pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	pbp_b13h_add_srvcs_yn	pbp_b13h_addl_services	pbp_b13h_addl_service_other1	pbp_b13h_addl_service_other2	pbp_b13h_addl_service_other3	pbp_b13h_addl_service_other4	pbp_b13h_addl_service_other5	pbp_b13h_addl_service_other6	pbp_b13h_addl_service_other7	pbp_b13h_addl_service_other8	pbp_b13h_addl_service_other9	pbp_b13h_addl_service_other10	pbp_b13h_addl_service_other11	pbp_b13h_addl_service_other12	pbp_b13h_addl_service_other13	pbp_b13h_limit_yn	pbp_b13h_limit_services	pbp_b13h_addl_service_other14	pbp_b13h_addl_service_other15	pbp_b13h_addl_service_other16	pbp_b13h_addl_service_other17	pbp_b13h_addl_service_other18	pbp_b13h_limit_unit_type_epsdt	pbp_b13h_limit_unit_num_epsdt	pbp_b13h_limit_unit_per_epsdt	pbp_b13h_limit_unit_type_tccpw	pbp_b13h_limit_unit_num_tccpw	pbp_b13h_limit_unit_per_tccpw	pbp_b13h_limit_unit_type_fbcs	pbp_b13h_limit_unit_num_fbcs	pbp_b13h_limit_unit_per_fbcs	pbp_b13h_limit_unit_type_rcs	pbp_b13h_limit_unit_num_rcs	pbp_b13h_limit_unit_per_rcs	pbp_b13h_limit_unit_type_fps	pbp_b13h_limit_unit_num_fps	pbp_b13h_limit_unit_per_fps	pbp_b13h_limit_unit_type_nhs	pbp_b13h_limit_unit_num_nhs	pbp_b13h_limit_unit_per_nhs	pbp_b13h_limit_unit_type_hcbs	pbp_b13h_limit_unit_num_hcbs	pbp_b13h_limit_unit_per_hcbs	pbp_b13h_limit_unit_type_pcs	pbp_b13h_limit_unit_num_pcs	pbp_b13h_limit_unit_per_pcs	pbp_b13h_limit_unit_type_sdpas	pbp_b13h_limit_unit_num_sdpas	pbp_b13h_limit_unit_per_sdpas	pbp_b13h_limit_unit_type_pdns	pbp_b13h_limit_unit_num_pdns	pbp_b13h_limit_unit_per_pdns	pbp_b13h_limit_unit_type_cm_lt	pbp_b13h_limit_unit_num_cm_lt	pbp_b13h_limit_unit_per_cm_lt	pbp_b13h_limit_unit_type_imds	pbp_b13h_limit_unit_num_imds	pbp_b13h_limit_unit_per_imds	pbp_b13h_limit_unit_type_icfmr	pbp_b13h_limit_unit_num_icfmr	pbp_b13h_limit_unit_per_icfmr	pbp_b13h_limit_unit_type_cm	pbp_b13h_limit_unit_num_cm	pbp_b13h_limit_unit_per_cm	pbp_b13h_limit_unit_type_oth1	pbp_b13h_limit_unit_num_oth1	pbp_b13h_limit_unit_per_oth1	pbp_b13h_limit_unit_type_oth2	pbp_b13h_limit_unit_num_oth2	pbp_b13h_limit_unit_per_oth2	pbp_b13h_limit_unit_type_oth3	pbp_b13h_limit_unit_num_oth3	pbp_b13h_limit_unit_per_oth3	pbp_b13h_limit_unit_type_oth4	pbp_b13h_limit_unit_num_oth4	pbp_b13h_limit_unit_per_oth4	pbp_b13h_limit_unit_type_oth5	pbp_b13h_limit_unit_num_oth5	pbp_b13h_limit_unit_per_oth5	pbp_b13h_limit_unit_type_oth6	pbp_b13h_limit_unit_num_oth6	pbp_b13h_limit_unit_per_oth6	pbp_b13h_limit_unit_type_oth7	pbp_b13h_limit_unit_num_oth7	pbp_b13h_limit_unit_per_oth7	pbp_b13h_limit_unit_type_oth8	pbp_b13h_limit_unit_num_oth8	pbp_b13h_limit_unit_per_oth8	pbp_b13h_limit_unit_type_oth9	pbp_b13h_limit_unit_num_oth9	pbp_b13h_limit_unit_per_oth9	pbp_b13h_limit_unit_type_oth10	pbp_b13h_limit_unit_num_oth10	pbp_b13h_limit_unit_per_oth10	pbp_b13h_limit_unit_type_oth11	pbp_b13h_limit_unit_num_oth11	pbp_b13h_limit_unit_per_oth11	pbp_b13h_limit_unit_type_oth12	pbp_b13h_limit_unit_num_oth12	pbp_b13h_limit_unit_per_oth12	pbp_b13h_limit_unit_type_oth13	pbp_b13h_limit_unit_num_oth13	pbp_b13h_limit_unit_per_oth13	pbp_b13h_limit_unit_type_oth14	pbp_b13h_limit_unit_num_oth14	pbp_b13h_limit_unit_per_oth14	pbp_b13h_limit_unit_type_oth15	pbp_b13h_limit_unit_num_oth15	pbp_b13h_limit_unit_per_oth15	pbp_b13h_limit_unit_type_oth16	pbp_b13h_limit_unit_num_oth16	pbp_b13h_limit_unit_per_oth16	pbp_b13h_limit_unit_type_oth17	pbp_b13h_limit_unit_num_oth17	pbp_b13h_limit_unit_per_oth17	pbp_b13h_limit_unit_type_oth18	pbp_b13h_limit_unit_num_oth18	pbp_b13h_limit_unit_per_oth18	pbp_b13h_maxplan_yn	pbp_b13h_maxplan_services	pbp_b13h_maxplan_epsdt_amt	pbp_b13h_maxplan_epsdt_per	pbp_b13h_maxplan_tccpw_amt	pbp_b13h_maxplan_tccpw_per	pbp_b13h_maxplan_fbcs_amt	pbp_b13h_maxplan_fbcs_per	pbp_b13h_maxplan_rcs_amt	pbp_b13h_maxplan_rcs_per	pbp_b13h_maxplan_fps_amt	pbp_b13h_maxplan_fps_per	pbp_b13h_maxplan_nhs_amt	pbp_b13h_maxplan_nhs_per	pbp_b13h_maxplan_hcbs_amt	pbp_b13h_maxplan_hcbs_per	pbp_b13h_maxplan_pcs_amt	pbp_b13h_maxplan_pcs_per	pbp_b13h_maxplan_sdpas_amt	pbp_b13h_maxplan_sdpas_per	pbp_b13h_maxplan_pdns_amt	pbp_b13h_maxplan_pdns_per	pbp_b13h_maxplan_cm_ltc_amt	pbp_b13h_maxplan_cm_ltc_per	pbp_b13h_maxplan_imds_amt	pbp_b13h_maxplan_imds_per	pbp_b13h_maxplan_icfmrs_amt	pbp_b13h_maxplan_icfmrs_per	pbp_b13h_maxplan_cm_amt	pbp_b13h_maxplan_cm_per	pbp_b13h_maxplan_other1_amt	pbp_b13h_maxplan_other1_per	pbp_b13h_maxplan_other2_amt	pbp_b13h_maxplan_other2_per	pbp_b13h_maxplan_other3_amt	pbp_b13h_maxplan_other3_per	pbp_b13h_maxplan_other4_amt	pbp_b13h_maxplan_other4_per	pbp_b13h_maxplan_other5_amt	pbp_b13h_maxplan_other5_per	pbp_b13h_maxplan_other6_amt	pbp_b13h_maxplan_other6_per	pbp_b13h_maxplan_other7_amt	pbp_b13h_maxplan_other7_per	pbp_b13h_maxplan_other8_amt	pbp_b13h_maxplan_other8_per	pbp_b13h_maxplan_other9_amt	pbp_b13h_maxplan_other9_per	pbp_b13h_maxplan_other10_amt	pbp_b13h_maxplan_other10_per	pbp_b13h_maxplan_other11_amt	pbp_b13h_maxplan_other11_per	pbp_b13h_maxplan_other12_amt	pbp_b13h_maxplan_other12_per	pbp_b13h_maxplan_other13_amt	pbp_b13h_maxplan_other13_per	pbp_b13h_maxplan_other14_amt	pbp_b13h_maxplan_other14_per	pbp_b13h_maxplan_other15_amt	pbp_b13h_maxplan_other15_per	pbp_b13h_maxplan_other16_amt	pbp_b13h_maxplan_other16_per	pbp_b13h_maxplan_other17_amt	pbp_b13h_maxplan_other17_per	pbp_b13h_maxplan_other18_amt	pbp_b13h_maxplan_other18_per	pbp_b13h_waiver_yn	pbp_b13h_waiver	pbp_b13h_payamt_yn	pbp_b13h_payamt	pbp_b13h_payamt_epsdt_min	pbp_b13h_payamt_epsdt_max	pbp_b13h_payamt_tccpw_min	pbp_b13h_payamt_tccpw_max	pbp_b13h_payamt_fbcs_min	pbp_b13h_payamt_fbcs_max	pbp_b13h_payamt_rcs_min	pbp_b13h_payamt_rcs_max	pbp_b13h_payamt_fps_min	pbp_b13h_payamt_fps_max	pbp_b13h_payamt_nhs_min	pbp_b13h_payamt_nhs_max	pbp_b13h_payamt_hcbs_min	pbp_b13h_payamt_hcbs_max	pbp_b13h_payamt_pcs_min	pbp_b13h_payamt_pcs_max	pbp_b13h_payamt_sdpas_min	pbp_b13h_payamt_sdpas_max	pbp_b13h_payamt_pdns_min	pbp_b13h_payamt_pdns_max	pbp_b13h_payamt_cm_ltc_min	pbp_b13h_payamt_cm_ltc_max	pbp_b13h_payamt_imds_min	pbp_b13h_payamt_imds_max	pbp_b13h_payamt_icfmrs_min	pbp_b13h_payamt_icfmrs_max	pbp_b13h_payamt_cm_min	pbp_b13h_payamt_cm_max
H0022	001	0	1	48	05	H0022_001_0	4	1	01110101001000011000000000000000	Mental Health and Addiction Services from a Certified Provider	Medically Necessary Wheelchair Van												1	00000000001000000000000000000000																																	3	16	1																																																																			2																																																																		1	00000001000000000000000000000000	2																													
H0028	001	0	1	01	01	H0028_001_0	3																																																																																																																																																																																																																								
H0028	002	0	1	01	01	H0028_002_0	3																																																																																																																																																																																																																								
H0028	003	0	1	01	01	H0028_003_0	3																																																																																																																																																																																																																								
H0028	004	0	1	01	01	H0028_004_0	3																																																																																																																																																																																																																								
H0028	801	0	1	01	01	H0028_801_0	3																																																																																																																																																																																																																								
H0028	802	0	1	01	01	H0028_802_0	2																																																																																																																																																																																																																								
H0084	001	0	1	04	01	H0084_001_0	4																																																																																																																																																																																																																								
H0084	004	0	1	04	01	H0084_004_0	4																																																																																																																																																																																																																								
H0084	014	0	1	04	01	H0084_014_0	3																																																																																																																																																																																																																								
