	01	01	H1170_009_0	6	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;		2		2						
H1170	011	0	1	01	01	H1170_011_0	6	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;		2		2						
H1170	011	0	1	01	01	H1170_011_0	6	2	3	Healthy Food Card										011111110011111110000000000															2			13i1;		2		2						
H1170	012	0	1	01	01	H1170_012_0	6	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;		2		2						
H1170	012	0	1	01	01	H1170_012_0	6	2	3	Healthy Food Card										011111110011111110000000000															2			13i1;		2		2						
H1170	013	0	1	02	01	H1170_013_0	6	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;	2	2		2						
H1170	013	0	1	02	01	H1170_013_0	6	2	3	Healthy Food Card										011111110011111110000000000															2			13i1;	2	2		2						
H1170	014	0	1	01	01	H1170_014_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;		2		2						
H1170	014	0	1	01	01	H1170_014_0	5	2	3	Healthy Food Card										011111110011111110000000000															2			13i1;		2		2						
H1170	015	0	1	01	01	H1170_015_0	6	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;		2		2						
H1170	015	0	1	01	01	H1170_015_0	6	2	3	Healthy Food Card										011111110011111110000000000															2			13i1;		2		2						
H1170	016	0	1	01	01	H1170_016_0	6	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;		2		2						
H1170	017	0	1	01	01	H1170_017_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;		2		2						
H1189	005	0	1	01	01	H1189_005_0	7	1	3	Food and Produce										000011010000000000000000000															2			13i1;		2		1	50.00	7		00010		13i1;
H1206	004	0	1	01	01	H1206_004_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1206	009	0	1	01	01	H1206_009_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1206	801	0	1	01	01	H1206_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H1206	801	0	1	01	01	H1206_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1212	001	0	1	01	01	H1212_001_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i10;13i1;		2		2						
H1212	002	0	1	01	01	H1212_002_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i10;13i1;		2		2						
H1215	001	0	1	02	01	H1215_001_0	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1224	001	0	1	01	01	H1224_001_0	4	1	3	Package 1										011111111111111111111110000															1	001		13i1;13i10;13i4;		1	13i10;13i1;13i4;	2						
H1225	003	0	1	01	01	H1225_003_0	10	1	3	Healthy Foods and Utilities										011111111111111111111110000															2			13i1;13i10;		2		2						
H1280	001	0	1	01	01	H1280_001_0	4	1	3	Grocery OTC										000110010010001000000000000															1	001		13b;13i1;		2		1	75.00	5		00010		13b;13i1;
H1285	001	0	1	01	01	H1285_001_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1285	002	0	1	02	01	H1285_002_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1290	019	0	1	01	01	H1290_019_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	163.00	7		00010		13i1;13i10;
H1290	020	0	1	01	01	H1290_020_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	156.00	7		00010		13i1;13i10;
H1290	021	0	1	01	01	H1290_021_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	156.00	7		00010		13i1;13i10;
H1290	022	0	1	01	01	H1290_022_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	156.00	7		00010		13i1;13i10;
H1290	023	0	1	01	01	H1290_023_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	156.00	7		00010		13i1;13i10;
H1290	024	0	1	01	01	H1290_024_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	151.00	7		00010		13i1;13i10;
H1290	033	0	1	01	01	H1290_033_0	8	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	152.00	7		00010		13i1;13i10;
H1290	034	0	1	01	01	H1290_034_0	8	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	162.00	7		00010		13i1;13i10;
H1290	037	1	1	01	01	H1290_037_1	8	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	20.00	7		00010		13i1;13i10;
H1290	037	2	1	01	01	H1290_037_2	11	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	20.00	7		00010		13i1;13i10;
H1290	039	0	1	01	01	H1290_039_0	8	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	155.00	7		00010		13i1;13i10;
H1290	041	0	1	01	01	H1290_041_0	8	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	157.00	7		00010		13i1;13i10;
H1290	042	0	1	01	01	H1290_042_0	9	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	272.00	7		00010		13i1;13i10;
H1290	043	0	1	01	01	H1290_043_0	9	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	144.00	7		00010		13i1;13i10;
H1290	044	2	1	01	01	H1290_044_2	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	20.00	7		00010		13i1;13i10;
H1290	044	3	1	01	01	H1290_044_3	8	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	25.00	7		00010		13i1;13i10;
H1290	052	0	1	01	01	H1290_052_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	263.00	7		00010		13i1;13i10;
H1290	053	0	1	01	01	H1290_053_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	284.00	7		00010		13i1;13i10;
H1290	054	0	1	01	01	H1290_054_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	288.00	7		00010		13i1;13i10;
H1290	055	0	1	01	01	H1290_055_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	289.00	7		00010		13i1;13i10;
H1290	056	0	1	01	01	H1290_056_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	31.00	7		00010		13i1;13i10;
H1290	057	0	1	01	01	H1290_057_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	35.00	7		00010		13i1;13i10;
H1290	058	0	1	01	01	H1290_058_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	33.00	7		00010		13i1;13i10;
H1290	059	0	1	01	01	H1290_059_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	31.00	7		00010		13i1;13i10;
H1290	060	0	1	01	01	H1290_060_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	34.00	7		00010		13i1;13i10;
H1290	061	0	1	01	01	H1290_061_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	38.00	7		00010		13i1;13i10;
H1290	062	0	1	01	01	H1290_062_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	39.00	7		00010		13i1;13i10;
H1290	063	0	1	01	01	H1290_063_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	31.00	7		00010		13i1;13i10;
H1290	064	0	1	01	01	H1290_064_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	40.00	7		00010		13i1;13i10;
H1290	065	0	1	01	01	H1290_065_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	31.00	7		00010		13i1;13i10;
H1290	066	0	1	01	01	H1290_066_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	31.00	7		00010		13i1;13i10;
H1290	067	0	1	01	01	H1290_067_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	240.00	7		00010		13i1;13i10;
H1290	068	0	1	01	01	H1290_068_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	240.00	7		00010		13i1;13i10;
H1290	069	0	1	01	01	H1290_069_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	240.00	7		00010		13i1;13i10;
H1290	070	0	1	01	01	H1290_070_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	240.00	7		00010		13i1;13i10;
H1290	071	0	1	01	01	H1290_071_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	240.00	7		00010		13i1;13i10;
H1290	072	0	1	01	01	H1290_072_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	240.00	7		00010		13i1;13i10;
H1290	073	0	1	01	01	H1290_073_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	240.00	7		00010		13i1;13i10;
H1290	074	0	1	01	01	H1290_074_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	240.00	7		00010		13i1;13i10;
H1290	077	0	1	01	01	H1290_077_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	426.00	7		00010		13i1;13i10;
H1290	078	0	1	01	01	H1290_078_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	425.00	7		00010		13i1;13i10;
H1290	079	0	1	01	01	H1290_079_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	426.00	7		00010		13i1;13i10;
H1290	080	0	1	01	01	H1290_080_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	426.00	7		00010		13i1;13i10;
H1290	081	0	1	01	01	H1290_081_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	426.00	7		00010		13i1;13i10;
H1290	082	0	1	01	01	H1290_082_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	425.00	7		00010		13i1;13i10;
H1290	083	0	1	01	01	H1290_083_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	426.00	7		00010		13i1;13i10;
H1290	084	0	1	01	01	H1290_084_0	9	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	492.00	7		00010		13i1;13i10;
H1290	085	0	1	01	01	H1290_085_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	490.00	7		00010		13i1;13i10;
H1290	086	0	1	01	01	H1290_086_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	493.00	7		00010		13i1;13i10;
H1290	087	0	1	01	01	H1290_087_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	490.00	7		00010		13i1;13i10;
H1290	088	0	1	01	01	H1290_088_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	490.00	7		00010		13i1;13i10;
H1290	089	0	1	01	01	H1290_089_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	490.00	7		00010		13i1;13i10;
H1290	090	0	1	01	01	H1290_090_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	490.00	7		00010		13i1;13i10;
H1290	091	0	1	01	01	H1290_091_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	489.00	7		00010		13i1;13i10;
H1304	803	0	1	04	01	H1304_803_0	3	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H1304	804	0	1	04	01	H1304_804_0	3	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H1304	805	0	1	04	01	H1304_805_0	3	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H1304	806	0	1	04	01	H1304_806_0	3	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H1347	001	0	1	04	01	H1347_001_0	4	1	2	GA Foods																01110000001100	Vascular Disease	Autoimmune Disorders				2	1	The enrollee must be diagnosed with a minimum of two of the chronic conditions listed above.	2			13c;	1	1	13c;	2						
H1347	002	0	1	04	01	H1347_002_0	4	1	2	GA Foods																01110000001100	Vascular Disease	Autoimmune Disorders				2	1	The enrollee must be diagnosed with a minimum of two of the chronic conditions listed above.	2			13c;	1	1	13c;	2						
H1347	003	0	1	04	01	H1347_003_0	4	1	2	GA Foods																01110000001100	Vascular Disease	Autoimmune Disorders				2	1	The enrollee must be diagnosed with a minimum of two of the chronic conditions listed above.	2			13c;	1	1	13c;	2						
H1360	001	0	1	02	01	H1360_001_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1360	002	0	1	02	01	H1360_002_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1360	003	0	1	02	01	H1360_003_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1365	001	0	1	04	01	H1365_001_0	5	2	2	Home and Bathroom Safety																00000000001100	History of Falls	Hip Fracture				2	2		2			14c8;	1	2		1	200.00	3		00001		14c8;
H1365	001	0	1	04	01	H1365_001_0	5	1	3	Meals										000001000010000000000000000															2			13i2;	1	2		2						
H1365	005	0	1	04	01	H1365_005_0	5	1	3	Meals										000001000010000000000000000															2			13i2;	1	2		2						
H1365	005	0	1	04	01	H1365_005_0	5	2	2	Bathroom Safety																00000000001100	History of Falls	Hip Fracture				2	2		2			14c8;	1	2		1	200.00	3		00001		14c8;
H1372	003	0	1	01	01	H1372_003_0	6	1	3	Food and Produce										000011010000000000000000000															2			13i1;		1	13i1;	1	0.00	7		00010		13i1;
H1395	001	0	1	04	01	H1395_001_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1396	001	0	1	01	01	H1396_001_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1416	033	0	1	02	01	H1416_033_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1416	034	0	1	02	01	H1416_034_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1416	035	0	1	02	01	H1416_035_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1416	043	0	1	02	01	H1416_043_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1416	044	0	1	02	01	H1416_044_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1416	081	0	1	02	01	H1416_081_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1423	001	0	1	02	01	H1423_001_0	4	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i10;13i2;13i1;	2	2		2						
H1423	002	0	1	02	01	H1423_002_0	4	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i2;13i10;	2	2		2						
H1423	004	0	1	02	01	H1423_004_0	4	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;	2	2		2						
H1423	009	0	1	02	01	H1423_009_0	4	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;	2	2		2						
H1468	017	0	1	01	01	H1468_017_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1468	017	0	1	01	01	H1468_017_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1526	001	0	1	02	01	H1526_001_0	5	1	3	Chronic Illness Package										000011010000000000000000000															1	011		13i1;13i10;13b;	2	1	13i1;13b;13i10;	2						
H1526	002	0	1	02	01	H1526_002_0	5	1	3	Chronic Illness Package										000011010000000000000000000															1	011		13i1;13i10;13b;	2	1	13i1;13b;13i10;	2						
H1526	003	0	1	02	01	H1526_003_0	5	2	2	ESRD Dental																00000000001000	End Stage Renal Disease (CKD Stage 5)								1	011		16b4;16b5;16b2;16b1;16b6;16c1;16c2;16c3;16c4;16c8;16c10;	2	2		1	1000.00	3		00100		16b1;16b2;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c8;16c10;
H1526	003	0	1	02	01	H1526_003_0	5	1	3	CKD Package										000000000010000000000000000															1	011		13i1;13b;13i10;13d;	2	1	13i1;13b;13i10;13d;	2						
H1526	003	0	1	02	01	H1526_003_0	5	3	2	ESRD Support Package																00000000001000	End Stage Renal Disease								1	011		10b1;14c21;	2	2		2						
H1526	004	0	1	02	01	H1526_004_0	4	3	2	ESRD Support Package																00000000001000	End Stage Renal Disease								1	011		10b1;14c21;	2	2		2						
H1526	004	0	1	02	01	H1526_004_0	4	1	3	CKD Package										000000000010000000000000000															1	011		13i1;13b;13i10;13d;	2	1	13i1;13b;13i10;13d;	2						
H1526	004	0	1	02	01	H1526_004_0	4	2	2	ESRD Dental																00000000001000	End Stage Renal Disease (CKD Stage 5)								1	011		16b4;16b5;16b2;16b1;16b6;16c1;16c2;16c3;16c8;16c10;	2	2		1	1000.00	3		00100		16b1;16b2;16b4;16b5;16b6;16c1;16c2;16c3;16c8;16c10;
H1526	008	0	1	02	01	H1526_008_0	4	1	3	Chronic Illness Package										000011010000000000000000000															1	011		13i1;13i10;13b;	2	1	13i1;13b;13i10;	2						
H1526	009	0	1	02	01	H1526_009_0	4	3	2	ESRD Support Package																00000000001000	End Stage Renal Disease								1	011		10b1;14c21;	2	2		2						
H1526	009	0	1	02	01	H1526_009_0	4	2	2	ESRD Dental																00000000001000	End Stage Renal Disease (CKD Stage 5)								1	011		16b4;16b5;16b2;16b1;16b6;16c1;16c2;16c3;16c4;16c8;16c10;	2	2		1	1000.00	3		00100		16b1;16b2;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c8;16c10;
H1526	009	0	1	02	01	H1526_009_0	4	1	3	CKD Package										000000000010000000000000000															1	011		13i1;13b;13i10;13d;	2	1	13i1;13b;13i10;	2						
H1587	001	0	1	01	01	H1587_001_0	5	1	3	Health Choices Produce and Food Benefit										011111110001111110000000000															1	001		13i1;		2		1	265.00	7		00010		13i1;
H1608	021	0	1	04	01	H1608_021_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	25.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1608	027	0	1	04	01	H1608_027_0	2	2	2	Healthy Heart (CHF)																00000000001000	Chronic heart failure								1	001		13b;13c;14c8;	1	1	13b;13c;14c8;	2						
H1608	027	0	1	04	01	H1608_027_0	2	1	3	SSBCI Pkg										000001000000000000000000000															1	001		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1608	062	0	1	04	01	H1608_062_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1608	076	0	1	04	01	H1608_076_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1608	077	0	1	04	01	H1608_077_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1608	121	0	1	04	01	H1608_121_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1608	801	0	1	04	01	H1608_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H1608	801	0	1	04	01	H1608_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H1609	017	0	1	01	01	H1609_017_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	019	0	1	01	01	H1609_019_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	043	0	1	01	01	H1609_043_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	044	0	1	01	01	H1609_044_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	045	0	1	01	01	H1609_045_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	046	0	1	01	01	H1609_046_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	047	0	1	01	01	H1609_047_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	048	0	1	01	01	H1609_048_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	049	0	1	01	01	H1609_049_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	055	0	1	01	01	H1609_055_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	056	0	1	01	01	H1609_056_0	4	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	061	0	1	01	01	H1609_061_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	062	0	1	01	01	H1609_062_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	064	0	1	01	01	H1609_064_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	068	0	1	02	01	H1609_068_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	073	0	1	01	01	H1609_073_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	074	0	1	01	01	H1609_074_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	075	0	1	01	01	H1609_075_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	076	0	1	01	01	H1609_076_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	077	0	1	01	01	H1609_077_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	078	0	1	01	01	H1609_078_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	079	0	1	01	01	H1609_079_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	080	0	1	01	01	H1609_080_0	3	1	3	SSBCI Pkg										000011010000000000000000000															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	081	0	1	01	01	H1609_081_0	3	1	3	SSBCI Pkg										000011010000000000000000000															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	082	0	1	01	01	H1609_082_0	3	1	3	SSBCI Pkg										000011010000000000000000000															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	083	0	1	01	01	H1609_083_0	3	1	3	SSBCI Pkg										000011010000000000000000000															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	084	0	1	01	01	H1609_084_0	3	1	3	SSBCI Pkg										000011010000000000000000000															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	085	0	1	01	01	H1609_085_0	3	1	3	SSBCI Pkg										000011010000000000000000000															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	088	0	1	01	01	H1609_088_0	4	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	089	0	1	01	01	H1609_089_0	4	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	090	0	1	01	01	H1609_090_0	4	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	092	0	1	01	01	H1609_092_0	4	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	094	0	1	01	01	H1609_094_0	4	1	3	SSBCI Pkg										000011010000000000000000000															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	801	0	1	01	01	H1609_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H1609	801	0	1	01	01	H1609_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1609	807	0	1	01	01	H1609_807_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1609	807	0	1	01	01	H1609_807_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H1610	001	0	1	01	01	H1610_001_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1644	001	0	1	01	01	H1644_001_0	4	1	3	SSBCI										011111111111111111111110000															2			13i6;14c17;13i-O1;13i-O2;		2		1	200.00	3		01000		13i6;13i-O1;13i-O2;
H1664	005	0	1	02	01	H1664_005_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1664	012	0	1	02	01	H1664_012_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1671	001	0	1	01	01	H1671_001_0	6	1	3	Healthy Food Benefit										011111110111111110000000000															1	101	Physician approval may be required.	13i1;		1	13i1;	1	55.00	7		00010		13i1;
H1692	005	0	1	01	01	H1692_005_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1692	006	0	1	01	01	H1692_006_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1692	801	0	1	01	01	H1692_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1692	801	0	1	01	01	H1692_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H1799	003	1	1	01	01	H1799_003_1	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i4;13i10;
H1799	003	2	1	01	01	H1799_003_2	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i4;13i10;
H1799	003	3	1	01	01	H1799_003_3	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i4;13i10;
H1799	004	0	1	01	01	H1799_004_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i4;13i10;
H1799	005	0	1	01	01	H1799_005_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i4;13i10;
H1822	002	0	1	01	01	H1822_002_0	7	1	3	Food and Non-medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i1;13i4;		2		2						
H1822	005	0	1	02	01	H1822_005_0	6	1	3	Non-Medical Transportation/Groceries										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;	2	2		2						
H1822	006	0	1	01	01	H1822_006_0	7	1	3	Food, Utilities and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;13i10;		1	13i1;13i4;13i10;	2						
H1822	008	0	1	02	01	H1822_008_0	6	1	3	Food and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;	2	2		2						
H1862	003	0	1	02	01	H1862_003_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1862	004	0	1	02	01	H1862_004_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1862	006	0	1	02	01	H1862_006_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1889	002	1	1	04	01	H1889_002_1	5	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1889	002	2	1	04	01	H1889_002_2	5	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1889	005	0	1	04	01	H1889_005_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1889	007	0	1	04	01	H1889_007_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1889	008	0	1	04	01	H1889_008_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1889	009	0	1	04	01	H1889_009_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1889	010	0	1	04	01	H1889_010_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1889	011	0	1	04	01	H1889_011_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1889	012	0	1	04	01	H1889_012_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1889	019	0	1	04	01	H1889_019_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H1889	020	0	1	04	01	H1889_020_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H1889	025	0	1	04	01	H1889_025_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H1889	026	0	1	04	01	H1889_026_0	5	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1889	028	0	1	04	01	H1889_028_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H1889	030	0	1	04	01	H1889_030_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1889	031	0	1	04	01	H1889_031_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1889	032	0	1	04	01	H1889_032_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1889	034	0	1	04	01	H1889_034_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1889	035	0	1	04	01	H1889_035_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1894	002	0	1	01	01	H1894_002_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H1894	011	0	1	01	01	H1894_011_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H1914	008	0	1	04	01	H1914_008_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H1947	001	0	1	01	01	H1947_001_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H1947	003	0	1	01	01	H1947_003_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H1947	004	0	1	01	01	H1947_004_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H1951	013	0	1	01	01	H1951_013_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1951	032	0	1	01	01	H1951_032_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1951	032	0	1	01	01	H1951_032_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H1951	038	0	1	01	01	H1951_038_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1951	039	0	1	01	01	H1951_039_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1951	041	0	1	01	01	H1951_041_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1951	041	0	1	01	01	H1951_041_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H1951	044	0	1	01	01	H1951_044_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1951	044	0	1	01	01	H1951_044_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1951	047	2	1	01	01	H1951_047_2	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1951	048	2	1	01	01	H1951_048_2	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1951	049	2	1	01	01	H1951_049_2	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1951	049	3	1	01	01	H1951_049_3	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1951	051	0	1	01	01	H1951_051_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1951	053	0	1	01	01	H1951_053_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1951	056	0	1	01	01	H1951_056_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1951	056	0	1	01	01	H1951_056_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H1951	057	0	1	01	01	H1951_057_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1951	057	0	1	01	01	H1951_057_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H1951	058	0	1	01	01	H1951_058_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1951	059	0	1	01	01	H1951_059_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1951	060	0	1	01	01	H1951_060_0	1	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H1951	061	0	1	01	01	H1951_061_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1951	061	0	1	01	01	H1951_061_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H1961	003	0	1	02	01	H1961_003_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1961	003	0	1	02	01	H1961_003_0	4	2	2	MAUF Package 1																00000000010000									2			14c22;	2	1	14c22;	2						
H1961	014	1	1	02	01	H1961_014_1	4	1	2	MAUF Package 1																00000000010000									2			14c22;	2	1	14c22;	2						
H1961	014	2	1	02	01	H1961_014_2	4	1	2	MAUF Package 1																00000000010000									2			14c22;	2	1	14c22;	2						
H1961	014	3	1	02	01	H1961_014_3	4	1	2	MAUF Package 1																00000000010000									2			14c22;	2	1	14c22;	2						
H1961	014	4	1	02	01	H1961_014_4	4	1	2	MAUF Package 1																00000000010000									2			14c22;	2	1	14c22;	2						
H1961	017	0	1	02	01	H1961_017_0	4	1	2	MAUF Package 1																00000000010000									2			14c22;	2	1	14c22;	2						
H1961	019	0	1	02	01	H1961_019_0	4	2	2	MAUF Package 1																00000000010000									2			14c22;	2	1	14c22;	2						
H1961	019	0	1	02	01	H1961_019_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1961	020	0	1	02	01	H1961_020_0	4	1	2	MAUF Package 1																00000000010000									2			14c22;	2	1	14c22;	2						
H1961	022	0	1	02	01	H1961_022_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H1961	022	0	1	02	01	H1961_022_0	4	2	2	MAUF Package 1																00000000010000									2			14c22;	2	1	14c22;	2						
H1961	023	0	1	02	01	H1961_023_0	4	2	2	MAUF Package 1																00000000010000									2			14c22;	2	1	14c22;	2						
H1961	023	0	1	02	01	H1961_023_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H1961	024	0	1	02	01	H1961_024_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H1961	024	0	1	02	01	H1961_024_0	4	2	2	MAUF Package 1																00000000010000									2			14c22;	2	1	14c22;	2						
H1961	025	0	1	02	01	H1961_025_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H1961	025	0	1	02	01	H1961_025_0	4	2	2	MAUF Package 1																00000000010000									2			14c22;	2	1	14c22;	2						
H1961	026	0	1	02	01	H1961_026_0	3	1	2	MAUF Package 1																00000000010000									2			14c22;	2	1	14c22;	2						
H1969	805	0	1	01	01	H1969_805_0	2	1	2	Routine Podiatry																01000000000000									2			7f_2;		2		2						
H1993	007	0	1	01	01	H1993_007_0	6	1	3	SSBCI - Food										000011010000000000000000000															2			13i1;		1	13i1;	1	145.00	7		00011		13i1;
H1993	008	0	1	01	01	H1993_008_0	5	1	3	SSBCI - Food										000011010000000000000000000															2			13i1;		1	13i1;	1	165.00	7		00011		13i1;
H1993	013	0	1	01	01	H1993_013_0	5	1	3	SSBCI - Food										000011010000000000000000000															2			13i1;		1	13i1;	1	155.00	7		00011		13i1;
H1994	015	0	1	01	01	H1994_015_0	4	1	3	Food, Produce, Utilities, & OTC Package										011111111111111110000001111	Chronic Hypertension	Chronic Malnutrition	Chronic Musculoskeletal disorders	Chronic Hyperlipidemia											2			13b;13i1;13i10;		2		1	86.00	7		01011		13b;13i1;13i10;
H1994	021	0	1	01	01	H1994_021_0	5	1	3	Food, Produce, & OTC Package										011111111111111110000001111	Chronic Hypertension	Chronic Malnutrition	Chronic Musculoskeletal disorders	Chronic Hyperlipidemia											2			13b;13i1;		2		1	55.00	7		01011		13b;13i1;
H1994	022	0	1	01	01	H1994_022_0	5	1	3	Food, Produce, OTC Package										011111111111111110000001111	Chronic Hypertension	Chronic Malnutrition	Chronic Musculoskeletal disorders	Chronic Hyperlipidemia											2			13b;13i1;		2		1	30.00	7		01011		13b;13i1;
H1994	030	0	1	01	01	H1994_030_0	6	1	3	Food, Produce & OTC Benefit										011111111111111110000001111	Chronic Hypertension	Chronic Malnutrition	Chronic Musculoskeletal disorders	Chronic Hyperlipidemia											2			13i1;13b;		2		1	60.00	7		01011		13b;13i1;
H1994	034	0	1	01	01	H1994_034_0	6	1	3	Food, Produce, & OTC Benefit										011111111111111110000001111	Chronic Hypertension	Chronic Malnutrition	Chronic Musculoskeletal Disorders	Chronic Hyperlipidemia											2			13i1;13b;		2		1	65.00	7		01011		13b;13i1;
H1994	040	0	1	01	01	H1994_040_0	4	1	3	Food, Produce, Utilities & OTC Package										011111111111111110000001111	Chronic Hypertension	Chronic Malnutrition	Chronic Musculoskeletal Disorders	Chronic Hyperlipidemia											2			13b;13i1;13i10;		2		1	75.00	7		01011		13b;13i1;13i10;
H1997	013	0	1	01	01	H1997_013_0	5	1	2	Routine Podiatry																01000000000000									2			7f_2;		2		2						
H2001	030	0	1	04	01	H2001_030_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	031	0	1	04	01	H2001_031_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	032	0	1	04	01	H2001_032_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	034	0	1	04	01	H2001_034_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	035	0	1	04	01	H2001_035_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	036	0	1	04	01	H2001_036_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H2001	037	0	1	04	01	H2001_037_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H2001	038	0	1	04	01	H2001_038_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H2001	039	0	1	04	01	H2001_039_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	040	0	1	04	01	H2001_040_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	041	0	1	04	01	H2001_041_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	042	0	1	04	01	H2001_042_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H2001	043	0	1	04	01	H2001_043_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H2001	044	0	1	04	01	H2001_044_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H2001	045	0	1	04	01	H2001_045_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H2001	046	0	1	04	01	H2001_046_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	047	0	1	04	01	H2001_047_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	048	0	1	04	01	H2001_048_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	049	0	1	04	01	H2001_049_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	050	0	1	04	01	H2001_050_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H2001	051	0	1	04	01	H2001_051_0	5	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	052	0	1	04	01	H2001_052_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	053	0	1	04	01	H2001_053_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	054	0	1	04	01	H2001_054_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	055	0	1	04	01	H2001_055_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H2001	056	0	1	04	01	H2001_056_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	058	0	1	04	01	H2001_058_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	059	0	1	04	01	H2001_059_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	060	0	1	04	01	H2001_060_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H2001	061	0	1	04	01	H2001_061_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	062	0	1	04	01	H2001_062_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	063	1	1	04	01	H2001_063_1	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	063	2	1	04	01	H2001_063_2	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	065	0	1	04	01	H2001_065_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	066	0	1	04	01	H2001_066_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	068	1	1	04	01	H2001_068_1	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	068	2	1	04	01	H2001_068_2	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	069	1	1	04	01	H2001_069_1	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	069	2	1	04	01	H2001_069_2	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	070	0	1	04	01	H2001_070_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H2001	075	0	1	04	01	H2001_075_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	076	0	1	04	01	H2001_076_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H2001	077	0	1	04	01	H2001_077_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	078	0	1	04	01	H2001_078_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	079	0	1	04	01	H2001_079_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	080	0	1	04	01	H2001_080_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	081	0	1	04	01	H2001_081_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	082	0	1	04	01	H2001_082_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	085	0	1	04	01	H2001_085_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2001	133	0	1	04	01	H2001_133_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H2001	134	0	1	04	01	H2001_134_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H2001	135	0	1	04	01	H2001_135_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
H2041	007	0	1	01	01	H2041_007_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	307.00	7		00010		13i1;13i10;
H2041	008	0	1	01	01	H2041_008_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	118.00	7		00010		13i1;13i10;
H2041	011	0	1	01	01	H2041_011_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	332.00	7		00010		13i1;13i10;
H2041	012	0	1	01	01	H2041_012_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H2041	013	0	1	01	01	H2041_013_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H2041	014	0	1	01	01	H2041_014_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H2041	015	0	1	01	01	H2041_015_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H2041	016	0	1	01	01	H2041_016_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	384.00	7		00010		13i1;13i10;
H2056	801	0	1	01	01	H2056_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H2056	801	0	1	01	01	H2056_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H2056	802	0	1	01	01	H2056_802_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H2056	802	0	1	01	01	H2056_802_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H2108	029	0	1	01	01	H2108_029_0	6	1	3	Food and Produce										000011010000000000000000000															2			13i1;		2		2						
H2108	030	0	1	01	01	H2108_030_0	6	1	3	Food and Produce										000011010000000000000000000															2			13i1;		2		2						
H2117	002	0	1	04	01	H2117_002_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H2126	001	0	1	01	01	H2126_001_0	7	1	3	SSBCI - Food and Produce										011111111111111111111110000															2			13i1;		1	13i1;	2						