H0104	010	1	1	04	01	H0104_010_1	4																																																																																																																																																																																																																								
H0104	010	2	1	04	01	H0104_010_2	4																																																																																																																																																																																																																								
H0104	010	3	1	04	01	H0104_010_3	4																																																																																																																																																																																																																								
H0104	010	4	1	04	01	H0104_010_4	4																																																																																																																																																																																																																								
H0104	010	5	1	04	01	H0104_010_5	4																																																																																																																																																																																																																								
H0104	011	1	1	04	01	H0104_011_1	10																																																																																																																																																																																																																								
H0104	011	2	1	04	01	H0104_011_2	8																																																																																																																																																																																																																								
H0104	011	3	1	04	01	H0104_011_3	8																																																																																																																																																																																																																								
H0104	011	4	1	04	01	H0104_011_4	8																																																																																																																																																																																																																								
H0104	011	5	1	04	01	H0104_011_5	8																																																																																																																																																																																																																								
H0104	011	6	1	04	01	H0104_011_6	8																																																																																																																																																																																																																								
H0104	801	0	1	04	01	H0104_801_0	2																																																																																																																																																																																																																								
H0104	802	0	1	04	01	H0104_802_0	2																																																																																																																																																																																																																								
H0104	804	0	1	04	01	H0104_804_0	2																																																																																																																																																																																																																								
H0105	001	0	1	20	08	H0105_001_0	1																																																																																																																																																																																																																								
H0105	002	0	1	20	08	H0105_002_0	1																																																																																																																																																																																																																								
H0107	001	0	1	04	01	H0107_001_0	8																																																																																																																																																																																																																								
H0107	002	0	1	04	01	H0107_002_0	9																																																																																																																																																																																																																								
H0107	801	0	1	04	01	H0107_801_0	4																																																																																																																																																																																																																								
H0107	802	0	1	04	01	H0107_802_0	4																																																																																																																																																																																																																								
H0108	004	0	1	01	01	H0108_004_0	3																																																																																																																																																																																																																								
H0108	005	0	1	01	01	H0108_005_0	3																																																																																																																																																																																																																								
H0108	006	0	1	01	01	H0108_006_0	3																																																																																																																																																																																																																								
H0108	008	0	1	01	01	H0108_008_0	5																																																																																																																																																																																																																								
H0108	009	0	1	01	01	H0108_009_0	3																																																																																																																																																																																																																								
H0108	010	0	1	01	01	H0108_010_0	3																																																																																																																																																																																																																								
H0108	011	0	1	01	01	H0108_011_0	3																																																																																																																																																																																																																								
H0108	021	0	1	01	01	H0108_021_0	3																																																																																																																																																																																																																								
H0108	022	0	1	01	01	H0108_022_0	3																																																																																																																																																																																																																								
H0108	023	0	1	01	01	H0108_023_0	3																																																																																																																																																																																																																								
H0108	024	0	1	01	01	H0108_024_0	3																																																																																																																																																																																																																								
H0108	025	0	1	01	01	H0108_025_0	3																																																																																																																																																																																																																								
H0108	026	0	1	01	01	H0108_026_0	3																																																																																																																																																																																																																								
H0108	027	0	1	01	01	H0108_027_0	3																																																																																																																																																																																																																								
H0108	028	0	1	01	01	H0108_028_0	3																																																																																																																																																																																																																								