H2168	001	0	1	01	01	H2168_001_0	4	1	3	Package 1										011111111111111111111111000	Osteoporosis														1	001		13i1;13i3;13i10;13i5;13i4;		1	13i1;13i10;13i5;13i3;13i4;	2						
H2168	002	0	1	01	01	H2168_002_0	4	1	3	Package 1										011111111111111111111111000	Osteoporosis														1	001		13i1;13i4;13i10;13i5;13i3;		1	13i1;13i10;13i4;13i3;13i5;	2						
H2168	004	0	1	01	01	H2168_004_0	4	1	3	Package 1										011111111111111111111111000	Osteoporosis														1	001		13i1;13i10;13i4;13i5;13i3;		1	13i1;13i10;13i3;13i4;13i5;	2						
H2172	001	0	1	02	01	H2172_001_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;	2	2		2						
H2172	002	0	1	02	01	H2172_002_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;	2	2		2						
H2172	005	0	1	01	01	H2172_005_0	3	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;		2		2						
H2172	008	0	1	02	01	H2172_008_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;	2	2		2						
H2172	009	0	1	02	01	H2172_009_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;	2	2		2						
H2172	010	0	1	02	01	H2172_010_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;	2	2		2						
H2172	013	0	1	02	01	H2172_013_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;	2	2		2						
H2172	014	0	1	02	01	H2172_014_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;	2	2		2						
H2172	016	0	1	01	01	H2172_016_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;		2		2						
H2172	016	0	1	01	01	H2172_016_0	4	2	3	Healthy Food Card										011111110011111110000000000															2			13i1;		2		2						
H2172	017	0	1	01	01	H2172_017_0	4	2	3	Healthy Food Card										011111110011111110000000000															2			13i1;		2		2						
H2172	017	0	1	01	01	H2172_017_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;		2		2						
H2172	018	0	1	01	01	H2172_018_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;		2		2						
H2172	018	0	1	01	01	H2172_018_0	4	2	3	Healthy Food Card										011111110011111110000000000															2			13i1;		2		2						
H2172	019	0	1	01	01	H2172_019_0	4	2	3	Healthy Food Card										011111110011111110000000000															2			13i1;		2		2						
H2172	019	0	1	01	01	H2172_019_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;		2		2						
H2172	020	0	1	02	01	H2172_020_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;	2	2		2						
H2172	021	0	1	02	01	H2172_021_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;	2	2		2						
H2172	022	0	1	02	01	H2172_022_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;	2	2		2						
H2172	023	0	1	02	01	H2172_023_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;	2	2		2						
H2172	024	0	1	02	01	H2172_024_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;	2	2		2						
H2172	025	0	1	01	01	H2172_025_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;		2		2						
H2172	026	0	1	01	01	H2172_026_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;		2		2						
H2172	027	0	1	02	01	H2172_027_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13f;	2	2		2						
H2174	001	0	1	02	01	H2174_001_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H2174	012	0	1	02	01	H2174_012_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H2174	013	0	1	02	01	H2174_013_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H2185	001	0	1	01	01	H2185_001_0	5	1	3	Flex Group and Transportation Benefit										011111111111111111111111110	Osteoporosis	Chronic Hypertension	Chronic Hyperlipidemia												2			13i4;13i1;		1	13i4;13i1;	2						
H2185	003	0	1	02	01	H2185_003_0	5	1	3	Flex Benefit										011111111111111111111111110	osteoporosis	chronic hypertension	chronic hyperlipidemia												2			13i6;13i4;	2	1	13i6;13i4;	2						
H2224	001	0	1	01	01	H2224_001_0	11	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i10;
H2224	003	0	1	01	01	H2224_003_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i10;
H2225	001	0	1	01	01	H2225_001_0	6	1	3	Food + Utilities + Non-Medical Transportation										000011010000010000000000000															2			13i1;13i10;10b1;		2		2						
H2226	001	0	1	01	01	H2226_001_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2226	003	0	1	01	01	H2226_003_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2247	001	0	1	02	01	H2247_001_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2247	003	0	1	02	01	H2247_003_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2247	004	0	1	01	01	H2247_004_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2247	005	0	1	01	01	H2247_005_0	5	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2272	001	0	1	02	01	H2272_001_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2272	003	0	1	02	01	H2272_003_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2293	001	0	1	04	01	H2293_001_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2293	002	0	1	04	01	H2293_002_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2293	004	0	1	04	01	H2293_004_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2293	009	0	1	04	01	H2293_009_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	150.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2293	021	0	1	04	01	H2293_021_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2293	023	0	1	04	01	H2293_023_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2293	029	0	1	04	01	H2293_029_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2293	031	0	1	04	01	H2293_031_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2293	033	0	1	04	01	H2293_033_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2293	035	0	1	04	01	H2293_035_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2320	031	0	1	02	01	H2320_031_0	6	1	3	OTC Plus										011111111111111111111111110	Chronic Hypertension	Osteoporosis	Chronic Low Back Pain												2			13i1;	2	1	13i1;	2						
H2322	008	0	1	04	01	H2322_008_0	7	1	3	Food and Produce										011111110111111110000000000															2			13i1;	1	2		1	0.00	5		01010		13i1;
H2322	011	0	1	04	01	H2322_011_0	7	1	3	Food and Produce										011111110111111110000000000															2			13i1;	1	2		1	0.00	5		01010		13i1;
H2322	016	0	1	04	01	H2322_016_0	6	1	3	Food and Produce										011111110111111110000000000															2			13i1;	1	1	13i1;	1	0.00	5		01010		13i1;
H2322	017	0	1	04	01	H2322_017_0	7	1	3	Food and Produce										011111110111111110000000000															2			13i1;	1	1	13i1;	1	0.00	5		01010		13i1;
H2322	020	0	1	04	01	H2322_020_0	6	1	3	Flex Card										011111110111111110000000000															2			13i1;13i3;13i9;13i10;13i4;	1	1	13i1;13i3;13i9;13i10;13i4;	1	0.00	7		01010		13i1;13i3;13i4;13i9;13i10;
H2354	015	0	1	01	01	H2354_015_0	6	1	3	Food and Produce										011111110111111110000000000															2			13i1;		2		1	0.00	5		01010		13i1;
H2354	018	0	1	01	01	H2354_018_0	7	1	3	Food and Produce										011111110111111110000000000															2			13i1;		2		1	0.00	5		01010		13i1;
H2354	019	0	1	01	01	H2354_019_0	5	1	3	Food and Produce										011111110111111110000000000															2			13i1;		2		1	0.00	5		01010		13i1;
H2354	021	0	1	02	01	H2354_021_0	7	1	3	Food and Produce										011111110111111110000000000															2			13i1;	2	2		1	0.00	5		01010		13i1;
H2354	025	0	1	01	01	H2354_025_0	7	1	3	Flex Card										011111110111111110000000000															2			13i1;13i3;13i9;13i10;13i4;		2		2						
H2354	028	0	1	01	01	H2354_028_0	6	1	3	Food and Produce										011111110111111110000000000															2			13i1;		2		1	0.00	5		01010		13i1;
H2354	029	0	1	01	01	H2354_029_0	7	1	3	Food and Produce										011111110111111110000000000															2			13i1;		2		2						
H2354	030	0	1	01	01	H2354_030_0	7	1	3	Food and Produce										011111110111111110000000000															2			13i1;		1	13i1;	1	0.00	5		01010		13i1;
H2385	001	0	1	04	01	H2385_001_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2385	002	0	1	04	01	H2385_002_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2385	003	0	1	04	01	H2385_003_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2385	004	0	1	04	01	H2385_004_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2392	003	0	1	01	01	H2392_003_0	3	1	3	Healthy Food										011111110111111111111110000															1	001		13i1;		1	13i1;	2						
H2400	001	0	1	01	01	H2400_001_0	6	1	3	Flex Card										011111111111111111111110000															2			13i1;13i10;		2		2						
H2400	002	0	1	01	01	H2400_002_0	5	1	3	Flex Card										011111111111111111111110000															2			13i1;13i10;		2		2						
H2406	050	0	1	04	01	H2406_050_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2406	052	0	1	04	01	H2406_052_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2406	053	0	1	04	01	H2406_053_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2406	099	0	1	04	01	H2406_099_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2416	001	0	1	01	01	H2416_001_0	7	1	3	MSHO SSBCI										011111111111111111111110000															2			13i1;13i6;		1	13i1;13i6;	2						
H2417	001	0	1	01	01	H2417_001_0	7	1	3	Healthy Foods										011111111111111111111110000															2			13i1;		1	13i1;	1	100.00	7		00010		13i1;
H2422	002	0	1	01	01	H2422_002_0	7	1	3	MSHO SSBCI Benefits										011111111111111110010000000															1	001		13i1;13i6;14c22;13i10;		2		2						
H2425	001	0	1	01	01	H2425_001_0	6	1	3	SSBCI										011111110110111110010001000	chronic pain syndrom														2			13i4;13i1;13i10;		1	13i4;13i1;13i10;	2						
H2441	001	0	1	04	01	H2441_001_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;	1	2		2						
H2445	001	0	1	02	01	H2445_001_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2445	002	0	1	02	01	H2445_002_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2445	003	0	1	02	01	H2445_003_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2445	004	0	1	02	01	H2445_004_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2445	005	0	1	02	01	H2445_005_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2456	002	0	1	01	01	H2456_002_0	7	1	3	Package 1										000011110000001000000001100	Chronic hypertension	Chronic lipid disorders													2			13i-O1;13i-O2;13i10;13i4;13i1;		1	13i-O1;13i-O2;13i4;13i10;13i1;	2						
H2458	002	0	1	01	01	H2458_002_0	8	1	3	Flex Part C										000010010000001000000000000															2			13i1;13i10;		2		1	0.00	7		00010		13i1;13i10;
H2478	001	0	1	01	01	H2478_001_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H2491	025	0	1	02	01	H2491_025_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H2491	032	1	1	02	01	H2491_032_1	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H2491	032	2	1	02	01	H2491_032_2	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H2491	033	1	1	02	01	H2491_033_1	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H2491	033	2	1	02	01	H2491_033_2	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H2509	001	0	1	02	01	H2509_001_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2509	002	0	1	02	01	H2509_002_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2509	003	0	1	02	01	H2509_003_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2526	003	0	1	04	01	H2526_003_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	70.00	7		00010		13i1;13i10;
H2563	020	0	1	01	01	H2563_020_0	7	1	3	Food and Produce/Transportation NonMedical Needs										011111111111111111111110000															2			13i1;13i4;13i10;		2		2						
H2564	001	0	1	01	01	H2564_001_0	10	1	3	Package 1										000011111100011010000001000	Connective Tissue Disease														2			13i1;13i10;		1	13i1;13i10;	1	70.00	7		00010		13i1;13i10;
H2593	031	0	1	02	01	H2593_031_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;	2	2		2						
H2593	032	0	1	01	01	H2593_032_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H2593	040	0	1	02	01	H2593_040_0	4	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;13i2;	2	2		2						
H2593	043	0	1	02	01	H2593_043_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;13i2;	2	2		2						
H2593	044	0	1	01	01	H2593_044_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H2593	045	0	1	01	01	H2593_045_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H2593	046	0	1	01	01	H2593_046_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H2593	047	0	1	01	01	H2593_047_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H2593	048	0	1	01	01	H2593_048_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H2593	051	0	1	01	01	H2593_051_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H2593	053	0	1	01	01	H2593_053_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H2624	001	0	1	01	01	H2624_001_0	6	1	3	Healthy Foods										000011010000000000000000000															2			13i1;		2		1	0.00	5		00010		13i1;
H2628	001	0	1	01	01	H2628_001_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H2628	003	0	1	01	01	H2628_003_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i10;13i1;		2		2						
H2628	004	0	1	01	01	H2628_004_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H2628	005	0	1	01	01	H2628_005_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H2630	001	0	1	01	01	H2630_001_0	7	1	3	SSBCI										011111111111111111111110000															2			13i1;13i10;13i-O1;		1	13i1;	2						
H2630	002	0	1	01	01	H2630_002_0	7	1	3	SSBCI										011111111111111111111110000															2			13i1;13i10;13i-O1;		1	13i1;	2						
H2663	039	0	1	01	01	H2663_039_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	25.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	052	0	1	01	01	H2663_052_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	053	0	1	01	01	H2663_053_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	056	0	1	01	01	H2663_056_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	057	0	1	02	01	H2663_057_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	120.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	064	0	1	01	01	H2663_064_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	067	0	1	01	01	H2663_067_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	55.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	097	0	1	01	01	H2663_097_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	098	0	1	01	01	H2663_098_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	099	0	1	01	01	H2663_099_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	100	0	1	01	01	H2663_100_0	2	1	3	SSBCI Pkg										000011010000000000000000000															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	102	0	1	01	01	H2663_102_0	2	1	3	SSBCI Pkg										000011010000000000000000000															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	805	0	1	01	01	H2663_805_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H2663	805	0	1	01	01	H2663_805_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H2686	004	1	1	04	01	H2686_004_1	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	24.00	7		00010		13i1;13i10;
H2686	004	3	1	04	01	H2686_004_3	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	27.00	7		00010		13i1;13i10;
H2686	006	1	1	04	01	H2686_006_1	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	37.00	7		00010		13i1;13i10;
H2686	006	2	1	04	01	H2686_006_2	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	37.00	7		00010		13i1;13i10;
H2686	008	0	1	04	01	H2686_008_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	20.00	7		00010		13i1;13i10;
H2686	010	0	1	04	01	H2686_010_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	37.00	7		00010		13i1;13i10;
H2694	002	0	1	04	01	H2694_002_0	4	1	3	Grocery and OTC										000110010010001000000000000															1	001		13b;13i1;	1	2		1	50.00	5		00010		13b;13i1;
H2697	007	0	1	01	01	H2697_007_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	60.00	7		00010		13i1;13i10;
H2697	010	0	1	01	01	H2697_010_0	9	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	267.00	7		00010		13i1;13i10;
H2697	011	0	1	01	01	H2697_011_0	9	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	119.00	7		00010		13i1;13i10;
H2697	016	0	1	01	01	H2697_016_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	395.00	7		00010		13i1;13i10;
H2697	017	0	1	01	01	H2697_017_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H2697	018	0	1	01	01	H2697_018_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H2697	020	0	1	01	01	H2697_020_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H2715	006	1	1	01	01	H2715_006_1	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i4;13i10;
H2715	006	2	1	01	01	H2715_006_2	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i4;13i10;
H2775	112	0	1	04	01	H2775_112_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H2775	115	0	1	04	01	H2775_115_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H2802	044	0	1	02	01	H2802_044_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2802	053	0	1	02	01	H2802_053_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2802	064	0	1	02	01	H2802_064_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H2802	067	0	1	02	01	H2802_067_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H2802	068	0	1	02	01	H2802_068_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H2802	070	0	1	02	01	H2802_070_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H2819	001	0	1	01	01	H2819_001_0	8	1	3	Food and Produce										011111111111111111111110000															2			13i1;		2		1	60.00	7		00010		13i1;
H2845	003	0	1	04	01	H2845_003_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	268.00	7		00010		13i1;13i10;
H2845	008	0	1	04	01	H2845_008_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	294.00	7		00010		13i1;13i10;
H2845	009	0	1	04	01	H2845_009_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	193.00	7		00010		13i1;13i10;
H2845	010	0	1	04	01	H2845_010_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	193.00	7		00010		13i1;13i10;
H2875	001	0	1	02	01	H2875_001_0	3	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H2875	002	0	1	02	01	H2875_002_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H2875	003	0	1	01	01	H2875_003_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H2875	004	0	1	01	01	H2875_004_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H2875	004	0	1	01	01	H2875_004_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H2875	005	0	1	01	01	H2875_005_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H2875	005	0	1	01	01	H2875_005_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H2875	006	0	1	02	01	H2875_006_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H2915	002	0	1	02	01	H2915_002_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H2915	018	0	1	02	01	H2915_018_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H2923	001	0	1	01	01	H2923_001_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	75.00	7		00010		13i1;13i10;
H2923	003	0	1	01	01	H2923_003_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	60.00	7		00010		13i1;13i10;
H2923	005	0	1	01	01	H2923_005_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	80.00	7		00010		13i1;13i10;
H2923	006	0	1	01	01	H2923_006_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	75.00	7		00010		13i1;13i10;
H2923	009	0	1	01	01	H2923_009_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	314.00	7		00010		13i1;13i10;
H2926	001	0	1	01	01	H2926_001_0	6	1	3	SNBC SSBCI										011111111111111111111110000															2			13i1;		1	13i1;	2						
H2962	021	0	1	01	01	H2962_021_0	16	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;13i10;		1	13i1;13i10;	1	105.00	7		00010		13i1;13i10;
H2962	023	0	1	01	01	H2962_023_0	14	1	3	SSBCI Package 1										000000000000010000000000000															2			13i1;13i10;		2		1	100.00	7		00010		13i1;13i10;
H2962	025	0	1	01	01	H2962_025_0	16	1	3	SSBCI Package 1										000000000000010000000000000															2			13i1;13i10;		2		1	100.00	7		00010		13i1;13i10;
H2962	026	0	1	01	01	H2962_026_0	14	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;13i10;		2		1	100.00	7		00010		13i1;13i10;
H2962	029	0	1	01	01	H2962_029_0	14	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;13i10;		2		1	100.00	7		00010		13i1;13i10;
H2962	033	0	1	01	01	H2962_033_0	14	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;13i10;		2		1	100.00	7		00010		13i1;13i10;
H2962	035	0	1	01	01	H2962_035_0	11	1	3	SSBCI Package 1										011111111111111111111110000															2			13i1;13i10;		1	13i1;13i10;	1	225.00	7		00010		13i1;13i10;
H2962	036	0	1	01	01	H2962_036_0	11	1	3	SSBCI Package 1										011111111111111111111110000															2			13i1;13i10;		1	13i1;13i10;	1	225.00	7		00010		13i1;13i10;
H2962	050	0	1	01	01	H2962_050_0	14	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;13i10;		1	13i1;13i10;	1	100.00	7		00010		13i1;13i10;
H2962	051	0	1	01	01	H2962_051_0	14	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;13i10;		1	13i1;13i10;	1	100.00	7		00010		13i1;13i10;
H2962	052	0	1	01	01	H2962_052_0	14	1	3	SSBCI Package 1										000011010000000000000000000															2			13i10;13i1;		1	13i1;13i10;	1	100.00	7		00010		13i1;13i10;
H3038	002	0	1	01	01	H3038_002_0	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H3038	004	1	1	01	01	H3038_004_1	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H3038	004	2	1	01	01	H3038_004_2	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H3038	004	3	1	01	01	H3038_004_3	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H3038	004	4	1	01	01	H3038_004_4	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H3041	001	0	1	01	01	H3041_001_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	61.00	7		00010		13i1;13i10;
H3041	003	0	1	01	01	H3041_003_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	90.00	7		00010		13i1;13i10;
H3048	002	0	1	01	01	H3048_002_0	11	1	3	Healthy Foods & Social Supports										011111110011111110000000000															1	001		13i1;13i6;		2		2						
H3071	002	0	1	01	01	H3071_002_0	9	1	3	Food										000001010010010000000000000															2			13i1;		2		1	70.00	5		01010		13i1;
H3080	001	0	1	01	01	H3080_001_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	48.00	7		00010		13i1;13i10;
H3080	003	0	1	01	01	H3080_003_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	212.00	7		00010		13i1;13i10;
H3080	004	0	1	01	01	H3080_004_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	177.00	7		00010		13i1;13i10;
H3080	006	0	1	01	01	H3080_006_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H3080	007	0	1	01	01	H3080_007_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	165.00	7		00010		13i1;13i10;
H3093	001	0	1	01	01	H3093_001_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i10;
H3093	002	0	1	01	01	H3093_002_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i10;
H3093	003	0	1	01	01	H3093_003_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i10;
H3093	004	0	1	01	01	H3093_004_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i10;
H3093	005	0	1	01	01	H3093_005_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i10;
H3113	005	0	1	01	01	H3113_005_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3113	009	0	1	02	01	H3113_009_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3113	010	0	1	02	01	H3113_010_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3113	014	0	1	02	01	H3113_014_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3113	016	0	1	02	01	H3113_016_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3146	002	0	1	01	01	H3146_002_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	006	0	1	01	01	H3146_006_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	150.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	011	0	1	01	01	H3146_011_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	225.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	012	0	1	01	01	H3146_012_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	90.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	016	0	1	01	01	H3146_016_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	021	0	1	01	01	H3146_021_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	022	0	1	01	01	H3146_022_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	023	0	1	01	01	H3146_023_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	036	0	1	01	01	H3146_036_0	3	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	037	0	1	01	01	H3146_037_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	038	0	1	01	01	H3146_038_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	044	0	1	01	01	H3146_044_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i4;13i10;13i-O1;
H3146	801	0	1	01	01	H3146_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3146	801	0	1	01	01	H3146_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H3152	801	0	1	01	01	H3152_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H3152	801	0	1	01	01	H3152_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3152	804	0	1	01	01	H3152_804_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3152	804	0	1	01	01	H3152_804_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H3192	007	0	1	01	01	H3192_007_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3192	021	0	1	02	01	H3192_021_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3192	028	0	1	01	01	H3192_028_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3192	029	0	1	01	01	H3192_029_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3192	033	0	1	01	01	H3192_033_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3192	801	0	1	01	01	H3192_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H3192	801	0	1	01	01	H3192_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3204	001	0	1	01	01	H3204_001_0	5	1	3	Food and Produce Benefit										000001010000000000000001100	Chronic Hypertension	Chronic Hyperlipidemia													1	100	Completion of Annual Wellness Visit (AWV) within a 12-month period (rolling year).	13i1;		2		1	35.00	5		00010		13i1;
H3204	007	0	1	01	01	H3204_007_0	5	1	3	Food and Produce Benefit										000001010000000000000001100	Chronic Hypertension	Chronic Hyperlipidemia													1	100	Completion of Annual Wellness Visit (AWV) within a 12-month period (rolling year).	13i1;		2		1	35.00	5		00010		13i1;
H3204	013	4	1	01	01	H3204_013_4	7	1	3	Food and Produce Benefit										000001010000000000000001100	Chronic Hypertension	Chronic Hyperlipidemia													1	100	Completion of Annual Wellness Visit (AWV) within a 12-month period (rolling year).	13i1;		2		1	170.00	5		00010		13i1;
H3204	013	6	1	01	01	H3204_013_6	7	1	3	Food and Produce Benefit										000001010000000000000001100	Chronic Hypertension	Chronic Hyperlipidemia													1	100	Completion of Annual Wellness Visit (AWV) within a 12-month period (rolling year).	13i1;		2		1	100.00	5		00010		13i1;
H3204	017	0	1	01	01	H3204_017_0	6	1	3	Food and Produce Benefit										000001010000000000000001100	Chronic Hypertension	Chronic Hyperlipidemia													1	100	Completion of Annual Wellness Visit (AWV) within a 12-month period (rolling year).	13i1;		2		1	45.00	5		00010		13i1;
H3219	015	0	1	04	01	H3219_015_0	2	1	3	SSBCI Pkg										000011010000000000000000000															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3219	016	0	1	04	01	H3219_016_0	2	1	3	SSBCI Pkg										000011010000000000000000000															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3219	801	0	1	04	01	H3219_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H3219	801	0	1	04	01	H3219_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H3239	001	0	1	01	01	H3239_001_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	002	0	1	01	01	H3239_002_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	005	0	1	01	01	H3239_005_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	007	0	1	01	01	H3239_007_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	010	0	1	01	01	H3239_010_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	012	0	1	01	01	H3239_012_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	015	0	1	01	01	H3239_015_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	017	0	1	01	01	H3239_017_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	55.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	020	0	1	01	01	H3239_020_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	94.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	022	0	1	01	01	H3239_022_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	55.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	023	0	1	01	01	H3239_023_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	026	0	1	01	01	H3239_026_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	027	0	1	01	01	H3239_027_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	028	0	1	01	01	H3239_028_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	030	0	1	01	01	H3239_030_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3240	013	0	1	01	01	H3240_013_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H3240	017	0	1	02	01	H3240_017_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;	2	2		2						
H3240	024	0	1	02	01	H3240_024_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;	2	2		2						
H3251	029	0	1	01	01	H3251_029_0	6	1	3	SSBCI Grocery/Dietitian Benefit										000011010000000010000000000															1	001		13i1;14c2;		2		2						
H3256	004	1	1	04	01	H3256_004_1	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3256	004	2	1	04	01	H3256_004_2	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3256	005	1	1	04	01	H3256_005_1	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3256	005	2	1	04	01	H3256_005_2	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3256	006	1	1	04	01	H3256_006_1	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3256	006	2	1	04	01	H3256_006_2	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3259	001	0	1	01	01	H3259_001_0	11	1	3	Healthy Food										011111111111111111111110000															2			13i1;		1	13i1;	1	0.00	7		00010		13i1;
H3259	002	0	1	01	01	H3259_002_0	12	1	3	Healthy Food										011111111111111111111110000															2			13i1;		1	13i1;	1	0.00	7		00010		13i1;
H3259	003	0	1	01	01	H3259_003_0	11	1	3	Healthy Food										011111111111111111111110000															2			13i1;		1	13i1;	1	0.00	7		00010		13i1;
H3274	001	0	1	01	01	H3274_001_0	5	1	3	Grocery and Transportation Benefit										011111111111111111111111110	osteoporosis	chronic hypertension	chronic hyperlipidemia												2			13i1;13i4;		1	13i1;13i4;	2						
H3274	002	0	1	01	01	H3274_002_0	5	1	3	Transportation										011111111111111111111111110	osteoporosis	chronic hypertension	chronic hyperlipidemia												2			13i4;		1	13i4;	2						
H3274	005	0	1	01	01	H3274_005_0	5	1	3	Transportation and Food/Produce										011111111111111111111111110	osteoporosis	chronic hypertension	chronic hyperlipidemia												2			13i4;13i1;		1	13i4;13i1;	2						
H3276	001	0	1	02	01	H3276_001_0	13	1	3	SSBCI										011111111111111111111110000															1	001		13i1;	2	2		2						
H3288	001	0	1	04	01	H3288_001_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	18.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	002	0	1	04	01	H3288_002_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	15.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	003	0	1	04	01	H3288_003_0	4	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	15.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	004	0	1	04	01	H3288_004_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	017	0	1	04	01	H3288_017_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	018	0	1	04	01	H3288_018_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	15.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	019	0	1	04	01	H3288_019_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	15.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	034	0	1	04	01	H3288_034_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	105.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	048	0	1	04	01	H3288_048_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	15.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	053	0	1	04	01	H3288_053_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	165.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	801	0	1	04	01	H3288_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H3288	801	0	1	04	01	H3288_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H3291	002	0	1	01	01	H3291_002_0	4	1	3	Meal, Food and Produce, Utilities, Transportation										011111111111111111111111110	Chronic Hyperlipidemia	Chronic Hypertension	Osteoporosis												2			13c;13i1;13i10;13i4;		2		2						
H3291	003	0	1	01	01	H3291_003_0	3	1	3	Food and Produce										011111111111111111111111110	Chronic Hypertension	Chronic Hyperlipidemia	Chronic malnutrition including failure to thrive												2			13i1;		1	13i1;	1	0.00	5		00010		13i1;
H3305	007	0	1	02	01	H3305_007_0	8	3	2	Package 3																00000000101100	Osteoarthritis	Undergone a joint replacement				2	1	Enrollee must have a diagnosis for Rheumatoid Arthritis or Osteoarthritis, along with having undergone a joint replacement.	2			14c8;	2	1	14c8;	2						
H3305	007	0	1	02	01	H3305_007_0	8	2	2	Package 2																00001000000000									2			14c8;	2	1	14c8;	1	250.00	3		01000		14c8;
H3305	007	0	1	02	01	H3305_007_0	8	1	2	Package 1																00000100000000									2			13b;	2	1	13b;	2						
H3305	015	0	1	02	01	H3305_015_0	17	3	2	Package 3																00000000101100	Osteoarthritis	Undergone a joint replacement				2	1	Enrollee must have a diagnosis for Rheumatoid Arthritis or Osteoarthritis, along with having undergone a joint replacement.	2			14c8;	2	1	14c8;	2						
H3305	015	0	1	02	01	H3305_015_0	17	2	2	Package 2																00001000000000									2			14c8;	2	1	14c8;	1	250.00	3		01000		14c8;
H3305	015	0	1	02	01	H3305_015_0	17	1	2	Package 1																00000100000000									2			13b;	2	1	13b;	2						
H3305	020	0	1	02	01	H3305_020_0	8	3	2	Package 3																00000000101100	Osteoarthritis	Undergone a joint replacement				2	1	Enrollee must have a diagnosis for Rheumatoid Arthritis or Osteoarthritis, along with having undergone a joint replacement.	2			14c8;	2	1	14c8;	2						
H3305	020	0	1	02	01	H3305_020_0	8	1	2	Package 1																00000100000000									2			13b;	2	1	13b;	2						
H3305	020	0	1	02	01	H3305_020_0	8	2	2	Package 2																00001000000000									2			14c8;	2	1	14c8;	1	250.00	3		01000		14c8;
H3305	022	0	1	02	01	H3305_022_0	16	2	2	Package 2																00001000000000									2			14c8;	2	1	14c8;	1	250.00	3		01000		14c8;
H3305	022	0	1	02	01	H3305_022_0	16	1	2	Package 1																00000100000000									2			13b;	2	1	13b;	2						
H3305	022	0	1	02	01	H3305_022_0	16	3	2	Package 3																00000000101100	Osteoarthritis	Undergone a joint replacement				2	1	Enrollee must have a diagnosis for Rheumatoid Arthritis or Osteoarthritis, along with having undergone a joint replacement.	2			14c8;	2	1	14c8;	2						
H3305	033	0	1	01	01	H3305_033_0	9	2	3	SSBCI Package 1										000111110000011000000000000															2			13i1;13i10;		1	13i1;13i10;	1	75.00	7		01011		13i1;13i10;
H3305	033	0	1	01	01	H3305_033_0	9	1	2	UF Package 1																00000000101100	Osteoarthritis	Undergone a joint replacement				2	1	Enrollee must have a diagnosis for Rheumatoid Arthritis or Osteoarthritis, along with having undergone a joint replacement.	2			14c8;		1	14c8;	2						
H3305	034	0	1	01	01	H3305_034_0	9	1	2	UF Package 1																00000000101100	Osteoarthritis	Undergone a joint replacement				2	1	Enrollee must have a diagnosis for Rheumatoid Arthritis or Osteoarthritis, along with having undergone a joint replacement.	2			14c8;		1	14c8;	2						
H3305	034	0	1	01	01	H3305_034_0	9	2	3	SSBCI package 1										000111110000011000000000000															2			13i1;13i10;		1	13i1;13i10;	1	95.00	7		01011		13i1;13i10;
H3312	069	0	1	01	01	H3312_069_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3312	070	0	1	01	01	H3312_070_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3312	073	0	1	01	01	H3312_073_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3312	074	0	1	01	01	H3312_074_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	45.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3312	087	0	1	01	01	H3312_087_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3312	089	0	1	01	01	H3312_089_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3312	090	0	1	01	01	H3312_090_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3312	091	0	1	01	01	H3312_091_0	3	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3312	801	0	1	01	01	H3312_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3312	801	0	1	01	01	H3312_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H3312	804	0	1	01	01	H3312_804_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H3312	804	0	1	01	01	H3312_804_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3347	002	0	1	02	01	H3347_002_0	8	1	3	Package 1										011111111111111111111111100	Osteoporosis	RSD (Reflex Sympathetic Dystrophy)													2			13i10;13i1;	2	2		1	0.00	5		00010		13i1;13i10;
H3347	003	0	1	02	01	H3347_003_0	8	1	3	1										011111111111111111111111100	Osteoporosis	RSD (Reflex Sympathetic Dystrophy)													2			13i10;13i1;13i-O1;13i6;	2	2		1	0.00	7		00010		13i1;13i6;13i10;13i-O1;
H3347	007	0	1	02	01	H3347_007_0	9	1	3	Package 1										011111111111111111111111100	Osteoporosis	RSD (Reflex Sympathetic Dystrophy)													2			13i10;13i1;13i4;	2	2		1	0.00	5		00010		13i1;13i4;13i10;
H3347	009	0	1	02	01	H3347_009_0	9	1	3	Package 1										011111111111111111111111100	Osteoporosis	RSD (Reflex Sympathetic Dystrophy)													2			13i1;	2	2		2						
H3347	016	0	1	02	01	H3347_016_0	8	1	3	Package 1										011111111111111111111111100	Osteoporosis	RSD (Reflex Sympathetic Dystrophy)													2			13i1;	2	2		2						
H3347	018	0	1	02	01	H3347_018_0	8	1	3	1										011111111111111111111111100	Osteoporosis	RSD (Reflex Sympathetic Dystrophy)													2			13i10;13i1;13i-O1;	2	2		1	0.00	7		00010		13i1;13i10;13i-O1;
H3359	021	0	1	01	01	H3359_021_0	7	1	3	OTC Plus										011111111111111111111111100	Chronic hypertension	Osteoporosis													2			13i10;13i1;		1	13i1;13i10;	1	0.00	7		00011		13i1;13i10;
H3359	034	0	1	01	01	H3359_034_0	5	1	3	SSBCI										011111111111111111111111100	chronic hypertension	osteoporosis													2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00011		13i1;13i10;
H3359	038	0	1	01	01	H3359_038_0	7	1	3	OTC Plus										011111111111111111111111100	Chronic Hypertension	Osteoporosis													2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00011		13i1;13i10;
H3379	053	0	1	02	01	H3379_053_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H3379	054	0	1	02	01	H3379_054_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H3379	056	0	1	02	01	H3379_056_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H3387	013	0	1	02	01	H3387_013_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3387	014	1	1	02	01	H3387_014_1	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3387	014	2	1	02	01	H3387_014_2	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3387	015	1	1	02	01	H3387_015_1	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3387	015	2	1	02	01	H3387_015_2	6	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3387	017	0	1	02	01	H3387_017_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3407	001	0	1	01	01	H3407_001_0	8	1	3	SSBCI Package 1										011111111111111111111110000															2			13i10;13i1;		1	13i10;13i1;	1	450.00	5		00010		13i1;13i10;
H3419	001	0	1	01	01	H3419_001_0	6	1	3	Transportation										011111111111111111111111110	chronic hyperlipidemia	chronic hypertension	osteoporosis												2			13i4;		2		2						
H3419	003	0	1	02	01	H3419_003_0	7	1	3	Combined Flex Benefits										011111111111111111111111110	osteoporosis	chronic hypertension	chronic hyperlipidemia												2			13i1;13i4;13i10;	2	1	13i1;13i4;13i10;	2						
H3419	004	0	1	02	01	H3419_004_0	6	1	3	Combined Flex Benefits										011111111111111111111111110	osteoporosis	chronic hypertension	chronic hyperlipidemia												2			13i1;13i4;13i10;	2	1	13i1;13i4;13i10;	2						
H3419	005	0	1	01	01	H3419_005_0	5	1	3	Flex Benefits										011111111111111111111111110	chronic hypertension	chronic hyperlipidemia	osteoporosis												2			13i4;14c22;		1	13i4;	2						
H3419	006	0	1	01	01	H3419_006_0	4	1	3	Combined Flex Benefits										011111111111111111111111110	osteoporosis	chronic hypertension	chronic hyperlipidemia												2			13i1;13i10;14c22;		1	13i1;13i10;14c22;	1	100.00	7		00011		13i1;13i10;14c22;
H3419	007	0	1	01	01	H3419_007_0	4	1	3	Combined Flex Benefits										011111111111111111111111110	osteoporosis	chronic hypertension	chronic hyperlipidemia												2			13i10;13i1;14c22;		1	13i1;13i10;14c22;	1	100.00	7		01011		13i1;13i10;14c22;
H3443	001	0	1	01	01	H3443_001_0	10	1	3	Package 1										011111111111111111111110000															2			13i3;13i5;13i1;13i10;14c8;13i-O1;		2		1	30.00	7		00010		13i1;13i10;14c8;
H3443	002	0	1	01	01	H3443_002_0	10	1	3	Package 1										011111111111111111111110000															2			14c8;13i-O1;13i3;13i10;13i1;13i5;		2		1	30.00	7		00010		13i1;13i10;14c8;
H3443	003	0	1	01	01	H3443_003_0	10	1	3	Package 1										011111111111111111111110000															2			13i3;13i5;14c8;13i1;13i10;13i-O1;		2		1	30.00	7		00010		13i1;13i10;14c8;
H3443	005	0	1	01	01	H3443_005_0	11	1	3	Package 1										011111111111111111111110000															2			13i-O1;13i3;13i10;		2		2						
H3443	006	0	1	01	01	H3443_006_0	10	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i1;13i10;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3443	007	0	1	01	01	H3443_007_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i1;13i10;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3447	018	0	1	01	01	H3447_018_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H3447	033	0	1	02	01	H3447_033_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;	2	2		2						
H3447	053	0	1	01	01	H3447_053_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H3447	056	0	1	02	01	H3447_056_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;	2	2		2						
H3467	002	0	1	02	01	H3467_002_0	5	1	3	Food, Produce and Utilities										000000000010000000000000000															2			13i10;13i1;	2	1	13i1;13i10;	2						
H3467	005	0	1	02	01	H3467_005_0	3	1	3	Food and Produce										000000010000000000000000000															2			13i1;	2	1	13i1;	2						
H3533	002	0	1	01	01	H3533_002_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H3533	033	0	1	01	01	H3533_033_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H3533	034	1	1	01	01	H3533_034_1	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H3533	034	1	1	01	01	H3533_034_1	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H3533	034	2	1	01	01	H3533_034_2	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H3533	034	2	1	01	01	H3533_034_2	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H3551	001	0	1	01	01	H3551_001_0	4	1	3	Grocery and OTC										000110010010001000000000000															1	001		13b;13i1;		2		1	65.00	5		00010		13b;13i1;
H3551	003	0	1	02	01	H3551_003_0	4	1	3	Essentials wallet										000110010010001000000000000															1	001		13i1;14c8;13i10;13i4;	2	2		1	200.00	5		00010		13i1;13i4;13i10;14c8;
H3551	004	0	1	01	01	H3551_004_0	4	1	3	Grocery and OTC										000110010010001000000000000															1	001		13b;13i1;		2		1	130.00	5		00010		13b;13i1;
H3561	008	0	1	01	01	H3561_008_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H3561	009	0	1	01	01	H3561_009_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H3597	011	0	1	02	01	H3597_011_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3597	012	0	1	02	01	H3597_012_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3597	801	0	1	01	01	H3597_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H3597	801	0	1	01	01	H3597_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3597	802	0	1	01	01	H3597_802_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3597	802	0	1	01	01	H3597_802_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H3660	028	0	1	02	01	H3660_028_0	6	1	2	A1C Meals																00000000001000	High A1C (over 8) Levels								2			13c;	2	2		2						
H3660	029	0	1	02	01	H3660_029_0	7	2	2	A1C Meals																00000000001000	High A1C (over 8) Levels								2			13c;	2	2		2						
H3660	029	0	1	02	01	H3660_029_0	7	1	2	Home Safety Devices																00000000001111	History of Hip Replacement	History of Knee Replacement	History of Femur Fracture	Falls or History of Falls		2	2		2			14c8;	2	2		1	225.00	3		01000		14c8;
H3660	044	0	1	01	01	H3660_044_0	7	2	2	A1C Meals																00000000001000	High A1C (over 8) Levels								2			13c;		2		2						
H3660	044	0	1	01	01	H3660_044_0	7	1	2	Home Safety Devices																00000000001111	History of Hip Replacement	History of Hip Knee Replacement	History of Hip Femur Fracture	Falls or History of Falls		2	2		2			14c8;		2		1	175.00	3		01000		14c8;
H3660	050	0	1	01	01	H3660_050_0	7	1	2	Home Safety Devices																00000000001111	History of Hip Replacement	History of Knee Replacement	History of Femur Fracture	Falls or History of Falls		2	2		2			14c8;		2		1	150.00	3		01000		14c8;
H3660	052	1	1	01	01	H3660_052_1	6	2	2	A1C Meals																00000000001000	High A1C (over 8) Levels								2			13c;		2		2						
H3660	052	1	1	01	01	H3660_052_1	6	1	2	Home Safety Devices																00000000001111	History of Hip Replacement	History of Knee Replacement	History of Femur Fracture	Falls or History of Falls		2	2		2			14c8;		2		1	150.00	3		01000		14c8;
H3660	052	2	1	01	01	H3660_052_2	6	2	2	A1C Meals																00000000001000	High A1C (over 8) Levels								2			13c;		2		2						
H3660	052	2	1	01	01	H3660_052_2	6	1	2	Home Safety Devices																00000000001111	History of Hip Replacement	History of Knee Replacement	History of Femur Fracture	Falls or History of Falls		2	2		2			14c8;		2		1	150.00	3		01000		14c8;
H3660	053	1	1	01	01	H3660_053_1	6	1	2	Home Safety Devices																00000000001111	History of Hip Replacement	History of Knee Replacement	History of Femur Fracture	Falls or History of Falls		2	2		2			14c8;		2		1	200.00	3		01000		14c8;
H3660	053	2	1	01	01	H3660_053_2	5	1	2	Home Safety Devices																00000000001111	History of Hip Replacement	History of Knee Replacement	History of Femur Fracture	Falls or History of Falls		2	2		2			14c8;		2		1	200.00	3		01000		14c8;
H3660	801	0	1	01	01	H3660_801_0	2	2	2	A1C Meals																00000000001000	High A1C (over 8)								2			13c;		2		2						
H3660	801	0	1	01	01	H3660_801_0	2	1	2	Home Safety Devices																00000000001111	History of Hip Replacement	History of Knee Replacement	History of Femur Fracture	Falls or History of Falls		2	2		2			14c8;		2		1	175.00	3		01000		14c8;
H3660	805	0	1	02	01	H3660_805_0	2	2	2	A1C Meals																00000000001000	High A1C (over 9)								2			13c;	2	2		2						
H3660	805	0	1	02	01	H3660_805_0	2	1	2	Home Safety Devices																00000000001111	History of Hip Replacement	History of Knee Replacement	History of Femur Fracture	Falls or History of Falls		2	2		2			14c8;	2	2		2						
H3672	019	0	1	01	01	H3672_019_0	5	1	3	SSBCI Benefits										011111111111111111111110000															2			13i1;13i10;13i4;		2		2						
H3706	024	0	1	01	01	H3706_024_0	6	1	3	Smart Wallet Benefit										000011010000000000000000000															2			13i1;13b;13i4;13i10;		2		1	0.00	7		00010		13b;13i1;13i4;13i10;
H3706	025	0	1	01	01	H3706_025_0	5	1	3	Smart Wallet Benefit										000011010000000000000000000															2			13b;13i1;13i4;13i10;		2		1	0.00	7		00010		13b;13i1;13i4;13i10;
H3706	028	0	1	01	01	H3706_028_0	5	1	3	Smart Wallet Benefit										111111111111111111111111111	Chronic anemia	Chronic hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i4;13i10;13i1;		2		1	0.00	7		00010		13i1;13i4;13i10;
H3706	029	0	1	01	01	H3706_029_0	5	1	3	Smart Wallet Benefit										111111111111111111111111111	Chronic Anemia,	Chronic hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i4;13i10;13i1;		2		1	0.00	7		00010		13i1;13i4;13i10;
H3748	801	0	1	01	01	H3748_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H3748	801	0	1	01	01	H3748_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3755	006	0	1	01	01	H3755_006_0	7	1	3	Meal Benefit										000010010000000000000000000															1	001		13c;		1	13c;	2						
H3794	002	0	1	02	01	H3794_002_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3794	004	0	1	02	01	H3794_004_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3794	006	0	1	02	01	H3794_006_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3805	040	0	1	02	01	H3805_040_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H3805	043	0	1	02	01	H3805_043_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H3815	001	0	1	01	01	H3815_001_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i10;		2		2						
H3815	008	0	1	01	01	H3815_008_0	7	1	3	Package 1										011111111111111111111110000															2			13i1;13i3;13i-O1;13i10;		2		2						
H3815	010	0	1	01	01	H3815_010_0	7	1	3	Package 1										011111111111111111111110000															2			13i5;13i3;13i-O1;13i1;13i10;14c8;		2		1	25.00	7		00010		13i1;13i10;14c8;
H3815	011	0	1	01	01	H3815_011_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i1;13i10;14c8;		2		1	10.00	7		00010		13i1;13i10;14c8;
H3815	013	0	1	01	01	H3815_013_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;		2		2						
H3815	016	0	1	02	01	H3815_016_0	7	1	3	Package 1										011111111111111111111110000															2			13i1;13i3;13i-O1;13i10;	2	2		2						
H3815	019	0	1	01	01	H3815_019_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;		2		2						
H3815	020	0	1	01	01	H3815_020_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;		2		2						
H3815	021	0	1	01	01	H3815_021_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;		2		2						
H3815	023	0	1	01	01	H3815_023_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;		2		2						
H3815	028	0	1	01	01	H3815_028_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;		2		2						
H3815	030	0	1	01	01	H3815_030_0	6	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i10;13i1;14c8;		2		1	165.00	7		00010		13i1;13i10;14c8;
H3815	031	0	1	01	01	H3815_031_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i1;13i10;14c8;		2		1	30.00	7		00010		13i1;13i10;14c8;
H3815	033	0	1	01	01	H3815_033_0	6	1	3	Package 1										000000000010000000000000000															2			13i3;13i-O1;13i1;13i10;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3815	034	0	1	01	01	H3815_034_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;		2		2						
H3815	035	0	1	01	01	H3815_035_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;13i1;14c8;		2		1	10.00	7		00010		13i1;13i10;14c8;
H3815	038	0	1	01	01	H3815_038_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;		2		2						
H3815	039	0	1	01	01	H3815_039_0	6	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i10;13i1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3815	040	0	1	01	01	H3815_040_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;		2		2						
H3815	041	0	1	01	01	H3815_041_0	6	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i10;13i1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3815	042	0	1	01	01	H3815_042_0	6	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i10;13i1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3815	044	0	1	01	01	H3815_044_0	6	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i10;13i1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3815	045	0	1	01	01	H3815_045_0	6	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i10;13i1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3815	046	0	1	01	01	H3815_046_0	8	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;13i1;14c8;		2		1	20.00	7		00010		13i1;13i10;14c8;
H3815	047	0	1	01	01	H3815_047_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;		2		2						
H3815	048	0	1	01	01	H3815_048_0	7	1	3	Package 1										011111111111111111111110000															2			13i5;13i3;13i-O1;13i1;13i10;14c8;		2		1	25.00	7		00010		13i1;13i10;14c8;
H3815	049	0	1	01	01	H3815_049_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i10;		2		2						
H3815	050	0	1	01	01	H3815_050_0	8	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;14c8;13i1;		2		1	40.00	7		00010		13i1;13i10;14c8;
H3815	051	0	1	01	01	H3815_051_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;14c8;13i1;		2		1	40.00	7		00010		13i1;13i10;14c8;
H3815	052	0	1	01	01	H3815_052_0	6	1	3	Package 1										011111111111111111111110000															2			13i1;13i3;13i10;13i-O1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3815	053	0	1	01	01	H3815_053_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;		2		2						
H3815	054	0	1	01	01	H3815_054_0	8	1	3	Package 1										011011111111111111111110000															2			13i5;13i3;13i-O1;13i1;13i10;14c8;		2		1	25.00	7		00010		13i1;13i10;14c8;
H3815	055	0	1	01	01	H3815_055_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;		2		2						
H3815	056	0	1	01	01	H3815_056_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;		2		2						
H3817	008	1	1	04	01	H3817_008_1	6	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H3817	008	2	1	04	01	H3817_008_2	6	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H3817	008	4	1	04	01	H3817_008_4	6	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H3817	009	1	1	04	01	H3817_009_1	6	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H3817	009	2	1	04	01	H3817_009_2	6	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H3817	010	0	1	04	01	H3817_010_0	5	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H3817	011	1	1	04	01	H3817_011_1	6	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H3817	011	2	1	04	01	H3817_011_2	6	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H3817	011	3	1	04	01	H3817_011_3	6	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H3817	801	0	1	04	01	H3817_801_0	3	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H3817	802	0	1	04	01	H3817_802_0	3	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H3817	803	0	1	04	01	H3817_803_0	3	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H3817	804	0	1	04	01	H3817_804_0	3	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H3832	007	0	1	04	01	H3832_007_0	5	3	2	OHTH 3																01101010001110	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome			2	2		2			16c3;	1	2		2						
H3832	007	0	1	04	01	H3832_007_0	5	2	2	OHTH 2																00000000001110	Oral Cancer	Sjorgens	Head and Neck Cancer			2	2		2			16b4;16b5;16b1;16c3;	1	2		2						
H3832	007	0	1	04	01	H3832_007_0	5	1	2	OHTH 1																01101010001110	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome			2	2		2			16b4;16c3;	1	2		2						
H3832	007	0	1	04	01	H3832_007_0	5	4	2	OHTH 4																00000000001110	Oral Cancer	Sjorgens	Head and Neck Cancer			2	2		2			16c3;	1	2		2						
H3832	008	0	1	04	01	H3832_008_0	7	4	2	OHTH 4																00000000001110	Oral Cancer	Sjorgens	Head and Neck Cancer			2	2		2			16c3;	1	2		2						
H3832	008	0	1	04	01	H3832_008_0	7	3	2	OHTH 3																01101010001110	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome			2	2		2			16c3;	1	2		2						
H3832	008	0	1	04	01	H3832_008_0	7	1	2	OHTH 1																01101010001110	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome			2	2		2			16b4;16c3;	1	2		2						
H3832	008	0	1	04	01	H3832_008_0	7	2	2	OHTH 2																00000000001110	Oral Cancer	Sjorgens	Head and Neck Cancer			2	2		2			16b4;16b5;16b1;16c3;	1	2		2						
H3832	009	0	1	04	01	H3832_009_0	5	4	2	OHTH 4																00000000001110	Oral Cancer	Sjorgens	Head and Neck Cancer			2	2		2			16c3;	1	2		2						
H3832	009	0	1	04	01	H3832_009_0	5	1	2	OHTH 1																01101010001110	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome			2	2		2			16b4;16c3;	1	2		2						
H3832	009	0	1	04	01	H3832_009_0	5	2	2	OHTH 2																00000000001110	Oral Cancer	Sjorgens	Head and Neck Cancer			2	2		2			16b4;16b5;16b1;16c3;	1	2		2						
H3832	009	0	1	04	01	H3832_009_0	5	3	2	OHTH 3																01101010001110	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome			2	2		2			16c3;	1	2		2						
H3832	010	0	1	04	01	H3832_010_0	5	1	2	OHTH 1																01101010001110	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome			2	2		2			16b4;16c3;	1	2		2						
H3832	010	0	1	04	01	H3832_010_0	5	4	2	OHTH 4																00000000001110	Oral Cancer	Sjorgens	Head and Neck Cancer			2	2		2			16c3;	1	2		2						
H3832	010	0	1	04	01	H3832_010_0	5	3	2	OHTH 3																01101010001110	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome			2	2		2			16c3;	1	2		2						
H3832	010	0	1	04	01	H3832_010_0	5	2	2	OHTH 2																00000000001110	Oral Cancer	Sjorgens	Head and Neck Cancer			2	2		2			16b4;16b5;16b1;16c3;	1	2		2						
H3868	001	0	1	02	01	H3868_001_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H3907	002	0	1	01	01	H3907_002_0	13	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3907	006	0	1	01	01	H3907_006_0	18	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3907	037	0	1	01	01	H3907_037_0	16	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3907	057	1	1	01	01	H3907_057_1	18	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3907	057	2	1	01	01	H3907_057_2	17	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3907	057	3	1	01	01	H3907_057_3	17	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3907	057	4	1	01	01	H3907_057_4	15	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3907	057	5	1	01	01	H3907_057_5	16	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3907	057	6	1	01	01	H3907_057_6	16	2	3	Healthy Food/Transportation										011111111111111111111100000															2			13i1;10b1;		2		2						
H3907	057	6	1	01	01	H3907_057_6	16	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3907	057	7	1	01	01	H3907_057_7	16	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3907	058	1	1	01	01	H3907_058_1	16	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3907	058	2	1	01	01	H3907_058_2	17	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3907	058	3	1	01	01	H3907_058_3	17	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3907	059	1	1	01	01	H3907_059_1	18	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3907	059	2	1	01	01	H3907_059_2	18	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3907	059	3	1	01	01	H3907_059_3	18	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3907	059	4	1	01	01	H3907_059_4	18	1	2	MA Uniformity Flexibility- CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3907	059	4	1	01	01	H3907_059_4	18	2	3	Healthy Food/Transportation										011111111111111111111100000															2			13i1;10b1;		2		2						
H3907	059	5	1	01	01	H3907_059_5	18	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;		1	13c;	2						
H3916	001	0	1	04	01	H3916_001_0	6	1	3	Healing at Home - In Home Support										000111100010010010000000000															2			14c21;	1	2		2						
H3916	022	0	1	04	01	H3916_022_0	6	1	3	Healing at Home - In Home Support										000111100010010010000000000															2			14c21;	1	2		2						
H3928	001	0	1	01	01	H3928_001_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3928	801	0	1	01	01	H3928_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3928	801	0	1	01	01	H3928_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H3928	803	0	1	01	01	H3928_803_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H3928	803	0	1	01	01	H3928_803_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3931	095	0	1	02	01	H3931_095_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	180.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3931	099	0	1	02	01	H3931_099_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	270.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3931	100	0	1	02	01	H3931_100_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	195.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3931	157	0	1	01	01	H3931_157_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3931	160	0	1	01	01	H3931_160_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3931	175	0	1	01	01	H3931_175_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3931	188	0	1	01	01	H3931_188_0	3	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3931	191	0	1	01	01	H3931_191_0	3	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3931	196	0	1	01	01	H3931_196_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3931	801	0	1	01	01	H3931_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H3931	801	0	1	01	01	H3931_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3931	804	0	1	01	01	H3931_804_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H3931	804	0	1	01	01	H3931_804_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3949	024	0	1	01	01	H3949_024_0	5	1	3	Food and Produce										000011010000000000000000000															2			13i1;		2		2						
H3952	008	0	1	01	01	H3952_008_0	6	2	2	Package # 2 - Transportation																01010000000000						1			2			10b1;		2		2						
H3952	008	0	1	01	01	H3952_008_0	6	1	3	Package #1 - Food										000101010000001000000000000															1	001		13i1;13i2;		2		2						
H3952	008	0	1	01	01	H3952_008_0	6	3	2	Package #3 - PERS																00001000011111	Neurologic Disorders (Multiple Sclerosis, Transverse Myelitis, Muscular Dystrophy, Parkinsons)	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis With or Without Pathological Fracture		2	2		2			14c11;		2		2						
H3952	020	0	1	01	01	H3952_020_0	6	2	2	Package # 2 - Transportation																01010000000000						1			2			10b1;		2		2						
H3952	020	0	1	01	01	H3952_020_0	6	1	3	Package #1 - Food										000101010000001000000000000															1	001		13i1;13i2;		2		2						
H3952	020	0	1	01	01	H3952_020_0	6	3	2	Package #3 - PERS																00001000011111	Neurologic Disorders (Multiple Sclerosis, Transverse Myelitis, Muscular Dystrophy, Parkinsons)	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis With or Without Pathological Fracture		2	2		2			14c11;		2		2						
H3952	045	0	1	01	01	H3952_045_0	6	1	3	Package #1 - Food										000101010000001000000000000															1	001		13i1;13i2;		2		2						
H3952	045	0	1	01	01	H3952_045_0	6	3	2	Package #3 - PERS																00001000011111	Neurologic Disorders (Multiple Sclerosis, Transverse Myelitis, Muscular Dystrophy, Parkinsons)	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis With or Without Pathological Fracture		2	2		2			14c11;		2		2						
H3952	045	0	1	01	01	H3952_045_0	6	2	2	Package # 2 - Transportation																01010000000000						1			2			10b1;		2		2						
H3952	048	0	1	01	01	H3952_048_0	5	3	2	Package 3 - PERS																00001000011111	Neurologic Disorders (Multiple Sclerosis, Transverse Myelitis, Muscular Dystrophy, Parkinsons)	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis With or Without Pathological Fracture		2	2		2			14c11;		2		2						
H3952	048	0	1	01	01	H3952_048_0	5	2	2	Package 2 - Transportation																01010000000000						1			2			10b1;		2		2						
H3952	048	0	1	01	01	H3952_048_0	5	1	3	Package 1 - Food										000101010000001000000000000															1	001		13i1;13i2;		2		2						
H3952	049	0	1	01	01	H3952_049_0	6	1	3	Package 1 - Food										000101010000001000000000000															1	001		13i1;13i2;		2		2						
H3952	049	0	1	01	01	H3952_049_0	6	2	2	Package 2 - Transportation																01010000000000						1			2			10b1;		2		2						
H3952	049	0	1	01	01	H3952_049_0	6	3	2	Package 3 - PERS																00001000011111	Neurologic Disorders (Multiple Sclerosis, Transverse Myelitis, Muscular Dystrophy, Parkinsons)	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis With or Without Pathological Fracture		2	2		2			14c11;		2		2						
H3952	050	0	1	01	01	H3952_050_0	6	2	2	Package 2 - Transportation																01010000000000						1			2			10b1;		2		2						
H3952	050	0	1	01	01	H3952_050_0	6	1	3	Package 1 - Food										000101010000001000000000000															1	001		13i1;13i2;		2		2						
H3952	050	0	1	01	01	H3952_050_0	6	3	2	Package 3 - PERS																00001000011111	Neurologic Disorders (Multiple Sclerosis, Transverse Myelitis, Muscular Dystrophy, Parkinsons)	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis With or Without Pathological Fracture		2	2		2			14c11;		2		2						
H3952	051	0	1	01	01	H3952_051_0	6	3	2	Package 3 - PERS																00001000011111	Neurologic Disorders (Multiple Sclerosis, Transverse Myelitis, Muscular Dystrophy, Parkinsons)	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis With or Without Pathological Fracture		2	2		2			14c11;		2		2						
H3952	051	0	1	01	01	H3952_051_0	6	2	2	Package 2 - Transportation																01010000000000						1			2			10b1;		2		2						
H3952	051	0	1	01	01	H3952_051_0	6	1	3	Package 1 - Food										000101010000001000000000000															1	001		13i1;13i2;		2		2						
H3952	053	0	1	02	01	H3952_053_0	6	4	2	PERS																00001000011111	Neurologic Disorders (Multiple Sclerosis, Transverse Myelitis, Muscular Dystrophy, Parkinsons)	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis With or Without Pathological Fracture		2	2		2			14c11;	2	2		2						
H3952	053	0	1	02	01	H3952_053_0	6	3	2	Package 3 - OTC																01000000000000									2			13b;	2	2		2						
H3952	053	0	1	02	01	H3952_053_0	6	2	2	Package 2 - Transportation																01010000000000						1			2			10b1;	2	2		2						
H3952	053	0	1	02	01	H3952_053_0	6	1	3	Package 1 - Food										000101010000001000000000000															1	001		13i1;13i2;	2	2		2						
H3952	054	0	1	02	01	H3952_054_0	6	4	2	PERS																00001000011111	Neurologic Disorders (Multiple Sclerosis, Transverse Myelitis, Muscular Dystrophy, Parkinsons)	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis With or Without Pathological Fracture		2	2		2			14c11;	2	2		2						
H3952	054	0	1	02	01	H3952_054_0	6	3	2	Package 3 - OTC																01000000000000									2			13b;	2	2		2						
H3952	054	0	1	02	01	H3952_054_0	6	2	2	Package 2 - Transportation																01010000000000						1			2			10b1;	2	2		2						
H3952	054	0	1	02	01	H3952_054_0	6	1	3	Package 1 - Food										000101010000001000000000000															1	001		13i1;13i2;	2	2		2						
H3952	055	0	1	01	01	H3952_055_0	7	1	3	Package 1 - Food										000101010000001000000000000															1	001		13i1;13i2;		2		2						
H3952	055	0	1	01	01	H3952_055_0	7	2	2	Package 2 - Transportation																01010000000000						1			2			10b1;		2		2						
H3952	055	0	1	01	01	H3952_055_0	7	3	2	Package 3 - PERS																00001000011111	Neurologic Disorders (Multiple Sclerosis, Transverse Myelitis, Muscular Dystrophy, Parkinsons)	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis With or Without Pathological Fracture		2	2		2			14c11;		2		2						
H3952	060	0	1	02	01	H3952_060_0	6	1	3	Package 1 - Food										000011011010001000000001100	Chronic Hypertension	Chronic Hyperlipidemia													1	001		13i1;13i2;	2	2		2						
H3952	060	0	1	02	01	H3952_060_0	6	2	2	Package 2 - PERS																00001000011111	Neurologic Disorders (Multiple Sclerosis, Transverse Myelitis, Muscular Dystrophy, Parkinsons)	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis With or Without Pathological Fracture		2	2		2			14c11;	2	2		2						
H3957	031	0	1	02	01	H3957_031_0	6	1	3	Healing at Home										000111100010010010000000000															2			14c21;	2	2		2						
H3957	045	1	1	02	01	H3957_045_1	8	1	3	Healing at Home- In Home Support										000111100010010010000000000															2			14c21;	2	2		2						
H3957	046	1	1	02	01	H3957_046_1	7	1	3	Healing at Home - In Home Support										000111100010010010000000000															2			14c21;	2	2		2						
H3957	047	1	1	01	01	H3957_047_1	6	1	3	Healing at Home										000111100010010010000000000															2			14c21;		2		2						
H3957	048	0	1	01	01	H3957_048_0	6	1	3	Healing at Home- In Home Support										000111100010010010000000000															2			14c21;		2		2						
H3957	050	1	1	01	01	H3957_050_1	7	1	3	Healing at Home- In Home Support										000111100010010010000000000															2			14c21;		2		2						
H3959	010	0	1	02	01	H3959_010_0	2	1	2	Hypertension & Hyperlipidemia																00000100001000	Hyperlipidemia					2	2		2			10b1;13b;	2	1	10b1;13b;	2						
H3959	011	0	1	02	01	H3959_011_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	032	0	1	02	01	H3959_032_0	2	2	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	032	0	1	02	01	H3959_032_0	2	1	2	Hypertension & Hyperlipidemia																00000100001000	Hyperlipidemia					2	2		2			10b1;13b;	2	1	10b1;13b;	2						
H3959	033	0	1	02	01	H3959_033_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	105.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	035	0	1	01	01	H3959_035_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	036	0	1	01	01	H3959_036_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	041	0	1	02	01	H3959_041_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	150.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	053	0	1	02	01	H3959_053_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	25.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	056	0	1	01	01	H3959_056_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	066	0	1	01	01	H3959_066_0	4	1	3	SSBCI Pkg										010001100010011100000000000															1	001		13i6;		1	13i6;	2						