H0108	029	0	1	01	01	H0108_029_0	2																																																																																																																																																																																																																								
H0108	034	0	1	01	01	H0108_034_0	3																																																																																																																																																																																																																								
H0108	035	0	1	01	01	H0108_035_0	3																																																																																																																																																																																																																								
H0108	037	0	1	01	01	H0108_037_0	3																																																																																																																																																																																																																								
H0108	038	0	1	01	01	H0108_038_0	3																																																																																																																																																																																																																								
H0108	039	0	1	01	01	H0108_039_0	3																																																																																																																																																																																																																								
H0108	041	0	1	01	01	H0108_041_0	4																																																																																																																																																																																																																								
H0108	045	0	1	01	01	H0108_045_0	3																																																																																																																																																																																																																								
H0108	046	0	1	01	01	H0108_046_0	3																																																																																																																																																																																																																								
H0108	047	0	1	01	01	H0108_047_0	3																																																																																																																																																																																																																								
H0108	048	0	1	01	01	H0108_048_0	3																																																																																																																																																																																																																								
H0108	050	0	1	01	01	H0108_050_0	3																																																																																																																																																																																																																								
H0108	054	0	1	01	01	H0108_054_0	3																																																																																																																																																																																																																								
H0108	055	0	1	01	01	H0108_055_0	3																																																																																																																																																																																																																								
H0108	056	0	1	01	01	H0108_056_0	3																																																																																																																																																																																																																								
H0108	057	0	1	01	01	H0108_057_0	3																																																																																																																																																																																																																								
H0108	058	0	1	01	01	H0108_058_0	3																																																																																																																																																																																																																								
H0108	059	0	1	01	01	H0108_059_0	3																																																																																																																																																																																																																								
H0108	801	0	1	01	01	H0108_801_0	5																																																																																																																																																																																																																								
H0108	802	0	1	01	01	H0108_802_0	3																																																																																																																																																																																																																								
H0112	001	0	1	20	08	H0112_001_0	1																																																																																																																																																																																																																								
H0112	002	0	1	20	08	H0112_002_0	1																																																																																																																																																																																																																								
H0137	001	0	1	48	05	H0137_001_0	4	1	00111110111000011111111111100000	Behavioral Health Services	Chronic Disease and Rehabilitation Hospital Inpatient	Adult Day Health	Adult Foster Care	Day Habilitation	Group Adult Foster Care	Hospice	Orthotic Services	Speech and Hearing Services	Diversionary Behavioral Health Services	Community Based Services	Abortion		2																																																																																																							2																																																																		2		2																													
H0141	004	1	1	01	01	H0141_004_1	8																																																																																																																																																																																																																								
H0141	004	2	1	01	01	H0141_004_2	9																																																																																																																																																																																																																								
H0141	005	1	1	01	01	H0141_005_1	9																																																																																																																																																																																																																								
H0141	005	3	1	01	01	H0141_005_3	9																																																																																																																																																																																																																								
H0147	001	0	1	48	05	H0147_001_0	4	1	10101110110100111111111111111111	Respite Care Services	Adult Day Health Care	Personal Emergency Response System/Medication Monitoring System	Transition Services	Additional Skilled Nursing Facility Days	Community Mental Health Rehabilitative Services	Additional Outpatient Mental Health Services	Telemedicine Services	HIV Testing and Treatment Counseling (Prenatal)	High Risk Prenatal Services	Additional Outpatient Substance Abuse Treatment Services	Nutritional Education for Pregnant Women	Health Education for Pregnant Women	1	00000000000000010000000000110000	Day & Residential Treatment for Pregnant Women	Federally Qualified Health Center Services/Rural Health Clinic Services	Emergency Custody Orders/Temporary Detention Orders (TDOs)	Court Ordered Services	Service Facilitation																																											3	480	4																															1	3	5	1	12	5																1	00000000000000000010000000000000																																			5000.00	6																													1	10000000110000011110000000000000	1	00000010110000011001000000000000											0.00	2123.00			0.00	2123.00	0.00	2123.00										
H0148	001	0	1	48	05	H0148_001_0	2	1	00100110000010111111111110000000	Nursing Facility Resident Chiropractic Care & Foot Care	Nursing Facility Resident Vision & Dental	Nursing Facility Resident Acupuncture	Nursing Facility Resident Hearing Exams & Hearing Aids	Multi-Senior Services Program (MSSP)	Non-Emergency Medical Transportation	In-Home Supportive Services (IHSS)	Acupuncture (Pregnant Women)	Transgender Services	Incontinence Cream and Diapers				1	00000000000000000000010000000000																																																																		3	283	3																																		1	00000000000000000001000000000000																																					4285.00	3																											1	00000000000000000001000000000000	2																													