H3959	069	0	1	01	01	H3959_069_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	070	0	1	01	01	H3959_070_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	071	0	1	01	01	H3959_071_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	072	0	1	01	01	H3959_072_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	073	0	1	01	01	H3959_073_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	074	0	1	01	01	H3959_074_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	075	0	1	01	01	H3959_075_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	076	0	1	01	01	H3959_076_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	083	0	1	01	01	H3959_083_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	084	0	1	01	01	H3959_084_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	085	0	1	01	01	H3959_085_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	804	0	1	01	01	H3959_804_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H3959	804	0	1	01	01	H3959_804_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3975	004	0	1	04	01	H3975_004_0	7	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H4003	009	0	1	01	01	H4003_009_0	5	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain											2			13b;13i1;13i2;13i3;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;13i4;		2		1	65.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4003	017	0	1	01	01	H4003_017_0	6	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			13b;13i1;13i2;13i3;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;13i4;		2		1	85.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4003	019	0	1	02	01	H4003_019_0	6	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			13b;13i1;13i2;13i3;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;13i4;	2	2		1	45.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4003	034	0	1	02	01	H4003_034_0	5	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain											2			13b;13i1;13i2;13i3;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;13i4;	2	2		1	20.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4003	055	0	1	02	01	H4003_055_0	6	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			13i3;13i4;13i10;13b;13i1;13i2;13i6;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;	2	2		1	10.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4003	058	0	1	01	01	H4003_058_0	5	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain											2			13b;13i1;13i2;13i3;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;13i4;		2		1	145.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	048	0	1	01	01	H4004_048_0	5	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain											2			13b;13i1;13i2;13i3;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;13i4;		2		1	85.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	056	0	1	02	01	H4004_056_0	7	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			13b;13i1;13i2;13i3;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;13i4;	2	2		1	75.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	065	0	1	02	01	H4004_065_0	5	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			13b;13i1;13i2;13i3;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;13i4;	2	2		1	50.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	066	0	1	02	01	H4004_066_0	6	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain											2			13i-O1;13b;13i1;13i2;13i6;13i10;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;13i3;18b1;13i4;	2	2		1	15.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	068	0	1	01	01	H4004_068_0	5	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain											2			13b;13i1;13i2;13i3;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;13i4;		2		1	120.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	069	0	1	01	01	H4004_069_0	5	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain											2			13b;13i1;13i2;13i3;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;13i4;		2		1	220.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	070	0	1	02	01	H4004_070_0	5	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain											2			13b;13i1;13i2;13i3;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;13i4;	2	2		1	100.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	071	0	1	02	01	H4004_071_0	5	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			13b;13i1;13i2;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;13i3;18b1;13i4;	2	2		1	190.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	072	1	1	01	01	H4004_072_1	5	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			13b;13i1;13i2;13i3;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;13i4;		2		1	130.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	072	2	1	01	01	H4004_072_2	5	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			13b;13i1;13i2;13i3;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;13i4;		2		1	95.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	072	3	1	01	01	H4004_072_3	5	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			13b;13i1;13i2;13i3;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;13i4;		2		1	75.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	073	1	1	02	01	H4004_073_1	6	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			13b;13i1;13i2;13i3;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;13i4;	2	2		1	85.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	073	2	1	02	01	H4004_073_2	6	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			13b;13i1;13i2;13i3;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;13i4;	2	2		1	70.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	073	3	1	02	01	H4004_073_3	6	1	3	SSBCI Coverage										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			13b;13i1;13i2;13i3;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;13i4;	2	2		1	45.00	7		00010		13b;13i1;13i2;13i3;13i4;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4032	001	0	1	02	01	H4032_001_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H4032	002	0	1	02	01	H4032_002_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H4054	001	0	1	01	01	H4054_001_0	6	1	3	Food and Produce										011111111111111111111110000															2			13i1;		2		2						
H4057	001	0	1	01	01	H4057_001_0	4	1	3	Grocery Debit Card and Online Benefit										000011111001010110000000000															2			13i1;		1	13i1;	1	93.00	5		01010		13i1;
H4073	002	0	1	02	01	H4073_002_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H4073	003	0	1	02	01	H4073_003_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H4073	004	0	1	02	01	H4073_004_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H4091	001	0	1	04	01	H4091_001_0	4	1	3	SSBCI Package										000000100000001000000000000															2			13i6;	1	2		2						
H4091	002	0	1	04	01	H4091_002_0	4	1	3	Food, Produce, Rent and Utilities										011111111111111111111110000															2			13i1;13i10;13i6;	1	2		2						
H4091	003	0	1	04	01	H4091_003_0	4	1	3	SSBCI Package										000011110000011010000001000	Chronic malnutrition including failure to thrive														2			13i6;13i1;	1	2		2						
H4093	004	0	1	01	01	H4093_004_0	5	1	3	Food and Produce										011111111111111111111110000															2			13i1;		2		2						
H4093	008	0	1	01	01	H4093_008_0	5	1	3	Food and Produce										011111111111111111111110000															2			13i1;		2		2						
H4140	002	0	1	01	01	H4140_002_0	8	1	3	SSBCI Package 1										011111111101111110111111110	Chronic Hypertension	Osteoporosis	Chronic Back Pain												2			13i1;13i2;13i10;13i-O1;13i-O2;14c4;13i4;		1	13i1;13i2;13i10;13i-O1;13i-O2;14c4;13i4;	1	65.00	7		00010		13i1;13i2;13i4;13i10;13i-O1;13i-O2;14c4;
H4140	004	0	1	01	01	H4140_004_0	8	1	3	SSBCI Package										000011010000000000000000000															2			13b;13i1;13i2;13i10;13i-O1;13i-O2;13i4;		1	13b;13i1;13i2;13i10;13i-O1;13i-O2;13i4;	1	152.00	7		01010		13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;
H4140	012	0	1	01	01	H4140_012_0	8	1	3	SSBCI Package										011111111101111110111111110	Chronic Hypertension	Osteoporosis	Chronic Back Pain												2			13i1;13b;13i2;13i10;13i-O1;13i-O2;13i4;		2		1	128.00	7		01010		13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;
H4140	013	0	1	01	01	H4140_013_0	8	1	3	SSBCI Package										011111111101111110111111110	Chronic Hypertension	Osteoporosis	Chronic Back Pain												2			13b;13i2;13i1;13i10;13i-O1;13i-O2;14c4;13i4;		1	13b;13i1;13i2;13i10;13i-O1;13i-O2;14c4;13i4;	1	300.00	7		01010		13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;14c4;
H4140	016	0	1	01	01	H4140_016_0	8	1	3	SSBCI Package										011111111101111110111111110	Chronic Hypertension	Osteoporosis	Chronic Back Pain												2			13i1;13i2;13i10;13i-O1;13i-O2;13i4;		2		1	69.65	7		01010		13i1;13i2;13i4;13i10;13i-O1;13i-O2;
H4140	017	0	1	01	01	H4140_017_0	8	1	3	SSBCI Package										011111111101111110111111110	Chronic Hypertension	Osteoporosis	Chronic Back Pain												2			13b;13i2;13i1;13i10;13i-O1;13i-O2;14c4;13i4;		1	13b;13i1;13i2;13i10;13i-O1;13i-O2;14c4;13i4;	1	275.00	7		01010		13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;14c4;
H4140	018	0	1	01	01	H4140_018_0	8	1	3	SSBCI Package										000011010000000000000000000															2			13b;13i1;13i2;13i10;13i-O1;13i-O2;14c4;13i4;		1	13b;13i1;13i2;13i10;13i-O1;13i-O2;14c4;13i4;	1	145.00	7		01010		13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;14c4;
H4141	003	0	1	01	01	H4141_003_0	6	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4141	024	0	1	01	01	H4141_024_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4141	025	0	1	01	01	H4141_025_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4152	021	0	1	01	01	H4152_021_0	6	1	3	Food and Produce										011111111111111111111110000															2			13i1;		2		1	0.00	7		00010		13i1;
H4152	022	0	1	02	01	H4152_022_0	6	1	3	Food and Produce										011111111111111111111110000															1	100	N/A	13b;13i1;	2	2		1	100.00	5		01010		13b;13i1;
H4158	001	0	1	01	01	H4158_001_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H4161	004	0	1	02	01	H4161_004_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;	2	2		2						
H4161	014	0	1	02	01	H4161_014_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;13i2;	2	2		2						
H4161	015	0	1	02	01	H4161_015_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;13i2;	2	2		2						
H4161	016	0	1	02	01	H4161_016_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;	2	2		2						
H4161	017	0	1	02	01	H4161_017_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;13i2;	2	2		2						
H4172	001	0	1	01	01	H4172_001_0	4	1	3	Beauty and Barber Shop										011111111111111111111111110	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis												2			13i-O1;		1	13i-O1;	2						
H4172	003	0	1	01	01	H4172_003_0	6	1	3	Food and Barbershop										011111111111111111111111110	Osteoporosis	Chronic Hypertension	Chronic Hyperlipidemia												2			13i1;13i-O1;		1	13i1;13i-O1;	1	0.00	5		00010		13i1;13i-O1;
H4193	001	0	1	01	01	H4193_001_0	6	1	3	Healthy Benefits+										011111111111111111111110000															2			13i1;13i3;13i5;13i10;13i-O1;13i-O2;14c8;		1	13i1;13i3;13i5;13i10;13i-O1;13i-O2;14c8;	2						
H4227	001	0	1	01	01	H4227_001_0	5	1	3	Package 1										000011111100011010000001000	Connective Tissue Disease														2			13i1;13i10;13i3;13i4;		1	13i1;13i3;13i4;13i10;	1	65.00	7		01010		13i1;13i3;13i4;13i10;
H4227	002	0	1	01	01	H4227_002_0	5	1	3	Package 1										000011111100011010000001000	Connective Tissue Disease														2			13i1;13i4;13i3;13i10;		1	13i1;13i3;13i4;13i10;	1	0.00	7		01010		13i1;13i3;13i4;13i10;
H4279	001	0	1	01	01	H4279_001_0	17	1	3	Healthy Food/Non-Medical Transportation/Utilities										011111111111111111111100000															2			13i1;13i10;13i4;		2		2						
H4279	004	0	1	01	01	H4279_004_0	18	1	3	Healthy Food/Non-Medical Transportation/Utilities										011111111111111111111100000															2			13i1;13i10;13i4;		2		2						
H4286	002	0	1	01	01	H4286_002_0	6	1	3	Flex Card										011111111111111111111111111	Prediabetes	Chronic Hypertension	Chronic Hypercholesterolemia	Osteoporosis											1	001		13i1;13i2;13i10;14c4;13i3;14c11;13i-O1;14c17;13b;13i4;		2		1	150.00	7		00010		13b;13i1;13i2;13i3;13i4;13i10;13i-O1;14c4;14c11;14c17;
H4329	001	0	1	01	01	H4329_001_0	3	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H4346	001	0	1	02	01	H4346_001_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i10;13i1;	2	2		2						
H4346	005	0	1	02	01	H4346_005_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;13i2;	2	2		2						
H4346	006	0	1	02	01	H4346_006_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i2;13i10;	2	2		2						
H4346	014	0	1	01	01	H4346_014_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H4346	025	0	1	01	01	H4346_025_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H4346	031	0	1	01	01	H4346_031_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H4348	003	0	1	04	01	H4348_003_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H4348	004	0	1	04	01	H4348_004_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	359.00	7		00010		13i1;13i10;
H4348	007	0	1	04	01	H4348_007_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H4407	034	0	1	01	01	H4407_034_0	5	1	3	Food and Produce										000011010000000000000000000															2			13i1;		2		2						
H4439	002	0	1	01	01	H4439_002_0	5	1	3	Food and Produce										011111111111111111111110000															2			13i1;		2		2						
H4439	003	0	1	01	01	H4439_003_0	4	1	3	Food and Produce										011111111111111111111110000															2			13i1;		2		2						
H4444	001	0	1	01	01	H4444_001_0	6	1	3	Food and Produce										011111111111111111111110000															2			13i1;		2		2						
H4444	002	0	1	01	01	H4444_002_0	8	1	3	Food and Produce and Digital Communications										011111111111111111111110000															2			13i1;13i10;		2		1	150.00	5		00010		13i1;13i10;
H4444	003	0	1	01	01	H4444_003_0	7	1	3	Food and Produce and Digital Communications										011111111111111111111110000															2			13i1;13i10;		2		1	345.00	5		00010		13i1;13i10;
H4461	022	0	1	01	01	H4461_022_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H4461	022	0	1	01	01	H4461_022_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H4461	035	0	1	01	01	H4461_035_0	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	038	0	1	01	01	H4461_038_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H4461	041	0	1	01	01	H4461_041_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	042	0	1	01	01	H4461_042_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	042	0	1	01	01	H4461_042_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	044	0	1	02	01	H4461_044_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H4461	044	0	1	02	01	H4461_044_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	049	0	1	01	01	H4461_049_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	050	0	1	01	01	H4461_050_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	051	0	1	01	01	H4461_051_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	052	0	1	01	01	H4461_052_0	2	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H4461	052	0	1	01	01	H4461_052_0	2	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	053	0	1	01	01	H4461_053_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	054	0	1	01	01	H4461_054_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	055	0	1	01	01	H4461_055_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	057	0	1	01	01	H4461_057_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	058	0	1	01	01	H4461_058_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	060	0	1	01	01	H4461_060_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	061	0	1	01	01	H4461_061_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	063	0	1	01	01	H4461_063_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	063	0	1	01	01	H4461_063_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	064	0	1	01	01	H4461_064_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	065	0	1	01	01	H4461_065_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	065	0	1	01	01	H4461_065_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	066	0	1	01	01	H4461_066_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H4461	066	0	1	01	01	H4461_066_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	067	0	1	01	01	H4461_067_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	068	0	1	01	01	H4461_068_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H4461	068	0	1	01	01	H4461_068_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	069	0	1	01	01	H4461_069_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	069	0	1	01	01	H4461_069_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H4461	070	0	1	01	01	H4461_070_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H4461	070	0	1	01	01	H4461_070_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	071	0	1	01	01	H4461_071_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	071	0	1	01	01	H4461_071_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H4461	072	0	1	01	01	H4461_072_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	072	0	1	01	01	H4461_072_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H4461	074	0	1	01	01	H4461_074_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	074	0	1	01	01	H4461_074_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H4461	076	0	1	01	01	H4461_076_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	076	0	1	01	01	H4461_076_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H4461	077	0	1	01	01	H4461_077_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	077	0	1	01	01	H4461_077_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H4471	005	0	1	01	01	H4471_005_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H4471	010	1	1	01	01	H4471_010_1	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H4471	010	2	1	01	01	H4471_010_2	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H4471	011	0	1	01	01	H4471_011_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;13i2;		2		2						
H4473	003	0	1	04	01	H4473_003_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	196.00	7		00010		13i1;13i10;
H4473	004	0	1	04	01	H4473_004_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	223.00	7		00010		13i1;13i10;
H4473	007	0	1	04	01	H4473_007_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	257.00	7		00010		13i1;13i10;
H4490	003	0	1	01	01	H4490_003_0	3	1	3	Healthy Food										011111111111111111111110000															1	001		13i1;		1	13i1;	2						
H4499	001	0	1	01	01	H4499_001_0	7	1	3	Food and Produce/Transportation NonMedical Needs										011111111111111111111110000															2			13i1;13i4;13i10;		2		2						
H4513	094	0	1	01	01	H4513_094_0	5	1	3	Food and Produce										000011010000000000000000000															2			13i1;		2		2						
H4513	097	0	1	01	01	H4513_097_0	5	1	3	Food and Produce										000011010000000000000000000															2			13i1;		2		2						
H4513	098	0	1	01	01	H4513_098_0	4	1	3	Food and Produce										000011010000000000000000000															2			13i1;		2		2						
H4514	015	0	1	02	01	H4514_015_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H4514	016	0	1	02	01	H4514_016_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H4514	018	0	1	02	01	H4514_018_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H4514	021	0	1	02	01	H4514_021_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H4514	023	0	1	02	01	H4514_023_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H4514	024	0	1	02	01	H4514_024_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H4523	020	0	1	01	01	H4523_020_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	021	0	1	01	01	H4523_021_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	024	0	1	01	01	H4523_024_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	027	0	1	01	01	H4523_027_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	028	0	1	01	01	H4523_028_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	029	0	1	01	01	H4523_029_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	030	0	1	01	01	H4523_030_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	034	0	1	01	01	H4523_034_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	037	0	1	01	01	H4523_037_0	3	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	038	0	1	01	01	H4523_038_0	3	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	039	0	1	01	01	H4523_039_0	3	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	041	0	1	01	01	H4523_041_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	043	0	1	01	01	H4523_043_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	044	0	1	01	01	H4523_044_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	801	0	1	01	01	H4523_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H4523	801	0	1	01	01	H4523_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H4523	802	0	1	01	01	H4523_802_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H4523	802	0	1	01	01	H4523_802_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H4527	003	0	1	02	01	H4527_003_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H4527	015	0	1	02	01	H4527_015_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H4527	039	0	1	02	01	H4527_039_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H4527	040	0	1	02	01	H4527_040_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H4527	041	0	1	02	01	H4527_041_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H4527	042	0	1	02	01	H4527_042_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H4527	054	0	1	02	01	H4527_054_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H4527	057	0	1	02	01	H4527_057_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H4537	004	0	1	04	01	H4537_004_0	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H4604	017	0	1	02	01	H4604_017_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H4604	024	0	1	02	01	H4604_024_0	5	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H4604	025	0	1	02	01	H4604_025_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H4604	026	0	1	02	01	H4604_026_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H4605	001	0	1	04	01	H4605_001_0	5	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H4605	002	0	1	04	01	H4605_002_0	6	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H4605	004	0	1	04	01	H4605_004_0	6	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H4605	801	0	1	04	01	H4605_801_0	3	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H4605	802	0	1	04	01	H4605_802_0	3	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H4605	803	0	1	04	01	H4605_803_0	3	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H4605	804	0	1	04	01	H4605_804_0	3	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H4624	003	0	1	01	01	H4624_003_0	7	1	3	Foods & Produce and Utilities										000111110010010000000000000															2			13i1;13i10;		2		1	75.00	7		01011		13i1;13i10;
H4624	006	0	1	01	01	H4624_006_0	7	1	3	Foods & Produce and Utilities										000111110010010000000000000															2			13i1;13i10;		2		1	55.00	7		01011		13i1;13i10;
H4624	010	0	1	01	01	H4624_010_0	7	1	3	Foods & Produce and Utilities										000011010000000000000000000															1	100	HRA Completion	13i1;13i10;		2		1	120.00	7		01011		13i1;13i10;
H4624	011	0	1	01	01	H4624_011_0	7	1	3	Foods & Produce and Utilities										000011010000000000000000000															1	100	HRA Completion	13i1;13i10;		2		1	120.00	7		01011		13i1;13i10;
H4624	012	0	1	01	01	H4624_012_0	8	1	3	Foods & Produce, Utilities and AC										000011010000000000000000000															1	100	HRA Completion	13i1;13i10;13i5;		2		1	77.00	7		01011		13i1;13i5;13i10;
H4624	022	0	1	01	01	H4624_022_0	7	1	3	Foods & Produce and Utilities										000111110010010000000000000															2			13i10;13i1;		2		1	122.00	7		01011		13i1;13i10;
H4624	023	0	1	01	01	H4624_023_0	8	1	3	Foods & Produce, Util, OTC, RICS and AC										000000000010000000000000000															1	100	HRA Completion	13b;13i1;13i10;13i5;		2		1	137.00	7		01011		13b;13i1;13i5;13i10;
H4624	023	0	1	01	01	H4624_023_0	8	2	2	Transportation																00000000001000	Chronic Kidney Disease (CKD)Level 5 CKD (ESRD)								2			10b1;		2		2						
H4624	025	0	1	01	01	H4624_025_0	9	2	2	Transportation																00000000001000	Chronic Kidney Disease (CKD)Level 5 CKD (ESRD)								2			10b1;		2		2						
H4624	025	0	1	01	01	H4624_025_0	9	1	3	Foods & Produce, Utilities, OTC and RICS										000000000010000000000000000															1	100	HRA Completion	13b;13i1;13i10;		2		1	141.00	7		01011		13b;13i1;13i10;
H4624	026	0	1	01	01	H4624_026_0	9	1	3	Foods & Produce and Utilities										000111110010010000000000000															2			13i1;13i10;		2		1	75.00	7		01011		13i1;13i10;
H4624	027	0	1	01	01	H4624_027_0	10	1	3	Foods & Produce, Utilities and OTC										000011010000000000000000000															1	100	HRA Completion	13i1;13i10;13b;		1	13i1;13i10;13b;	1	180.00	7		01011		13b;13i1;13i10;
H4624	028	0	1	01	01	H4624_028_0	8	1	3	Foods & Produce, Utilities and OTC										000011010000000000000000000															1	100	HRA Completion	13b;13i1;13i10;		2		1	141.00	7		01011		13b;13i1;13i10;
H4624	029	0	1	01	01	H4624_029_0	8	1	3	Foods & Produce, Utilities, OTC and RICS										000000000010000000000000000															1	100	HRA Completion	13b;13i1;13i10;		2		1	130.00	7		01011		13b;13i1;13i10;
H4624	029	0	1	01	01	H4624_029_0	8	2	2	Transportation																00000000001000	Chronic Kidney Disease (CKD)Level 5 CKD (ESRD)								2			10b1;		2		2						
H4624	031	0	1	01	01	H4624_031_0	7	1	3	Foods & Produce, Utilities and OTC										000011010000000000000000000															1	100	HRA Completion	13b;13i1;13i10;		2		1	158.00	7		01011		13b;13i1;13i10;
H4624	032	0	1	01	01	H4624_032_0	7	1	3	Foods & Produce, Utilities, OTC and AC										000011010000000000000000000															1	100	HRA Completion	13b;13i1;13i5;13i10;		2		1	157.00	7		01011		13b;13i1;13i5;13i10;
H4624	033	0	1	01	01	H4624_033_0	7	1	3	Foods & Produce, Utilities and OTC										000011010000000000000000000															1	100	HRA Completion	13b;13i1;13i10;		2		1	174.00	7		01011		13b;13i1;13i10;
H4624	034	0	1	01	01	H4624_034_0	7	1	3	Foods & Produce and Utilities										000011010000000000000000000															1	100	HRA Completion	13i1;13i10;		2		1	125.00	7		01011		13i1;13i10;
H4624	036	0	1	01	01	H4624_036_0	8	2	2	Transportation																00000000001000	Chronic Kidney Disease (CKD)Level 5 CKD (ESRD)								2			10b1;		2		2						
H4624	036	0	1	01	01	H4624_036_0	8	1	3	Foods & Produce, Utilities, OTC and RICS										000000000010000000000000000															1	100	HRA Completion	13b;13i1;13i10;		2		1	136.00	7		01011		13b;13i1;13i10;
H4624	037	0	1	01	01	H4624_037_0	8	1	3	Foods & Produce and Utilities										000111110010010000000000000															2			13i10;13i1;		2		1	45.00	7		01011		13i1;13i10;
H4624	038	0	1	01	01	H4624_038_0	7	1	3	Foods & Produce and Utilities										000111110010010000000000000															2			13i1;13i10;		2		1	75.00	7		01011		13i1;13i10;
H4624	039	0	1	01	01	H4624_039_0	7	1	3	Foods & Produce, Utilities and OTC										000011010000000000000000000															1	100	HRA Completion	13b;13i1;13i10;		2		1	170.00	7		01011		13b;13i1;13i10;
H4624	040	0	1	01	01	H4624_040_0	7	1	3	Foods & Produce and Utilities										000011010000000000000000000															1	100	HRA Completion	13i1;13i10;		2		1	130.00	7		01011		13i1;13i10;
H4624	042	0	1	01	01	H4624_042_0	8	2	2	Transportation																00000000001000	Chronic Kidney Disease (CKD)Level 5 CKD (ESRD)								2			10b1;		2		2						
H4624	042	0	1	01	01	H4624_042_0	8	1	3	Foods & Produce, Utilities, OTC and RICS										000000000010000000000000000															1	100	HRA Completion	13b;13i1;13i10;		2		1	130.00	7		01011		13b;13i1;13i10;
H4624	043	0	1	01	01	H4624_043_0	8	1	3	Foods & Produce and Utilities										000111110010010000000000000															2			13i1;13i10;		2		1	80.00	7		01011		13i1;13i10;
H4624	044	0	1	01	01	H4624_044_0	8	1	3	Foods & Produce and Utilities										000111110010010000000000000															2			13i1;13i10;		2		1	75.00	7		01011		13i1;13i10;
H4624	045	0	1	01	01	H4624_045_0	7	1	3	Foods & Produce, Utilities and OTC										000011010000000000000000000															1	100	HRA Completion	13b;13i1;13i10;		2		1	195.00	7		01011		13b;13i1;13i10;
H4624	046	0	1	01	01	H4624_046_0	8	1	3	Foods & Produce and Utilities										000111110010010000000000000															1	100	HRA Completion	13i1;13i10;		2		1	60.00	7		01011		13i1;13i10;
H4647	002	0	1	01	01	H4647_002_0	5	1	3	Food, Meals, and Home Mod										000001010010000000000000000															2			13i9;13i1;13i2;14c10;		2		1	1230.00	3		00010		13i1;13i9;
H4661	003	0	1	02	01	H4661_003_0	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H4661	005	0	1	02	01	H4661_005_0	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H4676	001	0	1	01	01	H4676_001_0	7	1	3	Pest Control										011111111111111111111111000	Chronic Sleep Disorders														2			13i3;		2		2						
H4676	002	0	1	01	01	H4676_002_0	7	1	3	Healthy Foods and Utilities										011111111111111111111111000	Chronic sleep disorders														2			13i1;13i10;		2		2						
H4694	001	0	1	01	01	H4694_001_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i10;13i1;		2		2						
H4694	002	0	1	01	01	H4694_002_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i10;13i1;		2		2						
H4694	003	0	1	01	01	H4694_003_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i10;13i1;		2		2						
H4694	004	0	1	01	01	H4694_004_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i10;13i1;		2		2						
H4711	011	0	1	01	01	H4711_011_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4711	012	0	1	01	01	H4711_012_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4711	013	0	1	01	01	H4711_013_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4711	801	0	1	01	01	H4711_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H4711	801	0	1	01	01	H4711_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H4739	001	0	1	01	01	H4739_001_0	5	1	3	Package 1										000011111100011010000001000	Connective Tissue Disease														2			13i1;13i10;13i3;		1	13i1;13i3;13i10;	1	0.00	5		01010		13i1;13i3;13i10;
H4808	001	0	1	04	01	H4808_001_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	54.00	7		00010		13i1;13i10;
H4835	801	0	1	01	01	H4835_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H4835	801	0	1	01	01	H4835_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H4868	004	0	1	01	01	H4868_004_0	7	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H4868	014	0	1	01	01	H4868_014_0	7	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H4869	001	0	1	02	01	H4869_001_0	4	1	3	Chronic Illness Package										000011010000000000000000000															1	011		13i1;13i10;13b;	2	1	13i1;13b;13i10;	2						
H4869	003	0	1	02	01	H4869_003_0	5	2	2	ESRD Dental																00000000001000	End Stage Renal Disease (CKD Stage 5)								1	011		16b4;16b5;16b2;16b1;16b6;16c1;16c2;16c3;16c4;16c8;16c10;	2	2		1	1000.00	3		00100		16b1;16b2;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c8;16c10;
H4869	003	0	1	02	01	H4869_003_0	5	1	3	CKD Package										000000000010000000000000000															1	011		13i1;13b;13i10;13d;	2	1	13i1;13b;13i10;13d;	2						
H4869	003	0	1	02	01	H4869_003_0	5	3	2	ESRD Support Package																00000000001000	End Stage Renal Disease								1	011		10b1;14c21;	2	2		2						
H4869	011	0	1	02	01	H4869_011_0	4	1	3	Chronic Illness Package + Transportation										000011010000000000000000000															1	011		13i1;13i4;13i10;13b;	2	1	13i1;13i4;13b;13i10;	2						
H4869	013	0	1	02	01	H4869_013_0	5	2	2	ESRD Dental																00000000001000	End Stage Renal Disease (CKD Stage 5)								1	011		16b4;16b5;16b2;16b1;16b6;16c1;16c2;16c3;16c4;16c8;16c10;	2	2		1	1000.00	3		00100		16b1;16b2;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c8;16c10;
H4869	013	0	1	02	01	H4869_013_0	5	1	3	CKD Package + Transportation										000000000010000000000000000															1	011		13i1;13b;13i10;13i4;13d;	2	1	13i1;13b;13i10;13d;13i4;	2						
H4869	013	0	1	02	01	H4869_013_0	5	3	2	ESRD Support Package																00000000001000	End Stage Renal Disease								1	011		10b1;14c21;	2	2		2						
H4869	014	0	1	02	01	H4869_014_0	6	1	3	CKD Package										000000000010000000000000000															1	011		13i1;13b;13i10;13d;	2	1	13i1;13b;13i10;13d;	2						
H4869	014	0	1	02	01	H4869_014_0	6	2	2	ESRD Dental																00000000001000	End Stage Renal Disease (CKD Stage 5)								1	011		16b4;16b5;16b2;16b1;16b6;16c1;16c2;16c3;16c8;16c10;	2	2		1	1000.00	3		00100		16b1;16b2;16b4;16b5;16b6;16c1;16c2;16c3;16c8;16c10;
H4869	014	0	1	02	01	H4869_014_0	6	3	2	ESRD Support Package																00000000001000	End Stage Renal Disease								1	011		10b1;14c21;	2	2		2						
H4931	007	0	1	01	01	H4931_007_0	7	1	3	Flex Card										011111111111111111111110000															2			13i1;13i10;		2		1	0.00	5		00010		13i1;13i10;
H4931	015	0	1	01	01	H4931_015_0	7	1	3	Flex Card										011111111111111111111110000															2			13i1;13i10;		2		1	0.00	5		00010		13i1;13i10;
H4939	001	0	1	02	01	H4939_001_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H4939	002	0	1	02	01	H4939_002_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H4939	002	0	1	02	01	H4939_002_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4939	003	0	1	02	01	H4939_003_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4939	003	0	1	02	01	H4939_003_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H4961	001	0	1	04	01	H4961_001_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;	1	2		2						
H4961	003	0	1	04	01	H4961_003_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;	1	2		2						
H4961	006	0	1	04	01	H4961_006_0	8	1	3	Package 1										000000000010000000000000000															2			13i3;13i-O1;13i1;13i10;14c8;	1	2		1	100.00	7		00010		13i1;13i10;14c8;
H4982	022	0	1	02	01	H4982_022_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4982	801	0	1	01	01	H4982_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H4982	801	0	1	01	01	H4982_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5008	002	0	1	02	01	H5008_002_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5008	010	0	1	02	01	H5008_010_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5008	011	0	1	02	01	H5008_011_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5008	015	0	1	02	01	H5008_015_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5008	016	0	1	02	01	H5008_016_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5008	017	0	1	02	01	H5008_017_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5008	018	0	1	02	01	H5008_018_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5008	019	0	1	02	01	H5008_019_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5008	020	0	1	02	01	H5008_020_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5009	002	0	1	04	01	H5009_002_0	6	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H5009	011	1	1	04	01	H5009_011_1	6	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H5009	011	2	1	04	01	H5009_011_2	6	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H5009	801	0	1	04	01	H5009_801_0	3	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H5009	802	0	1	04	01	H5009_802_0	3	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H5009	803	0	1	04	01	H5009_803_0	3	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H5009	804	0	1	04	01	H5009_804_0	3	1	2	Routine Podiatry																01000000000000									2			7f_2;	1	2		2						
H5015	001	0	1	01	01	H5015_001_0	5	1	3	Non-Primarily Health Related Benefits										011111110011111110011000000															2			13i6;13i4;		2		2						
H5015	002	0	1	01	01	H5015_002_0	5	1	3	Non-Primarily Health Related Benefits										011111110011111110101000000															2			13i6;13i4;		2		2						
H5050	004	0	1	01	01	H5050_004_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13d;		2		2						
H5050	009	0	1	01	01	H5050_009_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13d;		2		2						
H5050	022	0	1	01	01	H5050_022_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13d;		2		2						
H5050	024	0	1	01	01	H5050_024_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13d;		2		2						
H5050	025	0	1	01	01	H5050_025_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13d;		2		2						
H5050	026	0	1	01	01	H5050_026_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13d;		2		2						
H5050	027	0	1	01	01	H5050_027_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13d;		2		2						
H5050	028	0	1	01	01	H5050_028_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13d;		2		2						
H5050	029	0	1	01	01	H5050_029_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13d;		2		2						
H5050	030	0	1	01	01	H5050_030_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13d;		2		2						
H5050	031	0	1	01	01	H5050_031_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13d;		2		2						
H5050	032	0	1	01	01	H5050_032_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13d;		2		2						
H5119	001	0	1	01	01	H5119_001_0	6	1	3	SSBCI Package 1										000111110000000000000000000															2			13i1;		1	13i1;	2						
H5163	001	0	1	01	01	H5163_001_0	8	1	3	SSBCI										011111111111111111111110000															2			13i1;13i4;13i10;13i-O1;		1	13i1;13i4;	2						
H5163	002	0	1	01	01	H5163_002_0	8	1	3	SSBCI										011111111111111111111110000															2			13i1;13i4;13i10;13i-O1;		1	13i1;13i4;	2						
H5163	003	0	1	01	01	H5163_003_0	8	1	3	SSBCI										011111111111111111111110000															2			13i1;13i10;13i-O1;		1	13i1;	2						
H5163	004	0	1	01	01	H5163_004_0	7	1	3	SSBCI										011111111111111111111110000															2			13i1;13i10;13i-O1;		1	13i1;	2						
H5178	002	0	1	01	01	H5178_002_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H5178	002	0	1	01	01	H5178_002_0	3	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H5209	005	1	1	01	01	H5209_005_1	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5209	005	2	1	01	01	H5209_005_2	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5209	006	1	1	01	01	H5209_006_1	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5209	006	2	1	01	01	H5209_006_2	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5211	001	0	1	02	01	H5211_001_0	9	2	2	Hospital at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13e;	2	2		2						
H5211	001	0	1	02	01	H5211_001_0	9	1	2	Home Delivered Meals																00010000000000									2			13c;	2	1	13c;	2						
H5211	002	0	1	02	01	H5211_002_0	10	1	2	Home Delivered Meals																00010000000000									2			13c;	2	1	13c;	2						
H5211	002	0	1	02	01	H5211_002_0	10	2	2	Hospital at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13e;	2	2		2						
H5211	003	0	1	02	01	H5211_003_0	9	2	2	Hospital at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13e;	2	2		2						
H5211	003	0	1	02	01	H5211_003_0	9	1	2	Home Delivered Meals																00010000000000									2			13c;	2	1	13c;	2						
H5211	004	0	1	02	01	H5211_004_0	11	2	2	Hospital at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13e;	2	2		2						
H5211	004	0	1	02	01	H5211_004_0	11	1	2	Home Delivered Meals																00010000000000									2			13c;	2	1	13c;	2						
H5211	010	0	1	01	01	H5211_010_0	11	1	2	Home Delivered Meals																00010000000000									2			13c;		2		2						
H5211	012	0	1	02	01	H5211_012_0	11	1	2	Home Delivered Meals																00010000000000									2			13c;	2	1	13c;	2						
H5211	012	0	1	02	01	H5211_012_0	11	2	2	Hospital at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			13e;	2	2		2						
H5215	002	0	1	04	01	H5215_002_0	5	1	3	SSBCI - 2026										000100000010000000000000000															1	001		13a;10b1;	1	2		2						
H5215	005	0	1	04	01	H5215_005_0	5	1	3	SSBCI - 2026										000100000010000000000000000															1	001		13a;10b1;	1	2		2						
H5215	007	0	1	04	01	H5215_007_0	5	1	3	SSBCI - 2026										000100000010000000000000000															1	001		13a;10b1;	1	2		2						
H5215	008	0	1	04	01	H5215_008_0	5	1	3	SSBCI - 2026										000100000010000000000000000															1	001		13a;10b1;	1	2		2						
H5215	009	0	1	04	01	H5215_009_0	5	1	3	SSBCI - 2026										000100000010000000000000000															1	001		13a;10b1;	1	2		2						
H5215	010	0	1	04	01	H5215_010_0	5	1	3	SSBCI - 2026										000100000010000000000000000															1	001		13a;10b1;	1	2		2						
H5215	011	0	1	04	01	H5215_011_0	5	1	3	SSBCI - 2026										000100000010000000000000000															1	001		13a;10b1;	1	2		2						
H5215	012	0	1	04	01	H5215_012_0	5	1	3	SSBCI - 2026										000100000010000000000000000															1	001		13a;10b1;	1	2		2						
H5215	013	0	1	04	01	H5215_013_0	4	1	3	SSBCI - 2026										000100000010000000000000000															1	001		13a;10b1;	1	2		2						
H5215	014	0	1	04	01	H5215_014_0	4	1	3	SSBCI - 2026										000100000010000000000000000															1	001		13a;10b1;	1	2		2						
H5216	059	0	1	04	01	H5216_059_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	114	0	1	04	01	H5216_114_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	116	0	1	04	01	H5216_116_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	138	0	1	04	01	H5216_138_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	160	0	1	04	01	H5216_160_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	160	0	1	04	01	H5216_160_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	161	0	1	04	01	H5216_161_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	161	0	1	04	01	H5216_161_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	164	0	1	04	01	H5216_164_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	164	0	1	04	01	H5216_164_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	174	0	1	04	01	H5216_174_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	175	0	1	04	01	H5216_175_0	5	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	179	0	1	04	01	H5216_179_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	179	0	1	04	01	H5216_179_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	180	0	1	04	01	H5216_180_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	180	0	1	04	01	H5216_180_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	201	0	1	04	01	H5216_201_0	1	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	205	0	1	04	01	H5216_205_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	219	0	1	04	01	H5216_219_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	219	0	1	04	01	H5216_219_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	220	0	1	04	01	H5216_220_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	220	0	1	04	01	H5216_220_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	221	0	1	04	01	H5216_221_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	227	0	1	04	01	H5216_227_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	228	0	1	04	01	H5216_228_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	228	0	1	04	01	H5216_228_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	242	0	1	04	01	H5216_242_0	3	1	3	Chronic Care Assistance and Music Therapy										011111110011111111000000000															1	001		10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;17b2;17b3;17b4;18b1;18c;
H5216	243	0	1	04	01	H5216_243_0	2	1	3	Chronic Care Assistance and Music Therapy										011111110011111111000000000															1	001		10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;17b2;17b3;17b4;18b1;18c;
H5216	244	0	1	04	01	H5216_244_0	7	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	246	0	1	04	01	H5216_246_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	249	0	1	04	01	H5216_249_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	257	0	1	04	01	H5216_257_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	257	0	1	04	01	H5216_257_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H5216	267	0	1	04	01	H5216_267_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	267	0	1	04	01	H5216_267_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	268	0	1	04	01	H5216_268_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	268	0	1	04	01	H5216_268_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	277	0	1	04	01	H5216_277_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H5216	287	0	1	04	01	H5216_287_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	289	0	1	04	01	H5216_289_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	291	0	1	04	01	H5216_291_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	291	0	1	04	01	H5216_291_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	292	0	1	04	01	H5216_292_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	292	0	1	04	01	H5216_292_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	296	0	1	04	01	H5216_296_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	296	0	1	04	01	H5216_296_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	298	0	1	04	01	H5216_298_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	298	0	1	04	01	H5216_298_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	302	0	1	04	01	H5216_302_0	6	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	302	0	1	04	01	H5216_302_0	6	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	317	0	1	04	01	H5216_317_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	330	0	1	04	01	H5216_330_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	331	0	1	04	01	H5216_331_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	331	0	1	04	01	H5216_331_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	332	0	1	04	01	H5216_332_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	332	0	1	04	01	H5216_332_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	334	0	1	04	01	H5216_334_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	352	0	1	04	01	H5216_352_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H5216	353	0	1	04	01	H5216_353_0	3	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	353	0	1	04	01	H5216_353_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H5216	361	0	1	04	01	H5216_361_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	361	0	1	04	01	H5216_361_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	362	0	1	04	01	H5216_362_0	2	1	3	Chronic Care Assistance and Music Therapy										011111110011111111000000000															1	001		10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;17b2;17b3;17b4;18b1;18c;
H5216	366	0	1	04	01	H5216_366_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	366	0	1	04	01	H5216_366_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	367	0	1	04	01	H5216_367_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	367	0	1	04	01	H5216_367_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	369	0	1	04	01	H5216_369_0	2	1	3	Chronic Care Assistance and Music Therapy										011111110011111111000000000															1	001		10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;17b2;17b3;17b4;18b1;18c;
H5216	370	0	1	04	01	H5216_370_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	370	0	1	04	01	H5216_370_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	372	0	1	04	01	H5216_372_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	375	0	1	04	01	H5216_375_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	375	0	1	04	01	H5216_375_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	377	0	1	04	01	H5216_377_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	377	0	1	04	01	H5216_377_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	379	0	1	04	01	H5216_379_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	381	0	1	04	01	H5216_381_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	382	0	1	04	01	H5216_382_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	385	0	1	04	01	H5216_385_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	385	0	1	04	01	H5216_385_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	386	1	1	04	01	H5216_386_1	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	386	2	1	04	01	H5216_386_2	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	388	0	1	04	01	H5216_388_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	390	0	1	04	01	H5216_390_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	394	0	1	04	01	H5216_394_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	400	0	1	04	01	H5216_400_0	5	1	3	Chronic Care Assistance and Music Therapy										011111110011111111000000000															1	001		10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;17b2;17b3;17b4;18b1;18c;
H5216	401	0	1	04	01	H5216_401_0	3	1	3	Chronic Care Assistance and Music Therapy										011111110011111111000000000															1	001		10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;17b2;17b3;17b4;18b1;18c;
H5216	402	0	1	04	01	H5216_402_0	3	1	3	Chronic Care Assistance and Music Therapy										011111110011111111000000000															1	001		10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;17b2;17b3;17b4;18b1;18c;
H5216	413	0	1	04	01	H5216_413_0	2	1	3	Chronic Care Assistance and Music Therapy										011111110011111111000000000															1	001		10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;17b2;17b3;17b4;18b1;18c;
H5216	414	0	1	04	01	H5216_414_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	414	0	1	04	01	H5216_414_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	416	0	1	04	01	H5216_416_0	2	1	3	Chronic Care Assistance and Music Therapy										011111110011111111000000000															1	001		10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;17b2;17b3;17b4;18b1;18c;
H5216	420	0	1	04	01	H5216_420_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	420	0	1	04	01	H5216_420_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	424	0	1	04	01	H5216_424_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	425	0	1	04	01	H5216_425_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	432	0	1	04	01	H5216_432_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H5216	437	1	1	04	01	H5216_437_1	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5216	443	0	1	04	01	H5216_443_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	443	0	1	04	01	H5216_443_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	444	0	1	04	01	H5216_444_0	2	1	3	Chronic Care Assistance and Music Therapy										011111110011111111000000000															1	001		10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;17b2;17b3;17b4;18b1;18c;
H5216	446	0	1	04	01	H5216_446_0	2	1	3	Chronic Care Assistance and Music Therapy										011111110011111111000000000															1	001		10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;17b2;17b3;17b4;18b1;18c;
H5216	447	0	1	04	01	H5216_447_0	2	1	3	Chronic Care Assistance and Music Therapy										011111110011111111000000000															1	001		10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;17b2;17b3;17b4;18b1;18c;
H5216	453	0	1	04	01	H5216_453_0	2	1	3	Chronic Care Assistance and Music Therapy										011111110011111111000000000															1	001		10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i8;13i10;13i-O1;14c15;17b2;17b3;17b4;18b1;18c;
H5216	459	0	1	04	01	H5216_459_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	468	0	1	04	01	H5216_468_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	468	0	1	04	01	H5216_468_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	469	0	1	04	01	H5216_469_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	469	0	1	04	01	H5216_469_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	470	0	1	04	01	H5216_470_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5216	470	0	1	04	01	H5216_470_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5244	002	0	1	01	01	H5244_002_0	8	1	3	Food and Non-medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;		2		2						
H5244	004	0	1	01	01	H5244_004_0	8	1	3	Food, Utilities and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;13i10;		1	13i1;13i4;13i10;	2						
H5253	024	0	1	02	01	H5253_024_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5253	041	0	1	02	01	H5253_041_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5253	059	0	1	01	01	H5253_059_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5253	064	0	1	02	01	H5253_064_0	6	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	116	0	1	02	01	H5253_116_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5253	122	0	1	01	01	H5253_122_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5253	155	0	1	02	01	H5253_155_0	7	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	161	0	1	02	01	H5253_161_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	166	0	1	02	01	H5253_166_0	6	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	168	0	1	02	01	H5253_168_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	175	0	1	02	01	H5253_175_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	176	0	1	02	01	H5253_176_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	179	0	1	02	01	H5253_179_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	180	0	1	02	01	H5253_180_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	182	0	1	02	01	H5253_182_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	183	0	1	02	01	H5253_183_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	184	0	1	02	01	H5253_184_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5253	186	0	1	02	01	H5253_186_0	11	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	188	0	1	02	01	H5253_188_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	189	0	1	02	01	H5253_189_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	190	0	1	02	01	H5253_190_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	192	0	1	02	01	H5253_192_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	193	1	1	02	01	H5253_193_1	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	193	2	1	02	01	H5253_193_2	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	194	1	1	02	01	H5253_194_1	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	194	2	1	02	01	H5253_194_2	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	195	0	1	02	01	H5253_195_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	196	0	1	02	01	H5253_196_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	197	0	1	02	01	H5253_197_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	200	0	1	02	01	H5253_200_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5253	202	0	1	02	01	H5253_202_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5262	001	0	1	01	01	H5262_001_0	4	2	2	Package 2 Hospital at Home																10110000001111	Pneumonia	Urinary Tract Infection (UTI)	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2		2			13d;		2		2						
H5262	001	0	1	01	01	H5262_001_0	4	1	3	Package 1										000001011000000000000001000	Chronic Hypertension														1	001		13b;13i1;13i2;		2		2						
H5262	003	0	1	01	01	H5262_003_0	4	1	3	Package 1										000001011000000000000001000	Chronic Hypertension														1	001		13b;13i1;13i2;		2		2						
H5262	003	0	1	01	01	H5262_003_0	4	2	2	Package 2 Hospital at Home																10110000001111	Pneumonia	Urinary Tract Infection (UTI)	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2		2			13d;		2		2						
H5262	004	0	1	01	01	H5262_004_0	3	1	3	Package 1										000001011000000000000001000	Chronic Hypertension														1	001		13b;13i1;13i2;		2		2						
H5262	004	0	1	01	01	H5262_004_0	3	2	2	Package 2 Hospital at Home																10110000001111	Pneumonia	Urinary Tract Infection (UTI)	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2		2			13d;		2		2						
H5262	005	0	1	01	01	H5262_005_0	3	1	3	Package 1										000001011000000000000001000	Chronic Hypertension														1	001		13b;13i1;13i2;		2		2						
H5262	005	0	1	01	01	H5262_005_0	3	2	2	Package 2 Hospital at Home																10110000001111	Pneumonia	Urinary Tract Infection (UTI)	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2		2			13d;		2		2						
H5262	007	0	1	01	01	H5262_007_0	4	1	3	Package 1										000001011000000000000001000	Chronic Hypertension														1	001		13b;13i1;13i2;		2		2						
H5262	008	0	1	01	01	H5262_008_0	4	1	3	Package 1										000001011000000000000001000	Chronic Hypertension														1	001		13b;13i1;13i2;		2		2						
H5262	009	0	1	01	01	H5262_009_0	3	1	3	Package 1										000001011000000000000001000	Chronic Hypertension														1	001		13b;13i1;13i2;		2		2						
H5262	010	0	1	01	01	H5262_010_0	3	1	3	Package 1										000001011000000000000001000	Chronic Hypertension														1	001		13b;13i1;13i2;		2		2						
H5262	021	0	1	01	01	H5262_021_0	4	1	3	Package 1										000001011000000000000001000	Chronic Hypertension														1	001		13b;13i1;13i2;		2		2						
H5262	021	0	1	01	01	H5262_021_0	4	2	2	Package 2 Hospital at Home																10110000001111	Pneumonia	Urinary Tract Infection (UTI)	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2		2			13d;		2		2						
H5262	023	0	1	01	01	H5262_023_0	4	1	3	Package 1										000001011000000000000001000	Chronic Hypertension														1	001		13b;13i1;13i2;		2		2						
H5262	029	0	1	01	01	H5262_029_0	5	1	3	Package 1										010001011000011000001001000	Chronic Hypertension														1	001		13b;13i1;13i2;13i10;		2		1	80.00	5		00010		13i1;13i10;
H5262	030	0	1	01	01	H5262_030_0	5	1	3	Package 1										010001011000011000001001000	Chronic Hypertension														1	001		13b;13i1;13i2;13i10;		2		1	95.00	5		00010		13i1;13i10;
H5262	032	0	1	01	01	H5262_032_0	4	2	2	Package 2 Hospital at Home																10110000001111	Pneumonia	Urinary Tract Infection (UTI)	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2		2			13d;		2		2						
H5262	032	0	1	01	01	H5262_032_0	4	1	3	Package 1										000001011000000000000001000	Chronic Hypertension														1	001		13b;13i1;13i2;		2		2						
H5262	033	0	1	01	01	H5262_033_0	4	1	3	Package 1										000001011000000000000001000	Chronic Hypertension														1	001		13b;13i1;13i2;		2		2						
H5272	001	0	1	01	01	H5272_001_0	7	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H5294	010	0	1	01	01	H5294_010_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H5294	015	0	1	01	01	H5294_015_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H5294	021	0	1	01	01	H5294_021_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H5294	022	0	1	01	01	H5294_022_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H5294	023	0	1	01	01	H5294_023_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H5294	024	0	1	01	01	H5294_024_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H5294	025	0	1	01	01	H5294_025_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H5296	003	0	1	01	01	H5296_003_0	9	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;		2		2						
H5296	004	0	1	02	01	H5296_004_0	6	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;13i1;14c8;	2	2		1	0.00	7		00010		13i1;13i10;14c8;
H5296	006	0	1	01	01	H5296_006_0	10	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;		2		2						
H5296	007	0	1	01	01	H5296_007_0	9	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i1;13i10;		2		2						
H5296	008	0	1	01	01	H5296_008_0	8	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;		2		2						
H5296	009	0	1	02	01	H5296_009_0	6	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;13i1;14c8;	2	2		1	0.00	7		00010		13i1;13i10;14c8;
H5296	010	0	1	01	01	H5296_010_0	8	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;		2		2						
H5296	011	0	1	01	01	H5296_011_0	6	1	3	Package 1										011111111111111111111110000															2			13i1;13i10;13i3;13i-O1;13i5;14c8;		2		1	60.00	7		00010		13i1;13i10;14c8;
H5299	001	0	1	01	01	H5299_001_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	54.00	7		00010		13i1;13i10;
H5299	006	0	1	01	01	H5299_006_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	361.00	7		00010		13i1;13i10;
H5299	009	0	1	01	01	H5299_009_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	185.00	7		00010		13i1;13i10;
H5299	013	0	1	01	01	H5299_013_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	442.00	7		00010		13i1;13i10;
H5299	014	0	1	01	01	H5299_014_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H5299	015	0	1	01	01	H5299_015_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	468.00	7		00010		13i1;13i10;
H5299	016	0	1	01	01	H5299_016_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H5299	017	0	1	01	01	H5299_017_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H5299	018	0	1	01	01	H5299_018_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H5302	012	0	1	01	01	H5302_012_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5302	020	0	1	01	01	H5302_020_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5302	022	0	1	01	01	H5302_022_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5302	024	0	1	01	01	H5302_024_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5302	026	0	1	01	01	H5302_026_0	2	1	3	SSBCI Pkg										000011010000000000000000000															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5302	809	0	1	01	01	H5302_809_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H5302	809	0	1	01	01	H5302_809_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5322	025	0	1	02	01	H5322_025_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5322	026	0	1	02	01	H5322_026_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5322	028	0	1	02	01	H5322_028_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5322	029	0	1	02	01	H5322_029_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5322	031	0	1	02	01	H5322_031_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5322	033	0	1	02	01	H5322_033_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5322	034	0	1	02	01	H5322_034_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5322	038	0	1	02	01	H5322_038_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5322	046	0	1	02	01	H5322_046_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5322	049	1	1	02	01	H5322_049_1	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5322	049	2	1	02	01	H5322_049_2	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5322	050	1	1	02	01	H5322_050_1	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5322	050	2	1	02	01	H5322_050_2	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5325	003	0	1	01	01	H5325_003_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5325	004	0	1	01	01	H5325_004_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5325	005	0	1	01	01	H5325_005_0	2	2	2	In-Home Support-Personal Care Services																00000000001000	Individuals with significant functional challenges from neuro, musculoskeletal & sensory impairments								1	001		14c21;		1	14c21;	2						
H5325	005	0	1	01	01	H5325_005_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5325	006	0	1	01	01	H5325_006_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5325	006	0	1	01	01	H5325_006_0	2	2	2	In-Home Support-Personal Care Services																00000000001000	Individuals with significant functional challenges from neuro, musculoskeletal & sensory impairments								1	001		14c21;		1	14c21;	2						
H5325	007	0	1	01	01	H5325_007_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5325	011	0	1	01	01	H5325_011_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5325	012	0	1	01	01	H5325_012_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5325	013	0	1	01	01	H5325_013_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5325	014	0	1	01	01	H5325_014_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5325	014	0	1	01	01	H5325_014_0	2	2	2	In-Home Support-Personal Care Services																00000000001000	Individuals with significant functional challenges from neuro, musculoskeletal & sensory impairments								1	001		14c21;		1	14c21;	2						
H5325	015	0	1	01	01	H5325_015_0	2	2	2	In-Home Support-Personal Care Services																00000000001000	Individuals with significant functional challenges from neuro, musculoskeletal & sensory impairments								1	001		14c21;		1	14c21;	2						
H5325	015	0	1	01	01	H5325_015_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5374	001	0	1	01	01	H5374_001_0	4	1	3	SSBCI										011111111111111111111110000															2			13i6;14c17;13i4;13i-O1;10b1;13i-O2;		2		1	200.00	3		01000		13i6;13i-O1;13i-O2;
H5377	003	0	1	01	01	H5377_003_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H5377	003	0	1	01	01	H5377_003_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5397	003	0	1	01	01	H5397_003_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	250.00	7		00010		13i1;13i10;
H5397	004	0	1	01	01	H5397_004_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	40.00	7		00010		13i1;13i10;
H5397	005	0	1	01	01	H5397_005_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	40.00	7		00010		13i1;13i10;
H5420	006	0	1	01	01	H5420_006_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5420	014	0	1	01	01	H5420_014_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;		1	13i1;	1	0.00	7		00010		13i1;
H5420	015	0	1	01	01	H5420_015_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5420	016	0	1	02	01	H5420_016_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H5422	015	0	1	02	01	H5422_015_0	4	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;	2	2		2						
H5422	018	0	1	01	01	H5422_018_0	4	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5422	019	0	1	01	01	H5422_019_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5425	034	0	1	01	01	H5425_034_0	7	1	3	Food and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;		2		2						
H5425	070	0	1	01	01	H5425_070_0	8	1	3	Food and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;		2		2						
H5425	076	0	1	01	01	H5425_076_0	8	1	3	Food and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;		2		2						
H5425	086	0	1	01	01	H5425_086_0	8	1	3	Non-Medical Transportation/Groceries										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;		2		2						
H5425	087	0	1	01	01	H5425_087_0	9	1	3	Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;		2		2						
H5425	091	0	1	02	01	H5425_091_0	7	1	3	Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;	2	2		2						
H5425	092	0	1	01	01	H5425_092_0	7	1	3	Legal Reimbursement										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i8;		2		1	200.00	3		00001		13i8;
H5425	096	0	1	01	01	H5425_096_0	7	1	3	Legal Reimbursement										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i8;		2		1	200.00	3		00001		13i8;
H5425	097	0	1	01	01	H5425_097_0	8	1	3	Food, Utilities and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;13i10;		1	13i1;13i4;13i10;	2						
H5425	098	0	1	01	01	H5425_098_0	9	1	3	Food, Utilities and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;13i10;		2		2						
H5425	102	0	1	01	01	H5425_102_0	8	1	3	Food and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;		2		2						
H5425	104	0	1	01	01	H5425_104_0	8	1	3	Food and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;		2		2						
H5425	105	0	1	01	01	H5425_105_0	8	1	3	Food and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;		2		2						
H5425	106	0	1	01	01	H5425_106_0	8	1	3	Food and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;		2		2						
H5425	107	0	1	01	01	H5425_107_0	7	1	3	Legal Reimbursement										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i8;		2		1	200.00	3		00001		13i8;
H5425	118	0	1	01	01	H5425_118_0	8	1	3	Food										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i1;		2		2						
H5425	123	0	1	01	01	H5425_123_0	7	1	3	Food										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i1;		2		2						
H5425	129	0	1	01	01	H5425_129_0	8	1	3	Food and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;		2		2						
H5425	131	0	1	01	01	H5425_131_0	8	1	3	Food and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;		1	13i1;13i4;	2						
H5425	132	0	1	02	01	H5425_132_0	6	1	3	Food and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i4;13i1;	2	2		2						
H5427	070	0	1	01	01	H5427_070_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5427	072	0	1	01	01	H5427_072_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5427	077	0	1	01	01	H5427_077_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5427	078	0	1	01	01	H5427_078_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5427	087	0	1	01	01	H5427_087_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5427	099	0	1	01	01	H5427_099_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5427	108	0	1	01	01	H5427_108_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5431	016	0	1	01	01	H5431_016_0	6	1	3	Meals and Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i-O1;13i2;13i1;13i10;		2		2						
H5431	019	0	1	01	01	H5431_019_0	6	1	3	Meals and Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i-O1;13i2;13i1;13i10;		2		2						
H5431	021	0	1	01	01	H5431_021_0	5	1	3	Meals and Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;13i-O1;13i2;		2		2						
H5431	022	0	1	01	01	H5431_022_0	5	1	3	Meals and Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;13i-O1;13i2;		2		2						
H5431	025	0	1	01	01	H5431_025_0	6	1	3	Meals and Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i-O1;13i2;13i1;13i10;		2		2						
H5431	026	0	1	01	01	H5431_026_0	6	1	3	Meals and Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i-O1;13i2;13i1;13i10;		2		2						
H5433	001	0	1	01	01	H5433_001_0	4	1	3	SSBCI - Food Card										011111111111111111111110000															2			13i1;		2		1	0.00	5		00010		13i1;
H5447	002	0	1	01	01	H5447_002_0	6	1	3	SSBCI Flex Card										011111111111111111111110000															2			13i1;13i10;		1	13i1;13i10;	1	110.00	5		00010		13i1;13i10;
H5453	001	0	1	04	01	H5453_001_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	92.00	7		00010		13i1;13i10;
H5453	004	0	1	04	01	H5453_004_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	57.00	7		00010		13i1;13i10;
H5453	010	0	1	04	01	H5453_010_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	52.00	7		00010		13i1;13i10;
H5453	015	0	1	04	01	H5453_015_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	150.00	7		00010		13i1;13i10;
H5453	016	0	1	04	01	H5453_016_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	343.00	7		00010		13i1;13i10;
H5453	017	0	1	04	01	H5453_017_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H5453	018	0	1	04	01	H5453_018_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H5454	001	0	1	01	01	H5454_001_0	9	1	3	Food										000001010010010000000000000															2			13i1;		2		1	70.00	5		01010		13i1;
H5454	002	0	1	01	01	H5454_002_0	9	1	3	Food										000001010010010000000000000															2			13i1;		2		1	40.00	5		01010		13i1;
H5454	005	0	1	01	01	H5454_005_0	7	1	3	Food										000011010000000000000000000															2			13i1;		2		1	50.00	7		01010		13i1;
H5454	006	0	1	01	01	H5454_006_0	8	1	3	Food										000011010000000000000000000															2			13i1;		2		1	60.00	7		01010		13i1;
H5471	064	0	1	01	01	H5471_064_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	066	0	1	01	01	H5471_066_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	069	0	1	01	01	H5471_069_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	070	0	1	01	01	H5471_070_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	072	0	1	01	01	H5471_072_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	075	0	1	01	01	H5471_075_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	076	0	1	01	01	H5471_076_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	080	0	1	01	01	H5471_080_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	082	0	1	01	01	H5471_082_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	084	0	1	01	01	H5471_084_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	111	0	1	01	01	H5471_111_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	115	0	1	01	01	H5471_115_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	116	0	1	01	01	H5471_116_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	118	0	1	01	01	H5471_118_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	119	0	1	01	01	H5471_119_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	121	0	1	01	01	H5471_121_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	122	0	1	01	01	H5471_122_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	125	0	1	01	01	H5471_125_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	126	0	1	01	01	H5471_126_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	127	0	1	01	01	H5471_127_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	128	0	1	01	01	H5471_128_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	129	0	1	01	01	H5471_129_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	130	0	1	01	01	H5471_130_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	131	0	1	01	01	H5471_131_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	132	0	1	01	01	H5471_132_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	133	0	1	01	01	H5471_133_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	134	0	1	01	01	H5471_134_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	135	0	1	01	01	H5471_135_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	136	0	1	01	01	H5471_136_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	137	0	1	01	01	H5471_137_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	138	0	1	01	01	H5471_138_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	139	0	1	01	01	H5471_139_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	140	0	1	01	01	H5471_140_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	141	0	1	01	01	H5471_141_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	142	0	1	01	01	H5471_142_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5471	143	0	1	01	01	H5471_143_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5472	001	0	1	02	01	H5472_001_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;13i1;14c8;	2	2		1	30.00	7		00010		13i1;13i10;14c8;