H0148	002	0	1	48	05	H0148_002_0	3	1	00100110000010111111111110000000	Nursing Facility Resident Chiropractic Care & Foot Care	Nursing Facility Resident Vision & Dental	Nursing Facility Resident Acupuncture	Nursing Facility Resident Hearing Exams & Hearing Aids	Multi-Senior Services Program (MSSP)	Non-Emergency Medical Transportation	In-Home Supportive Services (IHSS)	Acupuncture (Pregnant Women)	Transgender Services	Incontinence Cream and Diapers				1	00000000000000000000010000000000																																																																		3	283	3																																		1	00000000000000000001000000000000																																					4285.00	3																											1	00000000000000000001000000000000	2																													
H0150	007	0	1	01	01	H0150_007_0	4																																																																																																																																																																																																																								
H0150	012	0	1	01	01	H0150_012_0	2																																																																																																																																																																																																																								
H0150	024	1	1	01	01	H0150_024_1	4																																																																																																																																																																																																																								
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H1723	001	0	1	48	05	H1723_001_0	10	1	00000101111110111111111111100000	Palliative Care	Outpatient Mental Health Services	Infusion Centers	Residential Personal Care Services	Nursing HomeTransition Services	Respite Care	Adult Day Health Services	Environmental Modifications/Enhanced Environmental Modifications	Telemedicine	Companion Services	Adult Day Health Transportation	Two (2) Additional Prescription Drugs		1	00000000000000000001100010000000																																																												1	1	4	1	14	4										3	28	2																									1	00000000000000000000001000000000																																											7500.00	6																					2		2																													
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H1737	802	0	1	01	01	H1737_802_0	1																																																																																																																																																																																																																								
H1737	803	0	1	01	01	H1737_803_0	1																																																																																																																																																																																																																								
H1777	007	0	1	01	01	H1777_007_0	12																																																																																																																																																																																																																								
H1846	001	0	1	04	01	H1846_001_0	8																																																																																																																																																																																																																								
H1846	003	0	1	04	01	H1846_003_0	9																																																																																																																																																																																																																								
H1846	801	0	1	04	01	H1846_801_0	2																																																																																																																																																																																																																								
H1846	802	0	1	04	01	H1846_802_0	2																																																																																																																																																																																																																								
H1849	017	0	1	01	01	H1849_017_0	12																																																																																																																																																																																																																								
H1849	018	0	1	01	01	H1849_018_0	14																																																																																																																																																																																																																								
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H1903	022	0	1	01	01	H1903_022_0	7																																																																																																																																																																																																																								
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H1906	001	0	1	09	04	H1906_001_0	3																																																																																																																																																																																																																								
H1916	001	0	1	48	05	H1916_001_0	9	1	10111111111100111111111111111111	Adult Day Health Care, AIDS Adult Day Health Care	Nutrition, Wellness Counseling	Assertive Community Treatment, Assisted Living Program	Outpatient Hospitalization, Outpatient Surgery	Community Integration Counseling, Community Transition Services	Day Treatment, Continuing Day Treatment, OMH Licensed CRs	Substance Abuse Prog., Opioid Treatment Svcs - Substance Abuse	Medication Therapy Management	Medicare Part A and B Services as Covered by Medicaid	Intensive Psychiatric Rehab. Svcs., Partial Hospitalization (Medicaid)	Home Maintenance Services, Moving Assistance	Home Visits by Medical Personnel, Respite, Personal Emerg. Response Svcs	Independent Living Skills Traning and Development	2		Peer-Delivered Services, Peer Mentoring, Mobile Mental Health	Home and Comm. Support Services, Medical Social Services	Social Day Care, Structured Day Program, Soc. and Environmental Svcs.	Outpat. MH, Outpat. SA, Outpat. Med. Supervised Subst. Withdrawal - SA	Personalized Recovery Oriented Svcs., Pos. Behav. Interventions and Svcs																																																																																																	2																																																																		2		2																													
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H1994	003	0	1	02	01	H1994_003_0	10																																																																																																																																																																																																																								
H1994	004	0	1	02	01	H1994_004_0	10																																																																																																																																																																																																																								
H1994	005	0	1	02	01	H1994_005_0	8																																																																																																																																																																																																																								
H1994	006	0	1	02	01	H1994_006_0	8																																																																																																																																																																																																																								
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H1994	802	0	1	02	01	H1994_802_0	2																																																																																																																																																																																																																								
H1994	803	0	1	02	01	H1994_803_0	2																																																																																																																																																																																																																								
H1997	002	0	1	01	01	H1997_002_0	9																																																																																																																																																																																																																								
H2001	001	0	1	04	01	H2001_001_0	4																																																																																																																																																																																																																								
H2001	816	0	1	04	01	H2001_816_0	2																																																																																																																																																																																																																								
H2001	817	0	1	04	01	H2001_817_0	2																																																																																																																																																																																																																								
H2001	818	0	1	04	01	H2001_818_0	2																																																																																																																																																																																																																								
H2001	819	0	2	04	01	H2001_819_0	2																																																																																																																																																																																																																								
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H2001	827	0	1	04	01	H2001_827_0	2																																																																																																																																																																																																																								
H2001	828	0	1	04	01	H2001_828_0	2																																																																																																																																																																																																																								
H2001	829	0	1	04	01	H2001_829_0	2																																																																																																																																																																																																																								
H2001	830	0	1	04	01	H2001_830_0	2																																																																																																																																																																																																																								
H2001	831	0	1	04	01	H2001_831_0	2																																																																																																																																																																																																																								
H2001	832	0	2	04	01	H2001_832_0	2																																																																																																																																																																																																																								
H2001	833	0	2	04	01	H2001_833_0	2																																																																																																																																																																																																																								
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H2005	001	0	1	48	05	H2005_001_0	3	1	00111110111000011111111111100000	Behavioral Health Services	Chronic Disease and Rehabilitation Hospital Inpatient	Adult Day Health	Adult Foster Care	Day Habilitation	Group Adult Foster Care	Hospice	Orthotic Services	Speech and Hearing Services	Diversionary Behavioral Health Services	Community-based Services	Abortion		2																																																																																																							2																																																																		2		2																													
H2012	002	0	1	01	01	H2012_002_0	3																																																																																																																																																																																																																								
H2012	003	0	1	01	01	H2012_003_0	3																																																																																																																																																																																																																								
H2012	006	0	1	01	01	H2012_006_0	4																																																																																																																																																																																																																								
H2012	008	0	1	01	01	H2012_008_0	5																																																																																																																																																																																																																								
H2012	009	0	1	01	01	H2012_009_0	3																																																																																																																																																																																																																								
H2012	011	0	1	01	01	H2012_011_0	5																																																																																																																																																																																																																								
H2012	012	0	1	01	01	H2012_012_0	5																																																																																																																																																																																																																								
H2012	013	0	1	01	01	H2012_013_0	3																																																																																																																																																																																																																								
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H3018	001	0	1	48	05	H3018_001_0	4	1	10111111111100111111111111111111	Adult Day Health Care, AIDS Adult Day Health Care	Nutrition, Wellness Counseling	Assertive Community Treatment, Assisted Living Program	Outpatient Hospitalization, Outpatient Surgery	Community Integration Counseling, Community Transition Services	Day Treatment, Continuing Day Treatment, OMH Licensed CRs	Substance Abuse Prog., Opioid Treatment Svcs-Substance Abuse	Medication Therapy Management	Medicare Pt A and B Services as Covered by Medicaid	Intensive Psychiatric Rehab. Svcs., Partial Hosp (Medicaid)	Home Maintenance Services, Moving Assistance	Home visits by Medical Personnel,Respite,Personal Emerg. Response Svcs.	Independent Living Skills Training and Development	2		Peer-Delivered Services, Peer Mentoring, Mobile Mental Health	Home and Comm Support Services, Medical Social Services	Social Day Care,Structured Day Program, Soc. and Environmental Svcs	Outpat. MH, Outpat. SA, Outpat. Med. Supervised Subst. Withdrawal-SA	Personalized Recovery Oriented Svcs, Pos. Behav. Interventions and Svcs																																																																																																	2																																																																		2		2																													
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H3060	002	0	1	20	08	H3060_002_0	1																																																																																																																																																																																																																								
H3067	001	0	1	48	05	H3067_001_0	5	1	10101110110100111111111111111111	Respite Care Services	Adult Day Health Care	Personal Emergency/Medication Monitoring System	Transition Services	Additional Skilled Nursing Facility Days	Community Mental Health Rehabilitative Services	Additional Outpatient Mental Health Services	Telemedicine Services	HIV Testing and Treatment Counseling (Prenatal)	High Risk Prenatal Services	Additional Outpatient Substance Abuse Treatment Services	Nutrition Education for Pregnant Women	Health Education for Pregnant Women	1	00000000000000010000000000110000	Day and Residental Treatment for Pregnant Women	Federal Qualified Health Center Services/Rural Health Clinic Services	Emergency Custody Orders/Temporary Detention Orders (TDOs)	Court Ordered Services	Service Facililation																																											3	480	4																															1	3	5	1	12	5																1	00000000000000000010000000000000																																			5000.00	6																													1	10000000110000011110000000000000	1	00000010110000011001000000000000											0.00	2123.00			0.00	2123.00	0.00	2123.00										
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H7115	801	0	1	01	01	H7115_801_0	3																																																																																																																																																																																																																								
H7115	802	0	1	01	01	H7115_802_0	3																																																																																																																																																																																																																								
H7115	803	0	1	01	01	H7115_803_0	3																																																																																																																																																																																																																								