H5472	002	0	1	02	01	H5472_002_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;13i1;14c8;	2	2		1	40.00	7		00010		13i1;13i10;14c8;
H5472	003	0	1	02	01	H5472_003_0	10	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;	2	2		2						
H5472	004	0	1	02	01	H5472_004_0	6	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i1;13i10;14c8;	2	2		1	0.00	7		00010		13i1;13i10;14c8;
H5472	007	0	1	02	01	H5472_007_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i1;13i10;14c8;	2	2		1	100.00	7		00010		13i1;13i10;14c8;
H5472	009	0	1	02	01	H5472_009_0	6	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i1;13i10;14c8;	2	2		1	0.00	7		00010		13i1;13i10;14c8;
H5472	010	0	1	02	01	H5472_010_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;	2	2		2						
H5475	001	0	1	02	01	H5475_001_0	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H5475	039	0	1	02	01	H5475_039_0	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H5496	005	0	1	01	01	H5496_005_0	5	1	3	Grocery Card										011111111111111111111110000															2			13i1;		1	13i1;	1	20.00	5		00010		13i1;
H5496	012	0	1	01	01	H5496_012_0	5	1	3	Grocery Card										011111111111111111111110000															2			13i1;		1	13i1;	1	45.00	5		00010		13i1;
H5521	084	0	1	04	01	H5521_084_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	100.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	116	0	1	04	01	H5521_116_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	45.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	171	0	1	04	01	H5521_171_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	45.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	218	0	1	04	01	H5521_218_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	224	0	1	04	01	H5521_224_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	227	0	1	04	01	H5521_227_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	25.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	229	0	1	04	01	H5521_229_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	180.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	233	0	1	04	01	H5521_233_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	25.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	235	0	1	04	01	H5521_235_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	195.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	302	0	1	04	01	H5521_302_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	324	0	1	04	01	H5521_324_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	120.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	326	0	1	04	01	H5521_326_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	364	0	1	04	01	H5521_364_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	365	0	1	04	01	H5521_365_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	398	0	1	04	01	H5521_398_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	399	0	1	04	01	H5521_399_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	400	0	1	04	01	H5521_400_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	414	0	1	04	01	H5521_414_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	443	0	1	04	01	H5521_443_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	449	0	1	04	01	H5521_449_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	45.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	461	0	1	04	01	H5521_461_0	5	1	3	SSBCI Pkg										010001100010011100000000000															1	001		13i6;	1	1	13i6;	2						
H5521	464	0	1	04	01	H5521_464_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	465	0	1	04	01	H5521_465_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	467	0	1	04	01	H5521_467_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	470	0	1	04	01	H5521_470_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	65.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	472	0	1	04	01	H5521_472_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	490	0	1	04	01	H5521_490_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	52.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	496	0	1	04	01	H5521_496_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	500	0	1	04	01	H5521_500_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	45.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	502	0	1	04	01	H5521_502_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	506	0	1	04	01	H5521_506_0	5	1	3	SSBCI Pkg										010001100010011100000000000															1	001		13i6;	1	1	13i6;	2						
H5521	553	0	1	04	01	H5521_553_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	598	0	1	04	01	H5521_598_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	644	0	1	04	01	H5521_644_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	25.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	645	0	1	04	01	H5521_645_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	646	0	1	04	01	H5521_646_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	90.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	649	0	1	04	01	H5521_649_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	801	0	1	04	01	H5521_801_0	2	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H5521	801	0	1	04	01	H5521_801_0	2	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5521	805	0	2	04	01	H5521_805_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H5521	805	0	2	04	01	H5521_805_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	001	0	1	04	01	H5522_001_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5522	002	0	1	04	01	H5522_002_0	2	1	2	Hypertension & Hyperlipidemia																00000100001000	Hyperlipidemia					2	2		2			10b1;13b;	1	1	10b1;13b;	2						
H5522	005	0	1	04	01	H5522_005_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5522	013	0	1	04	01	H5522_013_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	105.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5522	802	0	1	04	01	H5522_802_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	802	0	1	04	01	H5522_802_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H5522	803	0	1	04	01	H5522_803_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	803	0	1	04	01	H5522_803_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	808	0	2	04	01	H5522_808_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H5522	808	0	2	04	01	H5522_808_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	809	0	2	04	01	H5522_809_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	809	0	2	04	01	H5522_809_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	810	0	1	04	01	H5522_810_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	810	0	1	04	01	H5522_810_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H5522	811	0	1	04	01	H5522_811_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	811	0	1	04	01	H5522_811_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	813	0	2	04	01	H5522_813_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H5522	813	0	2	04	01	H5522_813_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	814	0	2	04	01	H5522_814_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	814	0	2	04	01	H5522_814_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	815	0	1	04	01	H5522_815_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	815	0	1	04	01	H5522_815_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H5522	816	0	1	04	01	H5522_816_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	816	0	1	04	01	H5522_816_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	817	0	2	04	01	H5522_817_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	817	0	2	04	01	H5522_817_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H5522	818	0	2	04	01	H5522_818_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	818	0	2	04	01	H5522_818_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	819	0	1	04	01	H5522_819_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	819	0	1	04	01	H5522_819_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	820	0	1	04	01	H5522_820_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H5522	820	0	1	04	01	H5522_820_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	821	0	1	04	01	H5522_821_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	821	0	1	04	01	H5522_821_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	822	0	2	04	01	H5522_822_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	822	0	2	04	01	H5522_822_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	823	0	1	04	01	H5522_823_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	823	0	1	04	01	H5522_823_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H5522	824	0	2	04	01	H5522_824_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	824	0	2	04	01	H5522_824_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	825	0	2	04	01	H5522_825_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H5522	825	0	2	04	01	H5522_825_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	827	0	2	04	01	H5522_827_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H5522	827	0	2	04	01	H5522_827_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	828	0	1	04	01	H5522_828_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	828	0	1	04	01	H5522_828_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	832	0	1	04	01	H5522_832_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	832	0	1	04	01	H5522_832_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	836	0	1	04	01	H5522_836_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	836	0	1	04	01	H5522_836_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	837	0	1	04	01	H5522_837_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H5522	837	0	1	04	01	H5522_837_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5522	838	0	2	04	01	H5522_838_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H5522	838	0	2	04	01	H5522_838_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H5525	036	0	1	04	01	H5525_036_0	4	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H5525	046	0	1	04	01	H5525_046_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5525	046	0	1	04	01	H5525_046_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5525	059	0	1	04	01	H5525_059_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5525	072	0	1	04	01	H5525_072_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5525	086	1	1	04	01	H5525_086_1	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5525	086	2	1	04	01	H5525_086_2	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5533	003	0	1	04	01	H5533_003_0	15	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;	1	1	13c;	2						
H5533	005	0	1	04	01	H5533_005_0	15	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;	1	1	13c;	2						
H5533	008	0	1	04	01	H5533_008_0	16	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;	1	1	13c;	2						
H5533	011	0	1	04	01	H5533_011_0	17	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes																01110000000000						1			2			13c;	1	1	13c;	2						
H5533	013	0	1	04	01	H5533_013_0	18	1	2	MA Uniformity Flexibility- CHF/COPD/Diabetes																01110000000000						1			2			13c;	1	1	13c;	2						
H5533	015	1	1	04	01	H5533_015_1	17	1	2	MA Uniformity Flexibility- CHF/COPD/Diabetes																01110000000000						1			2			13c;	1	1	13c;	2						
H5533	015	2	1	04	01	H5533_015_2	17	1	2	MA Uniformity Flexibility- CHF/COPD/Diabetes																01110000000000						1			2			13c;	1	1	13c;	2						
H5533	015	3	1	04	01	H5533_015_3	17	1	2	MA Uniformity Flexibility- CHF/COPD/Diabetes																01110000000000						1			2			13c;	1	1	13c;	2						
H5533	015	4	1	04	01	H5533_015_4	15	1	2	MA Uniformity Flexibility- CHF/COPD/Diabetes																01110000000000						1			2			13c;	1	1	13c;	2						
H5533	015	6	1	04	01	H5533_015_6	16	1	2	MA Uniformity Flexibility- CHF/COPD/Diabetes																01110000000000						1			2			13c;	1	1	13c;	2						
H5533	016	1	1	04	01	H5533_016_1	14	1	2	MA Uniformity Flexibility-CHF/COPD/Diabetes																01110000000000						1			2			13c;	1	1	13c;	2						
H5533	016	2	1	04	01	H5533_016_2	13	1	2	MA Uniformity Flexibility- CHF/COPD/Diabetes																01110000000000						1			2			13c;	1	1	13c;	2						
H5533	017	1	1	04	01	H5533_017_1	15	1	2	MA Uniformity Flexibility/CHF/COPD/Diabetes																00110000000000						1			2			13c;	1	1	13c;	2						
H5533	017	2	1	04	01	H5533_017_2	15	1	2	MA Uniformity Flexibility/CHF/COPD/Diabetes																01110000000000						1			2			13c;	1	1	13c;	2						
H5549	003	0	1	01	01	H5549_003_0	5	1	3	Combined OTC, Food & Produce Card and FLEX Card										011111111111111111111110000															2			13i1;13i10;		2		1	0.00	7		01011		13i1;13i10;
H5549	011	0	1	01	01	H5549_011_0	5	1	3	Combined OTC, Food & Produce and FLEX Card										011111111111111111111110000															2			13i1;13i10;		2		2						
H5577	002	0	1	01	01	H5577_002_0	10	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i10;13i1;13i3;13i4;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	005	0	1	01	01	H5577_005_0	8	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i1;13i3;13i4;13i10;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	008	0	1	02	01	H5577_008_0	8	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i10;13i1;13i3;13i4;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;	2	2		2						
H5577	016	0	1	01	01	H5577_016_0	7	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i1;13i3;13i4;13i5;13i6;13i7;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	017	0	1	01	01	H5577_017_0	8	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i10;13i1;13i3;13i4;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	038	0	1	01	01	H5577_038_0	8	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i1;13i3;13i4;13i10;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	042	0	1	01	01	H5577_042_0	8	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i1;13i3;13i4;13i10;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	043	0	1	01	01	H5577_043_0	8	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i1;13i3;13i4;13i10;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	044	0	1	01	01	H5577_044_0	10	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i3;13i4;13i10;13i-O4;		2		2						
H5577	046	0	1	01	01	H5577_046_0	9	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i10;13i1;13i3;13i4;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	052	0	1	01	01	H5577_052_0	8	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i1;13i3;13i4;13i10;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	054	1	1	01	01	H5577_054_1	10	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i10;13i1;13i3;13i4;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	054	2	1	01	01	H5577_054_2	10	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i10;13i1;13i3;13i4;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	054	3	1	01	01	H5577_054_3	9	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i10;13i1;13i3;13i4;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	056	1	1	01	01	H5577_056_1	10	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i1;13i3;13i4;13i10;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	056	2	1	01	01	H5577_056_2	10	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i1;13i3;13i4;13i10;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	056	4	1	01	01	H5577_056_4	10	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i1;13i3;13i4;13i10;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	059	0	1	01	01	H5577_059_0	8	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i1;13i3;13i4;13i10;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	060	0	1	01	01	H5577_060_0	9	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i1;13i3;13i4;13i10;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	061	0	1	01	01	H5577_061_0	9	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i10;13i1;13i3;13i4;13i5;13i6;13i7;13i8;13i-O2;13i-O3;13i-O4;14c4;		2		2						
H5577	062	0	1	01	01	H5577_062_0	10	1	3	Package 1										111111111111111111111111111	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer										2			13i1;13i3;13i4;13i10;13i-O1;		2		2						
H5580	004	0	1	01	01	H5580_004_0	5	1	3	OTC + Food & Produce card										000011110110100000000000000															2			13b;13i1;		1	13b;13i1;	1	40.00	7		00010		13b;13i1;
H5587	002	0	1	01	01	H5587_002_0	14	1	3	Healthy Food and Produce										010011011100011000000110000															2			13i1;		1	13i1;	1	225.00	5		00010		13i1;
H5590	008	0	1	01	01	H5590_008_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H5590	010	0	1	01	01	H5590_010_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H5591	003	0	1	01	01	H5591_003_0	3	1	3	Meals										000001000010000000000000000															2			13i2;		2		2						
H5591	006	1	1	02	01	H5591_006_1	5	2	2	Bathroom Safety																00000000001100	History of Falls	Hip Fracture				2	2		2			14c8;	1	2		1	200.00	3		00001		14c8;
H5591	006	1	1	02	01	H5591_006_1	5	1	3	Meals										000001000010000000000000000															2			13i2;	2	2		2						
H5591	006	2	1	02	01	H5591_006_2	5	1	3	Meals										000001000010000000000000000															2			13i2;	2	2		2						
H5591	006	2	1	02	01	H5591_006_2	5	2	2	Bathroom Safety																00000000001100	History of Falls	Hip Fracture				2	2		2			14c8;	1	2		1	200.00	3		00001		14c8;
H5591	016	0	1	02	01	H5591_016_0	5	2	2	Bathroom Safety																00000000001100	History of Falls	Hip Fracture				2	2		2			14c8;	1	2		1	200.00	3		00001		14c8;
H5591	016	0	1	02	01	H5591_016_0	5	1	3	Meals										000001000010000000000000000															2			13i2;	2	2		2						
H5591	017	0	1	02	01	H5591_017_0	5	1	3	Meals										000001000010000000000000000															2			13i2;	2	2		2						
H5591	017	0	1	02	01	H5591_017_0	5	2	2	Bathroom Safety																00000000001100	History of Falls	Hip Fracture				2	2		2			14c8;	1	2		1	250.00	3		00001		14c8;
H5591	018	0	1	02	01	H5591_018_0	5	2	2	Bathroom Safety																00000000001100	History of Falls	Hip Fracture				2	2		2			14c8;	2	2		1	200.00	3		00001		14c8;
H5591	018	0	1	02	01	H5591_018_0	5	1	3	Meals										000001000010000000000000000															2			13i2;	2	2		2						
H5593	001	0	1	01	01	H5593_001_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5593	801	0	1	01	01	H5593_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H5593	801	0	1	01	01	H5593_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5594	016	0	1	01	01	H5594_016_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5594	017	0	1	01	01	H5594_017_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5594	028	0	1	01	01	H5594_028_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5594	029	0	1	01	01	H5594_029_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5594	036	0	1	01	01	H5594_036_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5599	003	0	1	01	01	H5599_003_0	9	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H5599	013	1	1	01	01	H5599_013_1	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H5599	013	2	1	01	01	H5599_013_2	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H5608	001	0	1	01	01	H5608_001_0	7	1	3	SSBCI Grocery Card and Phone Benefit										011111111111111111111110000															2			13i1;13i10;		1	13i1;13i10;	2						
H5619	003	0	1	01	01	H5619_003_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H5619	003	0	1	01	01	H5619_003_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	021	0	1	01	01	H5619_021_0	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H5619	038	0	1	01	01	H5619_038_0	6	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	049	0	1	02	01	H5619_049_0	4	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5619	053	0	1	02	01	H5619_053_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5619	055	0	1	01	01	H5619_055_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	071	0	1	01	01	H5619_071_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H5619	075	0	1	01	01	H5619_075_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H5619	075	0	1	01	01	H5619_075_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	093	0	1	01	01	H5619_093_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	093	0	1	01	01	H5619_093_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H5619	095	0	1	01	01	H5619_095_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H5619	113	0	1	02	01	H5619_113_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5619	123	0	1	02	01	H5619_123_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5619	123	0	1	02	01	H5619_123_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	126	0	1	02	01	H5619_126_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	145	0	1	01	01	H5619_145_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	161	0	1	01	01	H5619_161_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	162	0	1	02	01	H5619_162_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	162	0	1	02	01	H5619_162_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5619	163	0	1	01	01	H5619_163_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H5619	163	0	1	01	01	H5619_163_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	165	0	1	01	01	H5619_165_0	6	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H5619	165	0	1	01	01	H5619_165_0	6	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	166	0	1	01	01	H5619_166_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H5619	166	0	1	01	01	H5619_166_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	167	0	1	01	01	H5619_167_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H5619	167	0	1	01	01	H5619_167_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	173	0	1	01	01	H5619_173_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H5619	179	0	1	02	01	H5619_179_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	179	0	1	02	01	H5619_179_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H5619	180	0	1	01	01	H5619_180_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H5619	181	0	1	01	01	H5619_181_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	181	0	1	01	01	H5619_181_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H5619	182	0	1	01	01	H5619_182_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	182	0	1	01	01	H5619_182_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H5628	001	0	1	01	01	H5628_001_0	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5628	012	0	1	01	01	H5628_012_0	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5628	013	1	1	01	01	H5628_013_1	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5628	013	1	1	01	01	H5628_013_1	9	2	2	MA Uniformity Flexibility																01000000000000									1	001		13c;		2		2						
H5628	013	2	1	01	01	H5628_013_2	9	2	2	MA Uniformity Flexibility																01000000000000									1	001		13c;		2		2						
H5628	013	2	1	01	01	H5628_013_2	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5628	014	1	1	01	01	H5628_014_1	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5628	014	2	1	01	01	H5628_014_2	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5649	001	0	1	01	01	H5649_001_0	8	1	3	CHP SSBCI										011111111111111111111110000															1	001		13i4;13i1;		2		2						
H5649	009	0	1	01	01	H5649_009_0	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i4;		2		2						
H5649	022	0	1	01	01	H5649_022_0	8	1	3	CHP SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5649	024	0	1	01	01	H5649_024_0	9	1	3	BND SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5649	025	1	1	01	01	H5649_025_1	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5649	025	2	1	01	01	H5649_025_2	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5649	025	3	1	01	01	H5649_025_3	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5649	025	4	1	01	01	H5649_025_4	10	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5649	026	1	1	01	01	H5649_026_1	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5649	026	2	1	01	01	H5649_026_2	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5649	026	3	1	01	01	H5649_026_3	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5649	026	4	1	01	01	H5649_026_4	10	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5649	027	0	1	01	01	H5649_027_0	10	1	3	BND SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5649	028	0	1	01	01	H5649_028_0	10	1	3	BND SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5652	004	0	1	02	01	H5652_004_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	2	1	13i1;	1	0.00	7		00010		13i1;
H5718	004	0	1	04	01	H5718_004_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	287.00	7		00010		13i1;13i10;
H5718	005	0	1	04	01	H5718_005_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H5718	006	0	1	04	01	H5718_006_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H5774	028	0	1	01	01	H5774_028_0	5	1	2	Package 1																00000000001110	Oncology patients undergoing active chemo by infusion or systemic radiotherapy	Post-inpatient stay for acute stroke with the transition of care to patients home	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries			2	2		2			14c21;		2		2						
H5774	035	0	1	01	01	H5774_035_0	5	1	3	Package 1										011111110111111110000000000															2			13i1;13i3;13i4;13i10;		2		1	80.00	7		00010		13i1;13i3;13i4;13i10;
H5774	041	1	1	01	01	H5774_041_1	5	1	2	Package 1																00000000001110	Oncology patients undergoing active chemo by infusion or systemic radiotherapy.	Post-inpatient stay for acute stroke with the transition of care to patients home.	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries.			2	2		2			14c21;		2		2						
H5774	041	1	1	01	01	H5774_041_1	5	2	3	Package 2										011111110111111110000000000															2			13i1;13i4;13i10;13i3;		2		1	265.00	7		00010		13i1;13i3;13i4;13i10;
H5774	041	2	1	01	01	H5774_041_2	5	2	3	Package 2										011111110111111110000000000															2			13i1;13i4;13i10;13i3;		2		1	235.00	7		00010		13i1;13i3;13i4;13i10;
H5774	041	2	1	01	01	H5774_041_2	5	1	2	Package 1																00000000001110	Oncology patients undergoing active chemo by infusion or systemic radiotherapy.	Post-inpatient stay for acute stroke with the transition of care to patients home.	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries.			2	2		2			14c21;		2		2						
H5774	041	3	1	01	01	H5774_041_3	5	1	2	Package 1																00000000001110	Oncology patients undergoing active chemo by infusion or systemic radiotherapy.	Post-inpatient stay for acute stroke with the transition of care to patients home.	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries.			2	2		2			14c21;		2		2						
H5774	041	3	1	01	01	H5774_041_3	5	2	3	Package 2										011111110111111110000000000															2			13i1;13i4;13i10;13i3;		2		1	180.00	7		00010		13i1;13i3;13i4;13i10;
H5774	041	4	1	01	01	H5774_041_4	5	2	3	Package 2										011111110111111110000000000															2			13i1;13i4;13i10;13i3;		2		1	20.00	7		00010		13i1;13i3;13i4;13i10;
H5774	041	4	1	01	01	H5774_041_4	5	1	2	Package 1																00000000001110	Oncology patients undergoing active chemo by infusion or systemic radiotherapy.	Post-inpatient stay for acute stroke with the transition of care to patients home.	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries.			2	2		2			14c21;		2		2						
H5774	041	5	1	01	01	H5774_041_5	5	1	2	Package 1																00000000001110	Oncology patients undergoing active chemo by infusion or systemic radiotherapy.	Post-inpatient stay for acute stroke with the transition of care to patients home.	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries.			2	2		2			14c21;		2		2						
H5774	041	5	1	01	01	H5774_041_5	5	2	3	Package 2										011111110111111110000000000															2			13i1;13i4;13i10;13i3;		2		1	150.00	7		00010		13i1;13i3;13i4;13i10;
H5774	043	1	1	01	01	H5774_043_1	6	2	3	Package #2										011111110111111110000000000															2			13i1;13i4;13i10;13i3;		2		1	50.00	7		00010		13i1;13i3;13i4;13i10;
H5774	043	1	1	01	01	H5774_043_1	6	1	2	Package #1																00000000001110	Oncology patients undergoing active chemo by infusion or systemic radiotherapy	Post-inpatient stay for acute stroke with the transition of care to patients home	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries.			2	2		2			14c21;		2		2						
H5774	043	2	1	01	01	H5774_043_2	6	1	2	Package #1																00000000001110	Oncology patients undergoing active chemo by infusion or systemic radiotherapy	Post-inpatient stay for acute stroke with the transition of care to patients home	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries			2	2		2			14c21;		2		2						
H5774	043	2	1	01	01	H5774_043_2	6	2	3	Package #2										011111110111111110000000000															2			13i1;13i4;13i10;13i3;		2		1	50.00	7		00010		13i1;13i3;13i4;13i10;
H5774	043	3	1	01	01	H5774_043_3	6	2	3	Package #2										011111110111111110000000000															2			13i1;13i4;13i10;13i3;		2		1	50.00	7		00010		13i1;13i3;13i4;13i10;
H5774	043	3	1	01	01	H5774_043_3	6	1	2	Package #1																00000000001110	Oncology patients undergoing active chemo by infusion or systemic radiotherapy	Post-inpatient stay for acute stroke with the transition of care to patients home	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries			2	2		2			14c21;		2		2						
H5774	043	4	1	01	01	H5774_043_4	7	1	2	Package #1																00000000001110	Oncology patients undergoing active chemo by infusion or systemic radiotherapy	Post-inpatient stay for acute stroke with the transition of care to patients home	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries			2	2		2			14c21;		2		2						
H5774	043	4	1	01	01	H5774_043_4	7	2	3	Package #2										011111110111111110000000000															2			13i1;13i4;13i10;13i3;		2		1	30.00	7		00010		13i1;13i3;13i4;13i10;
H5774	043	5	1	01	01	H5774_043_5	7	1	2	Package #1																00000000001110	Oncology patients undergoing active chemo by infusion or systemic radiotherapy	Post-inpatient stay for acute stroke with the transition of care to patients home	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries			2	2		2			14c21;		2		2						
H5774	043	5	1	01	01	H5774_043_5	7	2	3	Package #2										011111110111111110000000000															2			13i1;13i4;13i10;13i3;		2		1	50.00	7		00010		13i1;13i3;13i4;13i10;
H5774	046	0	1	01	01	H5774_046_0	6	2	2	2																00000000001000	Bedridden patients								2			14c21;		2		2						
H5774	046	0	1	01	01	H5774_046_0	6	1	3	1										011111110111111110000000000															2			13i10;13i4;13i1;13i3;		2		1	75.00	7		00010		13i1;13i3;13i4;13i10;
H5774	047	1	1	01	01	H5774_047_1	6	1	3	1										011111110111111110000000000															2			13i1;13i4;13i10;13i3;		2		1	90.00	7		00010		13i1;13i3;13i4;13i10;
H5774	047	2	1	01	01	H5774_047_2	6	1	3	1										011111110111111110000000000															2			13i1;13i4;13i10;13i3;		2		1	50.00	7		00010		13i1;13i3;13i4;13i10;
H5774	047	3	1	01	01	H5774_047_3	6	1	3	1										011111110111111110000000000															2			13i1;13i4;13i10;13i3;		2		1	70.00	7		00010		13i1;13i3;13i4;13i10;
H5774	047	4	1	01	01	H5774_047_4	6	1	3	1										011111110111111110000000000															2			13i1;13i4;13i10;13i3;		2		1	10.00	7		00010		13i1;13i3;13i4;13i10;
H5774	047	5	1	01	01	H5774_047_5	6	1	3	1										011111110111111110000000000															2			13i1;13i4;13i10;13i3;		2		1	20.00	7		00010		13i1;13i3;13i4;13i10;
H5793	017	0	1	02	01	H5793_017_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5793	019	0	1	02	01	H5793_019_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5793	020	0	1	02	01	H5793_020_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5793	801	0	1	01	01	H5793_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H5793	801	0	1	01	01	H5793_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5793	802	0	1	01	01	H5793_802_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H5793	802	0	1	01	01	H5793_802_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5823	010	0	1	01	01	H5823_010_0	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5823	013	1	1	01	01	H5823_013_1	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5823	013	2	1	01	01	H5823_013_2	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5826	014	0	1	01	01	H5826_014_0	5	2	2	Package 3																10111010011111	Frailty	Osteoporosis	Parkinson's	Fall Risk or seizures	History of acute MI or angina	2	2		2			14c11;		2		2						
H5826	014	0	1	01	01	H5826_014_0	5	3	2	Package 4																00000110001100	Pre-hypertension	Refractory, high-risk high blood pressure				2	1	Members qualify for this benefit with hypertension and at least one other chronic condition	2			13b;		2		2						
H5826	014	0	1	01	01	H5826_014_0	5	1	2	Package 2																01000000000000									2			7f_2;		2		2						
H5826	014	0	1	01	01	H5826_014_0	5	4	3	Additional Benefit under SSBCI										011111111111111111111110000															2			13i1;		2		2						
H5826	017	0	1	01	01	H5826_017_0	6	3	2	Package 3																00010100001110	Prehypertension	Morbid obesity	Obesity with comorbidities			2	1	Member qualifies for this benefit with hypertension and at least one other chronic condition	1	001		13b;		2		2						
H5826	017	0	1	01	01	H5826_017_0	6	2	2	Package 2																11111111111111	Frailty	Osteoporosis	Parkinson's	Fall Risk or seizures	History of acute MI or angina	2	2		1	001		14c11;		2		2						
H5826	017	0	1	01	01	H5826_017_0	6	1	2	Package 1																01000000000000									2			7f_2;		2		2						
H5828	001	0	1	01	01	H5828_001_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5828	002	0	1	01	01	H5828_002_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5828	018	0	1	01	01	H5828_018_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5843	001	0	1	01	01	H5843_001_0	7	1	3	Flex Card										011111111111111111111110000															2			13i1;13i10;		2		1	0.00	5		00010		13i1;13i10;
H5852	001	0	1	01	01	H5852_001_0	6	1	3	SSBCI										000111010010110000001000000															2			13i3;14c18;13c;13i5;13i10;10b1;		2		2						
H5854	012	0	1	02	01	H5854_012_0	4	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;	2	2		2						
H5854	013	0	1	01	01	H5854_013_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5854	020	0	1	01	01	H5854_020_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H5859	001	0	1	01	01	H5859_001_0	9	1	2	Blood Pressure Monitors																00000100000000									2			13b;		1	13b;	2						
H5859	001	0	1	01	01	H5859_001_0	9	2	3	SSBCI Benefits										000001010000000000000000000															2			13i1;		1	13i1;	1	50.00	7		00010		13i1;