H7149	001	0	1	01	01	H7149_001_0	4																																																																																																																																																																																																																								
H7149	004	0	1	01	01	H7149_004_0	5																																																																																																																																																																																																																								
H7149	005	0	1	01	01	H7149_005_0	4																																																																																																																																																																																																																								
H7149	801	0	1	01	01	H7149_801_0	1																																																																																																																																																																																																																								
H7149	802	0	1	01	01	H7149_802_0	1																																																																																																																																																																																																																								
H7172	001	0	1	48	05	H7172_001_0	2	1	01110101001000011000000000000000	Mental Health and Addiction Services from a Certified Provider	Medically Necessary Wheelchair Van												1	00000000001000000000000000000000																																	3	16	1																																																																			2																																																																		1	00000001000000000000000000000000	2																													
H7173	001	0	1	01	01	H7173_001_0	7																																																																																																																																																																																																																								
H7187	003	0	1	01	01	H7187_003_0	2																																																																																																																																																																																																																								
H7187	009	0	1	01	01	H7187_009_0	2																																																																																																																																																																																																																								
H7187	010	0	1	01	01	H7187_010_0	2																																																																																																																																																																																																																								
H7187	011	0	1	01	01	H7187_011_0	2																																																																																																																																																																																																																								
H7195	001	0	1	20	08	H7195_001_0	1																																																																																																																																																																																																																								
H7195	002	0	1	20	08	H7195_002_0	1																																																																																																																																																																																																																								
H7200	006	0	1	01	01	H7200_006_0	11																																																																																																																																																																																																																								
H7200	007	0	1	01	01	H7200_007_0	12																																																																																																																																																																																																																								
H7220	002	0	1	01	01	H7220_002_0	8																																																																																																																																																																																																																								
H7220	003	0	1	01	01	H7220_003_0	9																																																																																																																																																																																																																								
H7220	004	0	1	02	01	H7220_004_0	9																																																																																																																																																																																																																								
H7220	801	0	1	02	01	H7220_801_0	6																																																																																																																																																																																																																								
H7220	802	0	1	02	01	H7220_802_0	7																																																																																																																																																																																																																								
H7220	804	0	1	01	01	H7220_804_0	7																																																																																																																																																																																																																								
H7220	805	0	1	01	01	H7220_805_0	7																																																																																																																																																																																																																								
H7245	001	0	1	01	01	H7245_001_0	12																																																																																																																																																																																																																								
H7245	002	0	1	02	01	H7245_002_0	10																																																																																																																																																																																																																								
H7245	003	0	1	01	01	H7245_003_0	7																																																																																																																																																																																																																								
H7245	004	0	1	02	01	H7245_004_0	13																																																																																																																																																																																																																								
H7301	002	0	1	04	01	H7301_002_0	7																																																																																																																																																																																																																								
H7301	006	0	1	04	01	H7301_006_0	5																																																																																																																																																																																																																								
H7301	007	0	1	04	01	H7301_007_0	5																																																																																																																																																																																																																								
H7301	008	0	1	04	01	H7301_008_0	4																																																																																																																																																																																																																								
H7301	801	0	1	04	01	H7301_801_0	2																																																																																																																																																																																																																								
H7301	803	0	1	04	01	H7301_803_0	2																																																																																																																																																																																																																								
H7306	001	0	1	04	01	H7306_001_0	13																																																																																																																																																																																																																								
H7306	801	0	1	04	01	H7306_801_0	1																																																																																																																																																																																																																								
H7306	803	0	1	04	01	H7306_803_0	1																																																																																																																																																																																																																								
H7419	001	0	1	48	05	H7419_001_0	4	1	00111110111000011111111111100000	Behavioral Health Services	Chronic Disease and Rehabilitation Hospital Inpatient	Adult Day Health	Adult Foster Care	Day Habilitation	Group Adult Foster Care	Hospice	Orthotic Services	Speech and Hearing Services	Diversionary Behavioral Health Services	Community Based Services	Abortion		2																																																																																																							2																																																																		2		2																													
H7475	001	0	1	01	01	H7475_001_0	2																																																																																																																																																																																																																								
H7501	001	0	1	20	08	H7501_001_0	1																																																																																																																																																																																																																								
H7501	002	0	1	20	08	H7501_002_0	1																																																																																																																																																																																																																								
H7542	001	0	1	48	05	H7542_001_0	3	1	00000101111110111111111111100000	Palliative Care	Outpatient Mental Health Services	Infusion Centers	Residential Personal Care Services	Nursing Home Transition Services	Respite Care	Adult Day Health Services	Environmental Modifications	Telemedicine	Companion Services	Adult Day Health Transportation	Two (2) Additional Prescription Drugs		1	00000000000000000001100010000000																																																												1	1	4	1	14	4										3	28	2																									1	00000000000000000000001000000000																																											7500.00	6																					1	00000001111100000011111011100000	2																													
H7660	001	0	1	20	08	H7660_001_0	1																																																																																																																																																																																																																								
H7660	002	0	1	20	08	H7660_002_0	1																																																																																																																																																																																																																								
H7678	001	0	1	01	01	H7678_001_0	9																																																																																																																																																																																																																								
H7680	001	0	1	01	01	H7680_001_0	9																																																																																																																																																																																																																								
H7680	002	0	1	01	01	H7680_002_0	9																																																																																																																																																																																																																								
H7680	801	0	1	01	01	H7680_801_0	5																																																																																																																																																																																																																								
H7680	802	0	1	01	01	H7680_802_0	8																																																																																																																																																																																																																								
H7680	803	0	1	01	01	H7680_803_0	7																																																																																																																																																																																																																								
H7680	804	0	1	01	01	H7680_804_0	4																																																																																																																																																																																																																								
H7680	805	0	1	01	01	H7680_805_0	6																																																																																																																																																																																																																								
H7680	806	0	1	01	01	H7680_806_0	6																																																																																																																																																																																																																								
H7728	002	0	1	04	01	H7728_002_0	15																																																																																																																																																																																																																								
H7728	801	0	1	04	01	H7728_801_0	7																																																																																																																																																																																																																								
H7728	802	0	1	04	01	H7728_802_0	6																																																																																																																																																																																																																								
H7728	803	0	1	04	01	H7728_803_0	6																																																																																																																																																																																																																								
H7787	001	0	1	04	01	H7787_001_0	3																																																																																																																																																																																																																								
H7787	002	0	1	04	01	H7787_002_0	3																																																																																																																																																																																																																								
H7811	002	0	1	01	01	H7811_002_0	4																																																																																																																																																																																																																								
H7844	001	0	1	48	05	H7844_001_0	4	1	00000010101000011111111111111100	Adaptive Medical Equipment and Supplies	Adult Day Program	Assistive Technology Devices	Assistive Technology Van Lifts and Tie Downs	Chore Services	Community Transition Services	Environmental Modifications	Expanded Community Living Supports	Fiscal Intermediary Services	Home Delivered Meals	Non-medical transportation	Personal Emergency Response System	Preventive Nursing Services	1	00000000001000000000000010010100	Respite - Waiver Service	Respite - General Service																															3	16	1																																								5	2	1							3	2	5				2	14	4										1	00000000000000000110000000000000																																	5000.00	3	15000.00	6																													1	00000000001000001111011111011000	1	00000010000000000000000000000000											0.00	9999.00																
H7855	001	0	1	20	08	H7855_001_0	1																																																																																																																																																																																																																								
H7855	002	0	1	20	08	H7855_002_0	1																																																																																																																																																																																																																								
H7885	001	0	1	48	05	H7885_001_0	4	1	00100110000010111111111110000000	Nursing Facility Resident Chiropractic Care & Foot Care	Nursing Facility Resident Vision & Dental	Nursing Facility Resident Acupuncture	Nursing Facility Resident Hearing Exams & Hearing Aids	Multi-Senior Services Program (MSSP)	Non-Emergency Medical Transportation	In-Home Supportivie Services (IHSS)	Acupuncture (Pregnam Women)	Transgender Services	Incontinence Cream and Diapers				1	00000000000000000000010000000000																																																																		3	283	3																																		1	00000000000000000001000000000000																																					3570.84	3																											1	00000000000000000001000000000000	2																													