H5883	001	1	1	02	01	H5883_001_1	6	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	001	2	1	02	01	H5883_001_2	6	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	001	3	1	02	01	H5883_001_3	6	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	001	4	1	02	01	H5883_001_4	6	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	001	5	1	02	01	H5883_001_5	6	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	002	1	1	02	01	H5883_002_1	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	002	2	1	02	01	H5883_002_2	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	002	3	1	02	01	H5883_002_3	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	002	4	1	02	01	H5883_002_4	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	002	7	1	02	01	H5883_002_7	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	003	1	1	02	01	H5883_003_1	8	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	003	2	1	02	01	H5883_003_2	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	003	3	1	02	01	H5883_003_3	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	003	4	1	02	01	H5883_003_4	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	003	5	1	02	01	H5883_003_5	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	007	0	1	01	01	H5883_007_0	8	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;		2		1	0.00	5		00010		13i1;
H5926	001	0	1	01	01	H5926_001_0	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H5926	008	0	1	01	01	H5926_008_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5926	009	0	1	01	01	H5926_009_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5932	001	0	1	01	01	H5932_001_0	6	1	3	Healthy Benefits										011111111111111111111110000															2			13i1;13i10;13i4;		1	13i10;13i1;13i4;	1	200.00	7		01010		13i1;13i4;13i10;
H5932	009	0	1	01	01	H5932_009_0	6	1	3	Healthy Benefits										011111111111111111111110000															2			13i1;13i4;13i10;		1	13i1;13i4;13i10;	1	120.00	5		01010		13i1;13i4;13i10;
H5932	012	0	1	01	01	H5932_012_0	6	1	3	Healthy Benefits										011111111111111111111110000															2			13i1;13i10;13i4;		1	13i10;13i1;13i4;	1	200.00	7		01010		13i1;13i4;13i10;
H5932	013	0	1	01	01	H5932_013_0	6	1	3	Healthy Benefits										011111111111111111111110000															2			13i1;13i4;13i10;		1	13i1;13i4;13i10;	1	120.00	5		01010		13i1;13i4;13i10;
H5937	001	0	1	01	01	H5937_001_0	13	1	3	Package 1										000000010000001000000001100	Chronic hypertension	Chronic lipid disorder													2			13i-O1;13i-O2;		1	13i-O1;13i-O2;	2						
H5938	001	0	1	01	01	H5938_001_0	8	1	3	Food and Produce										000000010000000000000000000															1	001		13i1;		2		1	0.00	3		00010		13i1;
H5938	006	0	1	01	01	H5938_006_0	8	1	3	Food and Produce										000000010000000000000000000															1	001		13i1;		2		1	0.00	3		00010		13i1;
H5938	008	0	1	01	01	H5938_008_0	8	1	3	Food and Produce										000000010000000000000000000															1	001		13i1;		2		1	0.00	3		00010		13i1;
H5943	003	0	1	02	01	H5943_003_0	7	1	3	OTC-Food-Utilities										000000000010000001000000000															2			13i1;13i10;13b;	2	1	13i1;13i10;13b;	1	125.00	7		00010		13b;13i1;13i10;
H5943	004	0	1	02	01	H5943_004_0	7	1	3	OTC-Food-Utilities										000000000010000001000000000															2			13i1;13i10;13b;	2	1	13i1;13i10;13b;	1	74.00	7		00010		13b;13i1;13i10;
H5945	002	0	1	01	01	H5945_002_0	7	1	3	SSBCI - Food / OTC										011111110001111110000000000															2			13i1;		1	13i1;	1	0.00	5		00010		13i1;
H5945	013	0	1	01	01	H5945_013_0	6	1	3	SSBCI - Food Card/OTC/Utilities										011111111001111110000001000	Chronic Hypertension														2			13i1;13i10;		1	13i1;13i10;	1	0.00	5		00010		13i1;13i10;
H5945	014	0	1	01	01	H5945_014_0	6	1	3	SSBCI - Food Card/OTC/Utilities										011111111001111110000001000	Chronic Hypertension														2			13i1;13i10;		1	13i1;13i10;	1	0.00	5		00010		13i1;13i10;
H5945	016	0	1	01	01	H5945_016_0	6	1	3	SSBCI - Food Card/OTC										011111111000111110000001000	Chronic Hypertension														2			13i1;		1	13i1;	1	0.00	5		00010		13i1;
H5945	017	0	1	01	01	H5945_017_0	6	1	3	SSBCI - Food Card/OTC/Utilities/Transportation										011111111001111100000001000	Chronic Hypertension														1	001		13i1;13i10;13i4;		1	13i1;13i10;13i4;	2						
H5945	018	0	1	01	01	H5945_018_0	7	1	3	SSBCI - Food Card/OTC/Utilities/Transportation										011111111000111110000001000	Chronic Hypertension														1	001		13i1;13i10;13i4;		1	13i1;13i10;13i4;	2						
H5959	009	0	1	04	01	H5959_009_0	4	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinance	osteoarthritis			2	2		1	010		14c1;	1	2		2						
H5959	010	1	1	04	01	H5959_010_1	3	1	2	MSK																00000000101110	history of Joint & muscle pain	Urinary incontinence	Osteoarthritis			2	2		1	010		14c1;	1	2		2						
H5959	010	2	1	04	01	H5959_010_2	3	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinance	osteoarthritis			2	2		1	010		14c1;	1	2		2						
H5959	011	0	1	04	01	H5959_011_0	5	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		14c1;	1	2		2						
H5959	012	0	1	04	01	H5959_012_0	4	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		14c1;	1	2		2						
H5959	013	1	1	04	01	H5959_013_1	3	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		14c1;	1	2		2						
H5959	013	2	1	04	01	H5959_013_2	3	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		14c1;	1	2		2						
H5959	014	1	1	04	01	H5959_014_1	3	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		14c1;	1	2		2						
H5959	014	2	1	04	01	H5959_014_2	3	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinance	osteoarthritis			2	2		1	010		14c1;	1	2		2						
H5959	015	0	1	04	01	H5959_015_0	3	1	2	MSK																00000000101110	history off joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		14c1;	1	2		2						
H5959	016	0	1	04	01	H5959_016_0	3	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		14c1;	1	2		2						
H5959	018	0	1	04	01	H5959_018_0	3	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		14c1;	1	2		2						
H5959	801	0	1	04	01	H5959_801_0	1	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinance	osteoarthritis			2	2		1	010		14c1;	1	2		2						
H5959	807	0	1	04	01	H5959_807_0	1	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	ostetarthritis			2	2		1	010		14c1;	1	2		2						
H5959	808	0	1	04	01	H5959_808_0	1	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteosrthritis			2	2		1	010		14c1;	1	2		2						
H5959	809	0	1	04	01	H5959_809_0	1	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthrists			2	2		1	010		14c1;	1	2		2						
H5965	004	0	1	04	01	H5965_004_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H5965	006	0	1	04	01	H5965_006_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H5969	002	0	1	01	01	H5969_002_0	5	1	3	SSBCI										011111110011111110000000000															1	001		13i1;13i10;		1	13i1;13i10;	1	0.00	7		01011		13i1;13i10;
H5970	016	0	1	04	01	H5970_016_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H5970	020	0	1	04	01	H5970_020_0	7	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5992	007	0	1	01	01	H5992_007_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5992	010	0	1	01	01	H5992_010_0	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H6019	001	0	1	01	01	H6019_001_0	4	1	3	Package 1										011111111001111110011101000	Chronic hypertension														2			13i1;		2		1	25.00	5		01111		13i1;
H6154	001	0	1	02	01	H6154_001_0	4	1	3	SSBCI										000111110111010110000001000	Osteoporosis														1	001		10b1;13i4;13c;13d;14c8;14c20;	1	2		2						
H6170	001	0	1	02	01	H6170_001_0	9	1	3	ESRD Care										000000000010000000000000000															1	001		13b;10b1;13i1;13i10;	1	2		1	330.00	5		00010		10b1;13b;13i1;13i10;
H6170	002	0	1	02	01	H6170_002_0	12	1	3	ESRD Care										000000000010000000000000000															1	001		13b;10b1;13i1;13i10;	1	2		1	505.00	5		00010		10b1;13b;13i1;13i10;
H6170	003	0	1	02	01	H6170_003_0	10	1	3	ESRD Care										000000000010000000000000000															1	001		10b1;13b;13i1;13i10;	1	2		1	400.00	5		00010		10b1;13b;13i1;13i10;
H6170	007	0	1	01	01	H6170_007_0	8	1	3	Healthy Choices										011111111111111111111110000															2			13b;13i1;13i10;		2		1	330.00	5		00010		13b;13i1;13i10;
H6170	008	0	1	01	01	H6170_008_0	7	1	3	Healthy Choices										000011010000000000000000000															1	001		13i1;13b;13i10;		2		1	330.00	5		00010		13b;13i1;13i10;
H6170	009	0	1	01	01	H6170_009_0	11	1	3	Healthy Choices										000011010000000000000000000															1	001		13i1;13b;13i10;		2		1	500.00	5		00010		13b;13i1;13i10;
H6170	010	0	1	01	01	H6170_010_0	10	1	3	Healthy Choices										000000000000001000000000000															1	001		13b;13i1;13i10;		2		1	500.00	5		00010		13b;13i1;13i10;
H6224	001	0	1	01	01	H6224_001_0	5	1	3	Healthy Benefits										011111111111111111111110000															2			13i1;13i10;13i4;		1	13i10;13i1;13i4;	1	185.00	7		01010		13i1;13i4;13i10;
H6237	009	0	1	01	01	H6237_009_0	6	1	2	Routine Podiatry																01000000000000									2			7f_2;		2		2						
H6316	002	0	1	01	01	H6316_002_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H6316	005	0	1	01	01	H6316_005_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H6322	002	0	1	01	01	H6322_002_0	7	1	3	Healthy Groceries										011111111111111111111110000															2			13i1;		1	13i1;	1	50.00	7		00010		13i1;
H6341	001	0	1	01	01	H6341_001_0	6	1	3	Package 1										000011111100011010000001000	Connective Tissue Disease														2			13i1;13i10;13i3;		1	13i1;13i10;13i3;	1	0.00	5		01010		13i1;13i3;13i10;
H6345	001	0	1	01	01	H6345_001_0	5	1	3	Food and Produce										011111111111111111111111110	Chronic Hyperlipidemia	Chronic Hypertension	Osteoporosis												2			13i1;		2		1	0.00	7		00010		13i1;
H6351	004	0	1	01	01	H6351_004_0	8	1	3	Package 1										000011010000010000000000000															2			13i1;		2		1	0.00	7		00010		13i1;
H6351	005	0	1	01	01	H6351_005_0	6	1	3	Package 1										000001010010010000000000000															2			14c6;		2		2						
H6378	001	0	1	01	01	H6378_001_0	6	1	3	Package 1										000011111100011010000001000	Connective Tissue Disease														2			13i1;13i10;		1	13i1;13i10;	1	105.00	7		00010		13i1;13i10;
H6379	001	0	1	01	01	H6379_001_0	8	1	3	Food										000001010010010000000000000															2			13i1;		2		1	50.00	5		01010		13i1;
H6379	002	0	1	01	01	H6379_002_0	7	1	3	Food										000011010000000000000000000															2			13i1;		2		1	65.00	7		01010		13i1;
H6396	017	0	1	01	01	H6396_017_0	6	1	3	Healthy Benefits+										011111111111111111111110000															2			13i1;13i3;13i5;13i10;13i-O1;13i-O2;14c8;		1	13i1;13i3;13i5;13i10;13i-O1;13i-O2;14c8;	2						
H6399	001	0	1	01	01	H6399_001_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H6453	019	0	1	02	01	H6453_019_0	13	1	3	Healthy Foods and Utilities										011111111111111111111110000															1	001		13i1;13i10;	2	1	13i1;13i10;	1	100.00	7		00011		13i1;13i10;
H6453	019	0	1	02	01	H6453_019_0	13	2	2	Transportation																00000000001000	Chronic Kidney Disease/ESRD								1	001		10b1;	2	1	10b1;	2						
H6474	001	0	1	02	01	H6474_001_0	8	1	3	ESRD Care										000000000010000000000000000															1	001		10b1;13b;13i1;13i10;	1	2		1	330.00	5		00010		10b1;13b;13i1;13i10;
H6474	002	0	1	02	01	H6474_002_0	9	1	3	ESRD Care										000000000010000000000000000															1	001		10b1;13b;13i1;13i10;	1	2		1	511.00	5		00010		10b1;13b;13i1;13i10;
H6474	003	0	1	02	01	H6474_003_0	8	1	3	ESRD Care										000000000010000000000000000															1	001		10b1;13b;13i1;13i10;	1	2		1	415.00	5		00010		10b1;13b;13i1;13i10;
H6474	007	0	1	01	01	H6474_007_0	8	1	3	Healthy Choices										011111111111111111111110000															2			13b;13i1;13i10;		2		1	330.00	5		00010		13b;13i1;13i10;
H6474	008	0	1	01	01	H6474_008_0	7	1	3	Healthy Choices										000011010000000000000000000															1	001		13i1;13b;13i10;		2		1	330.00	5		00010		13b;13i1;13i10;
H6474	009	0	1	01	01	H6474_009_0	11	1	3	Healthy Choices										000011010000000000000000000															1	001		13i1;13b;13i10;		2		1	511.00	5		00010		13b;13i1;13i10;
H6474	010	0	1	01	01	H6474_010_0	11	1	3	Healthy Choices										000000000000001000000000000															1	001		13b;13i1;13i10;		2		1	525.00	5		00010		13b;13i1;13i10;
H6515	001	0	1	01	01	H6515_001_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H6515	002	0	1	01	01	H6515_002_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H6515	003	0	1	01	01	H6515_003_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H6515	004	0	1	01	01	H6515_004_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H6515	005	0	1	01	01	H6515_005_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H6550	004	0	1	02	01	H6550_004_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H6550	009	0	1	02	01	H6550_009_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H6586	002	0	1	04	01	H6586_002_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	55.00	7		00010		13i1;13i10;
H6586	003	0	1	04	01	H6586_003_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	41.00	7		00010		13i1;13i10;
H6595	003	0	1	02	01	H6595_003_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H6595	004	0	1	02	01	H6595_004_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H6595	005	0	1	02	01	H6595_005_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H6622	004	0	1	01	01	H6622_004_0	3	1	2	Non-Emergency Medical Transportation																00000000001000	End Stage Renal Disease (ESRD)								2			10b1;		2		2						
H6622	008	0	1	01	01	H6622_008_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	008	0	1	01	01	H6622_008_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H6622	013	0	1	02	01	H6622_013_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H6622	014	0	1	02	01	H6622_014_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H6622	015	0	1	01	01	H6622_015_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	015	0	1	01	01	H6622_015_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H6622	017	0	1	01	01	H6622_017_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	018	0	1	01	01	H6622_018_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	018	0	1	01	01	H6622_018_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H6622	021	1	1	02	01	H6622_021_1	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H6622	021	2	1	02	01	H6622_021_2	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H6622	022	0	1	02	01	H6622_022_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H6622	023	0	1	02	01	H6622_023_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H6622	027	0	1	02	01	H6622_027_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	029	0	1	01	01	H6622_029_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H6622	033	0	1	01	01	H6622_033_0	2	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H6622	033	0	1	01	01	H6622_033_0	2	2	2	Non-Emergency Medical Transportation																00000000001100	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)				2	2		2			10b1;		2		2						
H6622	035	0	1	01	01	H6622_035_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H6622	036	0	1	01	01	H6622_036_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H6622	037	0	1	01	01	H6622_037_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H6622	048	0	1	01	01	H6622_048_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H6622	048	0	1	01	01	H6622_048_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	054	0	1	01	01	H6622_054_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H6622	056	0	1	01	01	H6622_056_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H6622	057	0	1	02	01	H6622_057_0	5	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H6622	078	1	1	01	01	H6622_078_1	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H6622	078	1	1	01	01	H6622_078_1	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	078	2	1	01	01	H6622_078_2	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H6622	078	2	1	01	01	H6622_078_2	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	079	0	1	01	01	H6622_079_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	079	0	1	01	01	H6622_079_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H6622	084	0	1	01	01	H6622_084_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	087	0	1	01	01	H6622_087_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	087	0	1	01	01	H6622_087_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H6622	095	0	1	01	01	H6622_095_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H6622	098	0	1	01	01	H6622_098_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		2		2						
H6622	098	0	1	01	01	H6622_098_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	101	0	1	01	01	H6622_101_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	101	0	1	01	01	H6622_101_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H6672	003	0	1	01	01	H6672_003_0	8	1	3	Food										000011010000000000000000000															2			13i1;		2		1	70.00	7		01010		13i1;
H6672	005	0	1	01	01	H6672_005_0	9	1	3	Food										000001010010010000000000000															2			13i1;		2		1	60.00	5		01010		13i1;
H6743	007	0	1	04	01	H6743_007_0	10	1	3	Pest Control										011111111111111111111110000															2			13i3;	1	1	13i3;	1	175.00	3		00011		13i3;
H6765	002	0	1	01	01	H6765_002_0	3	1	3	Healthy Food										011111111111111111111110000															1	001		13i1;		1	13i1;	2						
H6776	001	0	1	01	01	H6776_001_0	5	1	3	SSBCI OTC Benefit										011111110111111110001001100	Chronic Hypertension	Chronic Endocrine Disorders													2			13i1;		2		2						
H6776	002	0	1	01	01	H6776_002_0	5	1	3	SSBCI OTC Benefit										011111110111111110011101100	Chronic Hypertension	Chronic Endocrine Disorder													2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H6824	001	0	1	04	01	H6824_001_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H6824	002	0	1	04	01	H6824_002_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H6832	001	0	1	01	01	H6832_001_0	5	1	3	Flex Benefit										011111111111111111111111110	osteoporosis	chronic hypertension	chronic hyperlipidemia												2			13i1;13i6;13i4;		1	13i1;13i6;13i4;	2						
H6832	004	0	1	02	01	H6832_004_0	6	1	3	Flex Benefit										011111111111111111111111110	osteoporosis	chronic hypertension	chronic hyperlipidemia												2			13i1;13i6;13i4;	2	1	13i1;13i6;13i4;	2						
H6852	005	0	1	01	01	H6852_005_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	300.00	7		00010		13i1;13i10;
H6852	007	0	1	01	01	H6852_007_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	300.00	7		00010		13i1;13i10;
H6852	016	0	1	01	01	H6852_016_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H6852	017	0	1	01	01	H6852_017_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H6852	018	0	1	01	01	H6852_018_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H6852	019	0	1	01	01	H6852_019_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H6852	020	0	1	01	01	H6852_020_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H6852	021	0	1	01	01	H6852_021_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	406.00	7		00010		13i1;13i10;
H6852	022	0	1	01	01	H6852_022_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	406.00	7		00010		13i1;13i10;
H6852	025	0	1	01	01	H6852_025_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	350.00	7		00010		13i1;13i10;
H6852	026	0	1	01	01	H6852_026_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	350.00	7		00010		13i1;13i10;
H6874	001	0	1	04	01	H6874_001_0	9	1	2	Package 1																00010000000000									2			13c;	1	2		2						
H6874	003	0	1	04	01	H6874_003_0	8	1	2	Package 1																00010000000000									2			13c;	1	2		2						
H6876	001	0	1	04	01	H6876_001_0	9	1	3	Food & Produce and Utilities										000111110010010000000000000															2			13i1;13i10;	1	2		1	50.00	7		01011		13i1;13i10;
H6876	003	0	1	04	01	H6876_003_0	9	1	3	Food & Produce, Utilities and AC										000011010000000000000000000															1	100	HRA Completion	13i1;13i10;13i5;	1	2		1	95.00	7		01011		13i1;13i5;13i10;
H6876	004	0	1	04	01	H6876_004_0	9	1	3	Food & Produce and Utilities										000111110010010000000000000															2			13i1;13i10;	1	2		1	55.00	7		01011		13i1;13i10;
H6876	005	0	1	04	01	H6876_005_0	8	1	3	Food & Produce and Utilities										000011010000000000000000000															1	100	HRA Completion	13i1;13i10;	1	2		1	110.00	7		01011		13i1;13i10;
H6876	007	0	1	04	01	H6876_007_0	8	1	3	Food & Produce and Utilities										000011010000000000000000000															1	100	HRA Completion	13i1;13i10;	1	2		1	120.00	7		01011		13i1;13i10;
H6876	009	0	1	04	01	H6876_009_0	9	1	3	Food & Produce and Utilities										000111110010010000000000000															2			13i1;13i10;	1	2		1	55.00	7		01011		13i1;13i10;
H6959	001	0	1	01	01	H6959_001_0	6	1	3	Beauty and Barber Shop										011111111111111111111111110	Chronic Hyperlipidemia	Chronic Hypertension	Osteoporosis												2			13i-O1;		1	13i-O1;	2						
H6959	002	0	1	01	01	H6959_002_0	6	1	3	Food, Produce, House Cleaning										000011010000000000000000000															2			13i1;13i10;		1	13i1;13i10;	1	0.00	5		00010		13i1;13i10;
H6971	001	0	1	01	01	H6971_001_0	7	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H6988	004	0	1	01	01	H6988_004_0	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H6994	001	0	1	01	01	H6994_001_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	50.00	7		00010		13i1;13i10;
H6994	003	0	1	01	01	H6994_003_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H6994	004	0	1	01	01	H6994_004_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	421.00	7		00010		13i1;13i10;
H6994	010	0	1	01	01	H6994_010_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H6994	011	0	1	01	01	H6994_011_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	50.00	7		00010		13i1;13i10;
H6994	013	0	1	01	01	H6994_013_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H7006	018	0	1	04	01	H7006_018_0	10	1	3	Pest Control										011111111111111111111110000															2			13i3;	1	2		1	175.00	3		00011		13i3;
H7006	022	0	1	04	01	H7006_022_0	10	1	3	Pest Control										011111111111111111111110000															2			13i3;	1	2		1	175.00	3		00011		13i3;
H7028	001	0	1	04	01	H7028_001_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	59.00	7		00010		13i1;13i10;
H7028	004	0	1	04	01	H7028_004_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	49.00	7		00010		13i1;13i10;
H7028	005	0	1	04	01	H7028_005_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H7028	006	0	1	04	01	H7028_006_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	374.00	7		00010		13i1;13i10;
H7074	001	0	1	04	01	H7074_001_0	8	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;	1	2		2						
H7115	001	0	1	01	01	H7115_001_0	8	1	3	Healthy Food/Groceries										011111111111111111111110000															2			13i1;		2		1	80.00	5		00010		13i1;
H7115	005	0	1	01	01	H7115_005_0	10	1	3	Healthy Food/Groceries										011111111111111111111110000															2			13i1;		2		1	255.00	5		00010		13i1;
H7115	006	0	1	01	01	H7115_006_0	7	1	3	Healthy Food/Groceries										011111111111111111111110000															2			13i1;		2		1	40.00	5		00010		13i1;
H7123	001	0	1	01	01	H7123_001_0	17	1	3	Healthy Food/Non-Medical Transportation/Utilities										011111111111111111111100000															2			13i1;13i10;13i4;		2		2						
H7147	001	0	1	01	01	H7147_001_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	65.00	7		00010		13i1;13i10;
H7147	003	0	1	01	01	H7147_003_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	267.00	7		00010		13i1;13i10;
H7147	004	0	1	01	01	H7147_004_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	69.00	7		00010		13i1;13i10;
H7147	007	0	1	01	01	H7147_007_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	100.00	7		00010		13i1;13i10;
H7147	009	0	1	01	01	H7147_009_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H7147	010	0	1	01	01	H7147_010_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H7147	011	0	1	01	01	H7147_011_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H7147	012	0	1	01	01	H7147_012_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	321.00	7		00010		13i1;13i10;
H7147	013	0	1	01	01	H7147_013_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	368.00	7		00010		13i1;13i10;
H7149	006	0	1	01	01	H7149_006_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H7149	801	0	1	01	01	H7149_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H7149	801	0	1	01	01	H7149_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H7151	001	0	1	01	01	H7151_001_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	66.00	7		00010		13i1;13i10;
H7151	005	0	1	01	01	H7151_005_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	150.00	7		00010		13i1;13i10;
H7151	006	0	1	01	01	H7151_006_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	361.00	7		00010		13i1;13i10;
H7199	002	0	1	04	01	H7199_002_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	40.00	7		00010		13i1;13i10;
H7239	001	0	1	01	01	H7239_001_0	7	1	3	SSBCI - Food Card/OTC										011111101000111110000001000	Chronic Hypertension														2			13i1;		1	13i1;	1	0.00	5		00010		13i1;
H7239	002	0	1	01	01	H7239_002_0	7	1	3	SSBCI - Food Card/OTC/Utilities/Transportation										011111111000111110000001000	Chronic Hypertension														1	001		13i4;13i1;13i10;		1	13i1;13i4;13i10;	2						
H7239	003	0	1	01	01	H7239_003_0	6	1	3	SSBCI - Food Card/OTC/Utilities										011111111000111110000001000	Chronic Hypertension														2			13i1;13i10;		1	13i1;13i10;	2						
H7239	005	0	1	01	01	H7239_005_0	6	1	3	SSBCI - Food Card/OTC										011111111001111110000001000	Chronic Hypertension														2			13i1;		1	13i1;	1	0.00	5		00010		13i1;
H7275	001	0	1	01	01	H7275_001_0	6	1	3	Food and Produce										000000001000000000000000000															2			13i1;		2		2						
H7284	010	0	1	04	01	H7284_010_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7301	002	0	1	04	01	H7301_002_0	2	1	2	Hypertension & Hyperlipidemia																00000100001000	Hyperlipidemia					2	2		2			10b1;13b;	1	1	10b1;13b;	2						
H7301	006	0	1	04	01	H7301_006_0	2	1	2	Hypertension & Hyperlipidemia																00000100001000	Hyperlipidemia					2	2		2			10b1;13b;	1	1	10b1;13b;	2						
H7301	803	0	1	04	01	H7301_803_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H7301	803	0	1	04	01	H7301_803_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H7355	001	0	1	04	01	H7355_001_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	60.00	7		00010		13i1;13i10;
H7355	003	0	1	04	01	H7355_003_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	265.00	7		00010		13i1;13i10;
H7355	004	0	1	04	01	H7355_004_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	115.00	7		00010		13i1;13i10;
H7355	006	0	1	04	01	H7355_006_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	49.00	7		00010		13i1;13i10;
H7355	007	0	1	04	01	H7355_007_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	190.00	7		00010		13i1;13i10;
H7355	009	0	1	04	01	H7355_009_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	316.00	7		00010		13i1;13i10;
H7355	010	0	1	04	01	H7355_010_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	341.00	7		00010		13i1;13i10;
H7379	003	0	1	04	01	H7379_003_0	5	1	3	Healthcare Prepaid Card										011111111111111111111111000	Chronically underweight														2			13i10;13i1;	1	2		1	75.00	7		00011		13i1;13i10;
H7397	003	0	1	04	01	H7397_003_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	220.00	7		00010		13i1;13i10;
H7397	004	0	1	04	01	H7397_004_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	91.00	7		00010		13i1;13i10;
H7397	006	0	1	04	01	H7397_006_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	49.00	7		00010		13i1;13i10;
H7397	007	0	1	04	01	H7397_007_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	188.00	7		00010		13i1;13i10;
H7397	009	0	1	04	01	H7397_009_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	275.00	7		00010		13i1;13i10;
H7397	010	0	1	04	01	H7397_010_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	314.00	7		00010		13i1;13i10;
H7435	001	0	1	01	01	H7435_001_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;		1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H7464	008	1	1	01	01	H7464_008_1	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H7464	008	2	1	01	01	H7464_008_2	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H7464	010	0	1	01	01	H7464_010_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H7464	012	0	1	02	01	H7464_012_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H7471	013	0	1	04	01	H7471_013_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	340.00	7		00010		13i1;13i10;
H7471	014	0	1	04	01	H7471_014_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H7471	015	0	1	04	01	H7471_015_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H7471	016	0	1	04	01	H7471_016_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H7471	017	0	1	04	01	H7471_017_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H7518	003	0	1	04	01	H7518_003_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H7524	001	0	1	01	01	H7524_001_0	7	1	3	Healthy Food										011111111111111111111110000															2			13i1;		1	13i1;	1	30.00	7		00010		13i1;
H7524	002	0	1	01	01	H7524_002_0	7	1	3	Healthy Food										011111111111111111111110000															2			13i1;		1	13i1;	1	30.00	7		00010		13i1;
H7524	003	0	1	01	01	H7524_003_0	7	1	3	Healthy Food										011111111111111111111110000															2			13i1;		1	13i1;	1	30.00	7		00010		13i1;
H7524	004	0	1	01	01	H7524_004_0	7	1	3	Healthy Food										011111111111111111111110000															2			13i1;		1	13i1;	1	30.00	7		00010		13i1;
H7557	001	0	1	01	01	H7557_001_0	6	1	3	SSBCI										011111111111111111111110000															2			13i6;13i4;14c17;13i-O1;10b1;13i-O2;		2		1	200.00	3		01000		13i6;13i-O1;13i-O2;
H7598	003	0	1	01	01	H7598_003_0	5	1	3	Food / Grocery Card										011111111111111111111110000															2			13i1;		2		2						
H7605	004	0	1	01	01	H7605_004_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	85.00	7		00010		13i1;13i10;
H7605	016	0	1	01	01	H7605_016_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	196.00	7		00010		13i1;13i10;
H7607	014	0	1	01	01	H7607_014_0	12	1	3	Package 1										011111110111111111110000000															2			13c;13i1;13i6;14c6;14c10;14c21;14c22;		2		2						
H7607	015	0	1	01	01	H7607_015_0	12	1	3	Package 1										011111110111111111110000000															2			13i1;		2		2						
H7607	016	0	1	01	01	H7607_016_0	11	1	3	Package 1										011111110111111111110000000															2			13c;13i6;14c6;14c10;14c21;14c22;13i1;		2		2						
H7607	017	0	1	01	01	H7607_017_0	11	1	3	Package 1										011111110111111111110000000															2			13c;13i6;14c6;14c10;14c21;14c22;13i1;		2		2						
H7617	006	0	1	04	01	H7617_006_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H7617	006	0	1	04	01	H7617_006_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	033	0	1	04	01	H7617_033_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H7617	033	0	1	04	01	H7617_033_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	034	0	1	04	01	H7617_034_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	034	0	1	04	01	H7617_034_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H7617	036	0	1	04	01	H7617_036_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	036	0	1	04	01	H7617_036_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H7617	037	0	1	04	01	H7617_037_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	037	0	1	04	01	H7617_037_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H7617	038	0	1	04	01	H7617_038_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H7617	038	0	1	04	01	H7617_038_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	039	0	1	04	01	H7617_039_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	039	0	1	04	01	H7617_039_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H7617	046	0	1	04	01	H7617_046_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H7617	048	0	1	04	01	H7617_048_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	050	0	1	04	01	H7617_050_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H7617	053	0	1	04	01	H7617_053_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H7617	055	0	1	04	01	H7617_055_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H7617	063	0	1	04	01	H7617_063_0	3	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H7617	063	0	1	04	01	H7617_063_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H7617	067	0	1	04	01	H7617_067_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	067	0	1	04	01	H7617_067_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H7617	074	0	1	04	01	H7617_074_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	074	0	1	04	01	H7617_074_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H7617	075	0	1	04	01	H7617_075_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	075	0	1	04	01	H7617_075_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H7617	076	0	1	04	01	H7617_076_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	076	0	1	04	01	H7617_076_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H7617	077	0	1	04	01	H7617_077_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	077	0	1	04	01	H7617_077_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H7617	078	0	1	04	01	H7617_078_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	081	0	1	04	01	H7617_081_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	081	0	1	04	01	H7617_081_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H7617	082	0	1	04	01	H7617_082_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	082	0	1	04	01	H7617_082_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H7617	083	0	1	04	01	H7617_083_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	083	0	1	04	01	H7617_083_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H7617	084	0	1	04	01	H7617_084_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H7617	084	0	1	04	01	H7617_084_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	087	0	1	04	01	H7617_087_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	087	0	1	04	01	H7617_087_0	4	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H7617	088	0	1	04	01	H7617_088_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	088	0	1	04	01	H7617_088_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H7617	089	0	1	04	01	H7617_089_0	5	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
H7617	089	0	1	04	01	H7617_089_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	095	0	1	04	01	H7617_095_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H7617	113	0	1	04	01	H7617_113_0	4	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7635	001	0	1	01	01	H7635_001_0	12	1	3	SSBCI - Food and Produce/In-Home Support Services										011111111111111111111110000															2			13i1;14c21;		1	13i1;14c21;	2						
H7670	001	0	1	01	01	H7670_001_0	7	1	3	Package 1										011111111111111111111110000															2			13i1;		2		2						
H7670	002	0	1	01	01	H7670_002_0	7	1	3	Package 1										011111111111111111111110000															2			13i1;		2		2						
H7678	006	1	1	01	01	H7678_006_1	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H7678	006	2	1	01	01	H7678_006_2	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H7680	002	0	1	01	01	H7680_002_0	7	1	3	SSBCI - Food / OTC										011111111000111110000001000	Chronic Hypertension														2			13i1;		1	13i1;	1	0.00	5		00010		13i1;
H7680	007	0	1	01	01	H7680_007_0	5	1	3	SSBCI -Food Card/OTC/Utilities/Transportation										011111111001111110000001000	Chronic Hypertension														1	001		13i4;13i1;13i10;		1	13i4;13i1;13i10;	2						
H7680	009	0	1	01	01	H7680_009_0	6	1	3	SSBCI - Food Card/OTC/Utilities										011111111001111110000001000	Chronic Hypertension														2			13i1;13i10;		1	13i1;13i10;	1	0.00	5		00010		13i1;13i10;
H7680	015	0	1	01	01	H7680_015_0	6	1	3	SSBCI -Food Card/OTC										011111111000111110000001000	Chronic Hypertension														2			13i1;		1	13i1;	1	0.00	5		00010		13i1;
H7680	016	0	1	01	01	H7680_016_0	5	1	3	SSBCI - Food Card/OTC										011111111001111110000001000	Chronic Hypertension														2			13i1;		1	13i1;	1	0.00	5		00010		13i1;
H7680	017	0	1	01	01	H7680_017_0	5	1	3	SSBCI - Food Card/OTC/Utilities										011111111001111110000001000	Chronic Hypertension														2			13i1;13i10;		1	13i1;13i10;	1	0.00	5		00010		13i1;13i10;
H7680	018	0	1	01	01	H7680_018_0	6	1	3	SSBCI - Food Card/OTC/Utilities										011111111001111110000001000	Chronic Hypertension														2			13i10;13i1;		1	13i10;	1	0.00	7		00010		13i10;
H7680	020	0	1	01	01	H7680_020_0	5	1	3	SSBCI - Food Card/OTC										011111111001111110000001000	Chronic Hypertension														2			13i1;		1	13i1;	1	0.00	5		00010		13i1;
H7710	001	0	1	01	01	H7710_001_0	5	1	3	Healthy Benefits										011111111111111111111110000															2			13i1;13i4;13i10;		1	13i1;13i4;13i10;	1	200.00	7		01010		13i1;13i4;13i10;
H7710	002	0	1	01	01	H7710_002_0	5	1	3	Healthy Benefits										011111111111111111111110000															2			13i1;13i10;		1	13i1;13i10;	1	200.00	5		01010		13i1;13i10;
H7766	004	0	1	04	01	H7766_004_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	192.00	7		00010		13i1;13i10;
H7766	012	0	1	04	01	H7766_012_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	192.00	7		00010		13i1;13i10;
H7766	013	0	1	04	01	H7766_013_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	192.00	7		00010		13i1;13i10;
H7766	014	0	1	04	01	H7766_014_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	359.00	7		00010		13i1;13i10;
H7766	015	0	1	04	01	H7766_015_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	333.00	7		00010		13i1;13i10;
H7917	044	0	1	04	01	H7917_044_0	5	1	3	OTC + Health Food										000011010000000000000000000															2			13i1;	1	2		1	0.00	7		00010		13i1;
H7917	045	0	1	04	01	H7917_045_0	5	1	3	OTC + Health Food										000011010000000000000000000															2			13i1;	1	2		1	0.00	7		00010		13i1;
H7917	046	0	1	04	01	H7917_046_0	5	1	3	OTC + Health Food										000011010000000000000000000															2			13i1;	1	2		1	0.00	7		00010		13i1;
H7993	003	0	1	01	01	H7993_003_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	37.00	7		00010		13i1;13i10;
H7993	004	0	1	01	01	H7993_004_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	56.00	7		00010		13i1;13i10;
H7993	007	0	1	01	01	H7993_007_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	100.00	7		00010		13i1;13i10;
H7993	010	0	1	01	01	H7993_010_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	168.00	7		00010		13i1;13i10;
H7993	012	0	1	01	01	H7993_012_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	193.00	7		00010		13i1;13i10;
H7993	014	0	1	01	01	H7993_014_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	77.00	7		00010		13i1;13i10;
H7993	015	0	1	01	01	H7993_015_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	174.00	7		00010		13i1;13i10;
H7993	017	0	1	01	01	H7993_017_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H7993	019	0	1	01	01	H7993_019_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	50.00	7		00010		13i1;13i10;
H7993	023	0	1	01	01	H7993_023_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	105.00	7		00010		13i1;13i10;
H7993	024	0	1	01	01	H7993_024_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	300.00	7		00010		13i1;13i10;
H7993	027	0	1	01	01	H7993_027_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	40.00	7		00010		13i1;13i10;
H7993	028	0	1	01	01	H7993_028_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	175.00	7		00010		13i1;13i10;
H7993	029	0	1	01	01	H7993_029_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	425.00	7		00010		13i1;13i10;
H7993	030	0	1	01	01	H7993_030_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	150.00	7		00010		13i1;13i10;
H7993	031	0	1	01	01	H7993_031_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	400.00	7		00010		13i1;13i10;
H7993	033	0	1	01	01	H7993_033_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	400.00	7		00010		13i1;13i10;
H7993	036	0	1	01	01	H7993_036_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	318.00	7		00010		13i1;13i10;
H7993	037	0	1	01	01	H7993_037_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	251.00	7		00010		13i1;13i10;
H7993	038	0	1	01	01	H7993_038_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	375.00	7		00010		13i1;13i10;
H7993	040	0	1	01	01	H7993_040_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	350.00	7		00010		13i1;13i10;
H7993	041	0	1	01	01	H7993_041_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	350.00	7		00010		13i1;13i10;
H7993	046	0	1	01	01	H7993_046_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	65.00	7		00010		13i1;13i10;
H8051	001	0	1	01	01	H8051_001_0	10	1	3	SSBCI Package 1										011111111111111111111110000															2			13i1;13i10;13i4;		1	13i1;13i4;13i10;	2						
H8067	003	0	1	01	01	H8067_003_0	5	1	3	Food and Produce										011111111111111111111110000															2			13i1;		2		2						
H8067	004	0	1	01	01	H8067_004_0	4	1	3	Food and Produce										011111111111111111111110000															2			13i1;		2		2						
H8093	002	0	1	01	01	H8093_002_0	4	1	3	Healthy Food and Utility Services										011111111111111111111110000															1	001		13i1;13i10;		1	13i1;13i10;	1	110.00	7		00010		13i1;13i10;
H8145	052	0	1	09	04	H8145_052_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H8173	014	0	1	01	01	H8173_014_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	184.00	7		00010		13i1;13i10;
H8173	016	0	1	01	01	H8173_016_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	58.00	7		00010		13i1;13i10;
H8173	020	0	1	01	01	H8173_020_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	70.00	7		00010		13i1;13i10;
H8173	022	0	1	01	01	H8173_022_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	263.00	7		00010		13i1;13i10;
H8173	023	0	1	01	01	H8173_023_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	49.00	7		00010		13i1;13i10;
H8173	024	0	1	01	01	H8173_024_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H8173	025	0	1	01	01	H8173_025_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	274.00	7		00010		13i1;13i10;
H8173	027	0	1	01	01	H8173_027_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	263.00	7		00010		13i1;13i10;
H8176	004	1	1	01	01	H8176_004_1	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H8176	004	2	1	01	01	H8176_004_2	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i4;13i10;		2		1	0.00	7		01010		13i1;13i4;13i10;
H8189	001	0	1	02	01	H8189_001_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H8189	007	0	1	02	01	H8189_007_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H8212	001	0	1	01	01	H8212_001_0	9	1	3	Package 1										000011111100011010000001000	Connective Tissue Disease														2			13i1;13i10;		1	13i1;13i10;	1	125.00	7		00010		13i1;13i10;
H8298	001	0	1	01	01	H8298_001_0	7	1	3	Package 1										011111111111111111111111110	Prediabetes	Chronic Hypertension	Chronic Anemia												1	011		13i1;13i10;13b;		1	13b;13i1;13i10;	1	0.00	7		00010		13b;13i1;13i10;
H8320	011	0	1	04	01	H8320_011_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H8320	012	0	1	04	01	H8320_012_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	323.00	7		00010		13i1;13i10;
H8320	013	0	1	04	01	H8320_013_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H8320	014	0	1	04	01	H8320_014_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H8332	801	0	1	01	01	H8332_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H8332	801	0	1	01	01	H8332_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H8379	001	0	1	01	01	H8379_001_0	6	1	3	SSBCI Flex										011111111111111111111111110	Chronic Hypertension	Osteoporosis	Chronic Low Back Pain												2			13i1;13i3;13i2;13i10;13i-O1;		1	13i1;13i2;13i3;13i10;13i-O1;	2						
H8379	003	1	1	01	01	H8379_003_1	6	1	3	SSBCI Flex										011111111111111111111111110	chronic hypertension	Osteoporosis	Chronic low back pain												2			13i1;13i3;13i2;13i10;13i-O1;		1	13i1;13i2;13i3;13i10;13i-O1;	2						
H8379	003	2	1	01	01	H8379_003_2	6	1	3	SSBCI Flex										011111111111111111111111110	chronic hypertension	Osteoporosis	Chronic low back pain												2			13i1;13i3;13i2;13i10;13i-O1;		1	13i1;13i2;13i3;13i10;13i-O1;	2						
H8379	003	3	1	01	01	H8379_003_3	6	1	3	SSBCI Flex										011111111111111111111111110	chronic hypertension	Osteoporosis	Chronic low back pain												2			13i1;13i3;13i2;13i10;13i-O1;		1	13i1;13i2;13i3;13i10;13i-O1;	2						
H8379	003	4	1	01	01	H8379_003_4	6	1	3	SSBCI Flex										011111111111111111111111110	chronic hypertension	Osteoporosis	Chronic low back pain												2			13i1;13i3;13i2;13i10;13i-O1;		1	13i1;13i2;13i3;13i10;13i-O1;	2						
H8390	015	0	1	01	01	H8390_015_0	6	1	3	Healthy Benefits+										011111111111111111111110000															2			13i1;13i3;13i5;13i10;13i-O1;13i-O2;14c8;		1	13i1;13i3;13i5;13i10;13i-O1;13i-O2;14c8;	2						
H8390	017	0	1	01	01	H8390_017_0	6	1	3	Healthy Benefits+										011111111111111111111110000															2			13i1;13i3;13i5;13i10;13i-O1;13i-O2;14c8;		1	13i1;13i3;13i5;13i10;13i-O1;13i-O2;14c8;	2						
H8432	041	0	1	01	01	H8432_041_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H8432	042	0	1	01	01	H8432_042_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H8457	001	0	1	01	01	H8457_001_0	4	1	3	SSBCI										011111111111111111111110000															2			14c17;13i6;13i-O1;13i-O2;		2		1	200.00	3		01000		13i6;13i-O1;13i-O2;
H8481	001	0	1	04	01	H8481_001_0	6	5	2	OHTH 4																00000000001110	Oral Cancer	Sjorgens	Head and Neck			2	2		2			16c3;	1	2		2						
H8481	001	0	1	04	01	H8481_001_0	6	4	2	OHTH 3																01101010001110	Pregnancy	End Stage Renal Disease	Metabolic Syndrome			2	2		2			16c3;	1	2		2						
H8481	001	0	1	04	01	H8481_001_0	6	3	2	OHTH 2																00000000001110	Oral Cancer	Sjorgens	Head and Neck Cancer			2	2		2			16b4;16b5;16b1;16c3;	1	2		2						
H8481	001	0	1	04	01	H8481_001_0	6	1	3	Food and Utilities										011111111111111111111111100	Chronic Hypertension	Chronic Hyperlipidemia													2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01011		13i1;13i10;
H8481	001	0	1	04	01	H8481_001_0	6	2	2	OHTH 1																01101010001110	Pregnancy	End Stage Renal Disease	Metabolic Syndrome			2	2		2			16b4;16c3;	1	2		2						
H8552	028	0	1	04	01	H8552_028_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;	1	2		2						
H8554	003	0	1	01	01	H8554_003_0	6	1	3	SSBCI Grocery/Dietitian Benefit										000011010000000010000000000															1	001		13i1;14c2;		2		2						
H8597	001	0	1	01	01	H8597_001_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H8597	002	0	1	01	01	H8597_002_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H8597	003	0	1	01	01	H8597_003_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H8604	014	1	1	04	01	H8604_014_1	5	1	3	SSBCI Food & Utilities										011111111111111111111110000															2			13i1;13i10;	1	2		2						
H8604	014	2	1	04	01	H8604_014_2	5	1	3	SSBCI Food & Utilities										011111111111111111111110000															2			13i1;13i10;	1	2		2						
H8634	009	0	1	04	01	H8634_009_0	7	1	3	SSBCI Grocery/Dietitian Benefit										000011010000000010000000000															1	001		13i1;14c2;	2	2		2						
H8649	010	0	1	01	01	H8649_010_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H8649	801	0	1	01	01	H8649_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H8649	801	0	1	01	01	H8649_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H8649	803	0	1	01	01	H8649_803_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H8649	803	0	1	01	01	H8649_803_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c7;16c8;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;16c6;16c9;10b1;	2						
H8797	001	0	1	01	01	H8797_001_0	6	1	3	Combined Flex Benefits										011111111111111111111111110	osteoporosis	chronic hypertension	chronic hyperlipidemia												2			13i1;13i4;		1	13i1;13i4;	2						
H8797	003	0	1	02	01	H8797_003_0	6	1	3	Combined Flex Benefits										011111111111111111111111110	osteoporosis	chronic hypertension	chronic hyperlipidemia												2			13i1;13i4;13i10;	2	1	13i1;13i4;13i10;	2						
H8797	004	0	1	02	01	H8797_004_0	6	1	3	Combined Flex Benefits										011111111111111111111111110	osteoporosis	chronic hypertension	chronic hyperlipidemia												2			13i1;13i4;13i10;	2	1	13i1;13i4;13i10;	2						
H8832	001	0	1	04	01	H8832_001_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;	1	2		2						
H8832	002	0	1	04	01	H8832_002_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;	1	2		2						
H8832	003	0	1	04	01	H8832_003_0	6	1	3	Package 1										000000000010000000000000000															2			13i3;13i1;13i-O1;13i10;14c8;	1	2		1	200.00	7		00010		13i1;13i10;14c8;
H8845	001	0	1	01	01	H8845_001_0	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H8845	004	0	1	01	01	H8845_004_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i4;13i10;
H8845	005	0	1	01	01	H8845_005_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i4;13i10;
H8845	007	1	1	01	01	H8845_007_1	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i4;13i10;
H8845	007	2	1	01	01	H8845_007_2	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i4;13i10;
H8849	001	0	1	02	01	H8849_001_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i2;	2	2		2						
H8849	003	0	1	02	01	H8849_003_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;	2	2		2						
H8849	005	0	1	02	01	H8849_005_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;	2	2		2						
H8849	010	1	1	01	01	H8849_010_1	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H8849	010	2	1	01	01	H8849_010_2	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H8849	010	4	1	01	01	H8849_010_4	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H8849	010	5	1	01	01	H8849_010_5	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H8849	011	1	1	01	01	H8849_011_1	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H8849	011	2	1	01	01	H8849_011_2	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H8849	011	3	1	01	01	H8849_011_3	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H8849	011	4	1	01	01	H8849_011_4	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H8849	011	5	1	01	01	H8849_011_5	7	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i2;13i1;13i10;		2		2						
H8854	002	0	1	01	01	H8854_002_0	7	2	2	PERS																01111010101000	ESRD					2	2		2			14c11;		1	14c11;	2						
H8854	002	0	1	01	01	H8854_002_0	7	1	3	Flex Benefit										011111111111111111111111000	Chronically Underweight														2			13i10;13i1;		2		1	0.00	7		00011		13i1;13i10;
H8879	001	0	1	02	01	H8879_001_0	8	1	3	SSBCI										011111111111111111111110000															2			13i1;13i10;	2	1	13i1;13i10;	1	90.00	5		00010		13i1;13i10;
H8889	001	0	1	04	01	H8889_001_0	5	1	3	SSBCI										000111110111010110000001000	Osteoporosis														1	001		10b1;13i4;13c;13d;14c8;14c20;	1	2		2						
H8889	002	0	1	04	01	H8889_002_0	5	1	3	SSBCI										000111110111010110000000000															1	001		13c;10b1;13i4;14c8;	1	2		2						
H8889	003	0	1	04	01	H8889_003_0	5	1	3	SSBCI										000111110111010110000001000	Osteoporosis														1	001		10b1;13i4;13c;13d;14c8;14c20;	1	2		2						
H8889	004	0	1	04	01	H8889_004_0	5	1	3	SSBCI										000111110111010110000000000															1	001		10b1;13i4;13c;14c8;	1	2		2						
H8889	005	0	1	04	01	H8889_005_0	5	1	3	SSBCI										000111110111010110000000000															1	001		13c;10b1;13i4;14c8;14c20;	1	2		2						
H8889	008	0	1	04	01	H8889_008_0	5	1	3	SSBCI										000111110111010110000000000															1	001		10b1;13i4;13c;14c8;	1	2		2						
H8889	009	0	1	04	01	H8889_009_0	5	1	3	SSBCI										000111110111010110000000000															1	001		13c;14c8;	1	2		2						
H8889	010	0	1	04	01	H8889_010_0	5	1	3	SSBCI										000111110111010110000000000															1	001		13c;14c8;	1	2		2						
H8889	011	0	1	04	01	H8889_011_0	5	1	3	SSBCI										000111110111010110000000000															1	001		13c;14c8;	1	2		2						
H8889	012	0	1	04	01	H8889_012_0	5	1	3	SSBCI										000111110111010110000000000															1	001		13c;14c8;	1	2		2						
H8889	013	0	1	04	01	H8889_013_0	5	1	3	SSBCI										000111110111010110000000000															1	001		13c;14c8;	1	2		2						
H8889	014	0	1	04	01	H8889_014_0	5	1	3	SSBCI										000111110111010110000000000															1	001		13c;14c8;	1	2		2						
H8889	015	0	1	04	01	H8889_015_0	5	1	3	SSBCI										000111110111010110000000000															1	001		13c;14c8;	1	2		2						
H8889	016	0	1	04	01	H8889_016_0	8	1	3	Flex Part C										000010010000001000000000000															2			13i1;13i10;	1	2		1	0.00	7		00010		13i1;13i10;
H8889	017	0	1	04	01	H8889_017_0	5	1	3	SSBCI										000111110111010110000000000															1	001		13c;14c8;	1	2		2						
H8889	018	0	1	04	01	H8889_018_0	5	1	3	SSBCI										000111110111010110000000000															1	001		13c;14c8;	1	2		2						
H8902	002	0	1	01	01	H8902_002_0	7	1	3	Food and Non-medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i1;13i4;		2		2						
H8902	009	0	1	01	01	H8902_009_0	7	1	3	Food, Utilities and Non-Medical Transportation										111111111111111111111111111	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders										2			13i1;13i4;13i10;		1	13i4;13i1;13i10;	2						
H8908	001	0	1	02	01	H8908_001_0	2	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H8908	004	0	1	02	01	H8908_004_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
H8908	005	0	1	01	01	H8908_005_0	5	1	3	Healthy Options Allowance										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H8908	007	0	1	01	01	H8908_007_0	3	2	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;		1	10b1;	2						
H8908	007	0	1	01	01	H8908_007_0	3	1	3	Chronic Care Assistance and Healthy Options										011111110111111111011001100	Chronic Hyperlipidemia	Chronic Hypertension													1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;		1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i8;13i10;14c8;14c10;14c11;14c15;14c19;14c21;14c22;17b2;17b3;17b4;18b1;18c;
H8917	001	0	1	04	01	H8917_001_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	92.00	7		00010		13i1;13i10;
H8917	005	0	1	04	01	H8917_005_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	153.00	7		00010		13i1;13i10;
H8917	006	0	1	04	01	H8917_006_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	297.00	7		00010		13i1;13i10;
H8928	001	0	1	01	01	H8928_001_0	7	1	3	Grocery and Transportation										011111111111111111111110000															2			13i1;13i4;		1	13i1;13i4;	1	0.00	5		01011		13i1;
H9003	001	0	1	02	01	H9003_001_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;	2	2		2						
H9003	006	0	1	02	01	H9003_006_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;	2	2		2						
H9003	009	0	1	02	01	H9003_009_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			13f;	2	2		2						
H9047	043	0	1	01	01	H9047_043_0	10	1	3	SSBCI										011111111111111111111110000															2			13i1;13i4;		1	13i1;13i4;	2						
H9065	001	0	1	01	01	H9065_001_0	6	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H9066	001	0	1	01	01	H9066_001_0	5	1	3	Package 1										011111111111111111111110000															2			13i10;13i1;		2		2						
H9066	002	0	1	01	01	H9066_002_0	6	1	3	Package 1										011111111111111111111110000															2			13i-O1;		2		2						
H9066	003	0	1	01	01	H9066_003_0	7	1	3	Package 1										011111111111111111111110000															2			13i10;13i1;		2		2						
H9147	001	0	1	02	01	H9147_001_0	11	1	3	Non-Medical Transport & Wellness Support Allowance										011111111111111110011011100	Chronic hypertension, Osteoporosis, Chronic low back pain (cLBP)	Pre-diabetes (fasting blood glucose 100-125 mg/dl or Hgb A1C 5.7-6.4%)													2			13i4;13i1;	2	1	13i1;13i4;	2						
H9191	004	0	1	01	01	H9191_004_0	5	1	3	Food and Produce										011111111111111111111110000															2			13i1;		2		2						
H9191	005	0	1	01	01	H9191_005_0	4	1	3	Food and Produce										011111111111111111111110000															2			13i1;		2		2						
H9207	004	0	1	01	01	H9207_004_0	18	1	3	SSBCI Supplemental Benefit Package - Flexcard										011111111111111111111000000															2			13i10;13i1;		2		1	330.00	5		00010		13i1;13i10;
H9207	016	0	1	01	01	H9207_016_0	16	1	3	SSBCI Supplemental Benefit Package - Flexcard										011111111111111111111000000															2			13i10;13i1;		2		1	235.00	5		00010		13i1;13i10;
H9207	017	0	1	01	01	H9207_017_0	16	1	3	SSBCI Supplemental Benefit Package - Flexcard										011111111111111111111000000															2			13i10;13i1;		2		1	700.00	5		00010		13i1;13i10;
H9231	015	0	1	04	01	H9231_015_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	40.00	7		00010		13i1;13i10;
H9231	016	0	1	04	01	H9231_016_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H9231	017	0	1	04	01	H9231_017_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H9231	018	0	1	04	01	H9231_018_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H9231	019	0	1	04	01	H9231_019_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H9231	020	0	1	04	01	H9231_020_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	385.00	7		00010		13i1;13i10;
H9306	004	0	1	01	01	H9306_004_0	6	1	3	Flex Card										011111111111111111111110000															2			13i1;13i3;13i10;		2		1	0.00	7		01010		13i1;13i3;13i10;
H9306	007	0	1	01	01	H9306_007_0	7	1	3	Flex Card										011111111111111111111110000															2			13i1;13i3;13i10;		2		1	0.00	7		01010		13i1;13i3;13i10;
H9314	001	0	1	01	01	H9314_001_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H9314	001	0	1	01	01	H9314_001_0	2	2	2	In-Home Support-Personal Care Services																00000000001000	Individuals with significant functional challenges from neuro, musculoskeletal & sensory impairments								1	001		14c21;		1	14c21;	2						
H9364	002	0	1	02	01	H9364_002_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H9364	003	0	1	02	01	H9364_003_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H9387	004	0	1	04	01	H9387_004_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H9431	801	0	1	04	01	H9431_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7f_2;10b1;13a;13b;13c;13i6;13i7;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;7b1;7b2;13i-O1;	2						
H9431	801	0	1	04	01	H9431_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;10b1;	2						
H9525	003	0	1	01	01	H9525_003_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;		2		2						
H9525	011	0	1	02	01	H9525_011_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;	2	2		2						
H9525	018	0	1	01	01	H9525_018_0	5	1	3	Non-Health Related Benefits										011111111111111111111111100	Chronic Hypertension, Osteoporosis, Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%													2			13i1;13i10;		2		2						
H9572	001	1	1	04	01	H9572_001_1	7	1	3	Food and Produce										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	001	2	1	04	01	H9572_001_2	7	1	3	Food and Produce										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	001	3	1	04	01	H9572_001_3	7	1	3	Food and Produce										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	001	4	1	04	01	H9572_001_4	7	1	3	Food and Produce										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	001	6	1	04	01	H9572_001_6	7	1	3	Food and Produce										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	002	1	1	04	01	H9572_002_1	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-Diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	002	2	1	04	01	H9572_002_2	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-Diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	002	3	1	04	01	H9572_002_3	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-Diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	002	4	1	04	01	H9572_002_4	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-Diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	002	6	1	04	01	H9572_002_6	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-Diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	003	1	1	04	01	H9572_003_1	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	003	2	1	04	01	H9572_003_2	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	003	3	1	04	01	H9572_003_3	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	003	4	1	04	01	H9572_003_4	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	003	6	1	04	01	H9572_003_6	7	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	007	1	1	04	01	H9572_007_1	8	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	007	2	1	04	01	H9572_007_2	8	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	007	3	1	04	01	H9572_007_3	8	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	007	4	1	04	01	H9572_007_4	8	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	007	6	1	04	01	H9572_007_6	8	1	3	Package 1										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	009	0	1	04	01	H9572_009_0	7	1	3	Food and Produce										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	010	0	1	04	01	H9572_010_0	7	1	3	Food and Produce										011111110111111100001001100	Chronic Hypertension	Pre-diabetes													2			13i1;	1	2		1	0.00	5		00010		13i1;
H9590	001	0	1	01	01	H9590_001_0	4	1	3	SSBCI										011111111111111111111110000															2			13i6;14c17;13i-O1;13i-O2;		2		1	200.00	3		01000		13i6;13i-O1;13i-O2;
H9615	021	0	1	04	01	H9615_021_0	16	1	2	Package 1																00000100000000									2			13b;	1	1	13b;	2						
H9615	022	0	1	04	01	H9615_022_0	16	1	2	Package 1																00000100000000									2			13b;	1	1	13b;	2						
H9615	023	0	1	04	01	H9615_023_0	16	1	2	Package 1																00000100000000									2			13b;	1	1	13b;	2						
H9615	024	0	1	04	01	H9615_024_0	16	1	2	Package 1																00000100000000									2			13b;	1	1	13b;	2						
H9623	001	0	1	01	01	H9623_001_0	7	1	3	Non-medical Transportation										011111111111111111111110000															1	001		13i4;		1	13i4;	2						
H9630	010	0	1	02	01	H9630_010_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H9630	011	0	1	02	01	H9630_011_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H9630	014	0	1	02	01	H9630_014_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H9686	004	0	1	01	01	H9686_004_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i10;14c8;13i1;		2		1	50.00	7		00010		13i1;13i10;14c8;
H9686	005	0	1	01	01	H9686_005_0	8	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i1;14c8;13i10;		2		1	0.00	7		00010		13i1;13i10;14c8;
H9686	006	0	1	01	01	H9686_006_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i1;14c8;13i10;		2		1	0.00	7		00010		13i1;13i10;14c8;
H9686	007	0	1	01	01	H9686_007_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i1;13i10;		2		2						
H9686	008	0	1	01	01	H9686_008_0	10	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i10;		2		2						
H9686	009	0	1	01	01	H9686_009_0	7	1	3	Package 1										011111111111111111111110000															2			13i3;13i-O1;13i5;13i1;13i10;14c8;		2		1	25.00	7		00010		13i1;13i10;14c8;
H9700	001	0	1	04	01	H9700_001_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	70.00	7		00010		13i1;13i10;
H9700	003	0	1	04	01	H9700_003_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	60.00	7		00010		13i1;13i10;
H9700	005	0	1	04	01	H9700_005_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	61.00	7		00010		13i1;13i10;
H9706	002	0	1	01	01	H9706_002_0	6	1	3	SSBCI Grocery/Dietitian Benefit										000011010000000010000000000															1	001		13i1;14c2;		2		2						
H9730	003	0	1	02	01	H9730_003_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H9730	004	0	1	02	01	H9730_004_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H9730	011	0	1	02	01	H9730_011_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H9771	001	0	1	01	01	H9771_001_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H9802	004	0	1	04	01	H9802_004_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	162.00	7		00010		13i1;13i10;
H9802	006	0	1	04	01	H9802_006_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	336.00	7		00010		13i1;13i10;
H9802	008	0	1	04	01	H9802_008_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	258.00	7		00010		13i1;13i10;
H9802	009	0	1	04	01	H9802_009_0	7	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H9826	003	0	1	01	01	H9826_003_0	5	1	3	Combined SSBCI Benefits										011111111111111111111110000															2			13i10;13i1;13i6;13i8;		1	13i1;13i6;13i8;13i10;	1	130.00	7		00010		13i1;13i10;
H9826	004	0	1	01	01	H9826_004_0	5	1	3	Combined SSBCI Benefits										011111111111111111111110000															2			13i10;13i1;		1	13i1;13i10;	1	125.00	7		00010		13i1;13i10;
H9834	001	0	1	01	01	H9834_001_0	5	1	3	Package 1										000001011000000000000001000	Chronic Hypertension														1	001		13b;13i1;13i2;		2		2						
H9834	001	0	1	01	01	H9834_001_0	5	2	2	Package 2 Hospital at Home																10110000001111	Pneumonia	Urinary Tract Infection (UTI)	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2		2			13d;		2		2						
H9834	003	0	1	01	01	H9834_003_0	4	1	3	Package 1										000001011000000000000001000	Chronic Hypertension														1	001		13b;13i1;13i2;		2		2						
H9834	003	0	1	01	01	H9834_003_0	4	2	2	Package 2 Hospital at Home																10110000001111	Pneumonia	Urinary Tract Infection (UTI)	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2		2			13d;		2		2						
H9834	004	0	1	01	01	H9834_004_0	3	1	3	Package 1										000001011000000000000001000	Chronic Hypertension														1	001		13b;13i1;13i2;		2		2						
H9834	004	0	1	01	01	H9834_004_0	3	2	2	Package 2 Hospital at Home																10110000001111	Pnuemonia	Urinary Tract Infection (UTI)	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2		2			13d;		2		2						
H9834	006	0	1	01	01	H9834_006_0	4	1	3	Package 1										000001011000000000000001000	Chronic Hypertension														1	001		13b;13i1;13i2;		2		2						
H9834	006	0	1	01	01	H9834_006_0	4	2	2	Package 2 Hospital at Home																10110000001111	Pneumonia	Urinary Tract Infection (UTI)	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2		2			13d;		2		2						
H9834	007	0	1	01	01	H9834_007_0	4	1	3	Package 1										000001011000000000000001000	Chronic Hypertension														1	001		13b;13i1;13i2;		2		2						
H9834	007	0	1	01	01	H9834_007_0	4	2	2	Package 2 Hospital at Home																10110000001111	Pneumonia	Urinary Tract Infection (UTI)	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2		2			13d;		2		2						
H9888	001	0	1	04	01	H9888_001_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	40.00	7		00010		13i1;13i10;
H9888	008	0	1	04	01	H9888_008_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	49.00	7		00010		13i1;13i10;
H9888	009	0	1	04	01	H9888_009_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H9888	010	0	1	04	01	H9888_010_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	49.00	7		00010		13i1;13i10;
H9888	011	0	1	04	01	H9888_011_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H9888	012	0	1	04	01	H9888_012_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	321.00	7		00010		13i1;13i10;
H9888	013	0	1	04	01	H9888_013_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	296.00	7		00010		13i1;13i10;
H9888	014	0	1	04	01	H9888_014_0	5	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	266.00	7		00010		13i1;13i10;
H9888	015	0	1	04	01	H9888_015_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;	1	1	13i1;13i10;	1	291.00	7		00010		13i1;13i10;
H9909	001	0	1	01	01	H9909_001_0	3	1	3	Healthy Food										011111111111111111111110000															1	001		13i1;		1	13i1;	2						
H9916	001	0	1	02	01	H9916_001_0	8	1	3	SSBCI OTC DVH										011111111111111111011011000	Endometriosis														2			14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	1	14c8;13i1;13i2;13i3;13i4;13i5;13i9;13i10;	1	0.00	7		00010		13i1;13i2;13i3;13i4;13i5;13i9;13i10;14c8;
H9917	001	0	1	01	01	H9917_001_0	5	1	3	Combined Flex Benefits										011111111111111111111111110	osteoporosis	chronic hypertension	chronic hyperlipidemia												2			13i1;13i4;13i-O1;		1	13i1;13i4;13i-O1;	2						
H9917	004	0	1	01	01	H9917_004_0	5	1	3	Combined Flex Benefits										011111111111111111111111110	osteoporosis	chronic hypertension	chronic hyperlipidemia												2			13i1;13i-O1;13i4;		1	13i1;13i-O1;13i4;	2						
H9942	001	0	1	04	01	H9942_001_0	6	1	3	SSBCI										011111111111111111111110000															2			13i6;13i4;14c17;13i-O1;10b1;13i-O2;	1	2		1	200.00	3		01000		13i6;13i-O1;13i-O2;
H9942	002	0	1	04	01	H9942_002_0	6	1	3	SSBCI										011111111111111111111110000															2			13i6;13i4;14c17;13i-O1;10b1;13i-O2;	1	2		1	200.00	3		01000		13i6;13i-O1;13i-O2;
H9955	007	0	1	01	01	H9955_007_0	8	1	3	SSBCI										011111111111111111111110000															1	001		13i1;		2		2						
H9955	008	0	1	01	01	H9955_008_0	9	1	3	SSBCI										011111111111111111111110000															1	001		13i1;13i10;13i4;		2		1	0.00	7		00010		13i1;13i4;13i10;
H9977	003	0	1	01	01	H9977_003_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	185.00	7		00010		13i1;13i10;
H9977	004	0	1	01	01	H9977_004_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	276.00	7		00010		13i1;13i10;
H9977	007	0	1	01	01	H9977_007_0	6	1	3	Food, Utility, and Rent Card										111111111111111111111101111	Chronic infectious disorder, Chronic endocrine disease	Chronic Hyperlipidemia, Chronic Hypertension	Chronic Musculoskeletal Disorder, Osteoporosis	Chronic urological disease	Pre-diabetes										2			13i1;13i10;		1	13i1;13i10;	1	185.00	7		00010		13i1;13i10;
H9986	001	0	1	01	01	H9986_001_0	7	1	3	Package 1										011111111111111111111110000															2			13i8;		2		2						
H9986	002	0	1	02	01	H9986_002_0	8	2	3	SSBCI Benefits										011111111111111111111110000															2			13c;13i1;13i8;	2	2		2						
H9986	002	0	1	02	01	H9986_002_0	8	1	2	Advanced Care At Home																01111111110000						2	2		2			13d;	2	2		2						
H9986	004	1	1	02	01	H9986_004_1	10	1	2	Advanced Care At Home																01111111110000						2	2		2			13d;	2	2		2						
H9986	004	1	1	02	01	H9986_004_1	10	2	3	SSBCI Benefits										011111111111111111111110000															2			13c;13i1;13i8;	2	2		2						
H9986	004	2	1	02	01	H9986_004_2	10	2	3	SSBCI Benefits										011111111111111111111110000															2			13c;13i1;13i8;	2	2		2						
H9986	004	2	1	02	01	H9986_004_2	10	1	2	Advanced Care At Home																01111111110000						2	2		2			13d;	2	2		2						
H9986	004	3	1	02	01	H9986_004_3	10	1	2	Advanced Care At Home																01111111110000						2	2		2			13d;	2	2		2						
H9986	004	3	1	02	01	H9986_004_3	10	2	3	SSBCI Benefits										011111111111111111111110000															2			13c;13i1;13i8;	2	2		2						
R0110	001	0	1	31	11	R0110_001_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	1	10b1;	2						
R0110	007	0	1	31	11	R0110_007_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
R0110	011	0	1	31	11	R0110_011_0	3	1	2	Non-Emergency Medical Transportation																00000000001110	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer			2	2		2			10b1;	1	2		2						
R0759	003	0	1	31	11	R0759_003_0	5	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
R2604	002	0	1	31	11	R2604_002_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
R3444	008	0	1	31	11	R3444_008_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
R6801	008	0	1	31	11	R6801_008_0	4	1	3	SSBCI Package 1										000011010000000000000000000															2			13i1;	1	1	13i1;	1	0.00	7		00010		13i1;
R6801	011	0	1	31	11	R6801_011_0	4	1	3	SSBCI Package 1										011111111111111111111001110	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension												2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