H7890	001	0	1	48	05	H7890_001_0	2	1	00100110000010111111111110000000	Nursing Facility Resident Chiropractic Care & Foot Care	Nursing Facility Resident Vision & Dental	Nursing Facility Resident Acupuncture	Nursing Facility Resident Hearing Exams & Hearing Aids	Multi-Senior Services Program (MSSP)	Non-Emergency Medical Transport	In-Home Supportive Services (IHSS)	Acupuncture (Pregnant Women)	Transgender Services	Incontinence Cream and Diapers				1	00000000000000000000010000000000																																																																		3	283	3																																		1	00000000000000000001000000000000																																					4285.00	3																											1	00000000000000000001000000000000	2																													
H7903	001	0	1	01	01	H7903_001_0	12																																																																																																																																																																																																																								
H7908	001	0	1	01	01	H7908_001_0	6																																																																																																																																																																																																																								
H7908	801	0	1	01	01	H7908_801_0	2																																																																																																																																																																																																																								
H7908	802	0	1	01	01	H7908_802_0	2																																																																																																																																																																																																																								
H7917	008	0	1	04	01	H7917_008_0	7																																																																																																																																																																																																																								
H7917	009	0	1	04	01	H7917_009_0	7																																																																																																																																																																																																																								
H7917	010	0	1	04	01	H7917_010_0	7																																																																																																																																																																																																																								
H7917	011	0	1	04	01	H7917_011_0	7																																																																																																																																																																																																																								
H7917	012	0	1	04	01	H7917_012_0	8																																																																																																																																																																																																																								
H7917	013	0	1	04	01	H7917_013_0	8																																																																																																																																																																																																																								
H7917	014	0	1	04	01	H7917_014_0	8																																																																																																																																																																																																																								
H7917	015	0	1	04	01	H7917_015_0	8																																																																																																																																																																																																																								
H7917	030	0	1	04	01	H7917_030_0	7																																																																																																																																																																																																																								
H7917	031	0	1	04	01	H7917_031_0	7																																																																																																																																																																																																																								
H7917	032	0	1	04	01	H7917_032_0	7																																																																																																																																																																																																																								
H7917	033	0	1	04	01	H7917_033_0	7																																																																																																																																																																																																																								
H7917	801	0	1	04	01	H7917_801_0	1																																																																																																																																																																																																																								
H7917	802	0	1	04	01	H7917_802_0	1																																																																																																																																																																																																																								
H7917	803	0	1	04	01	H7917_803_0	2																																																																																																																																																																																																																								
H7949	001	0	1	01	01	H7949_001_0	4																																																																																																																																																																																																																								
H7949	801	0	1	01	01	H7949_801_0	1																																																																																																																																																																																																																								
H7949	803	0	1	01	01	H7949_803_0	1																																																																																																																																																																																																																								
H7949	804	0	1	01	01	H7949_804_0	1																																																																																																																																																																																																																								
H7960	001	0	1	01	01	H7960_001_0	8																																																																																																																																																																																																																								
H7971	001	0	1	04	01	H7971_001_0	10																																																																																																																																																																																																																								
H7971	801	0	1	04	01	H7971_801_0	8																																																																																																																																																																																																																								
H7971	802	0	1	04	01	H7971_802_0	7																																																																																																																																																																																																																								
H8016	001	0	1	48	05	H8016_001_0	2	1	00100110000010111111111110000000	Nursing Facility Resident Chiropractic Care & Foot Care	Nursing Facility Resident Vision & Dental	Nursing Facility Resident Acupuncture	Nursing Facility Resident Hearing Exams & Hearing Aids	Multi-Senior Services Program (MSSP)	Non-Emergency Medical Transportation	In-Home Supportive Services (IHSS)	Acupuncture (Pregnant Women)	Transgender Services	Incontinence Cream and Diapers				1	00000000000000000000010000000000																																																																		3	283	3																																		1	00000000000000000001000000000000																																					4285.00	3																											1	00000000000000000001000000000000	2																													
H8026	001	0	1	48	05	H8026_001_0	11	1	00000010101000011111111111111100	Adaptive Medical Equipment and Supplies	Adult Day Program	Assistive Technology Devices	Assistive Technology Van Lifts and Tie Downs	Chore Services	Community Transition Services	Environmental Modifications	Expanded Community Living Supports	Fiscal intermediary Services	Home Delivered Meals	Non-medical transportation	Personal Emergency Reponse System	Preventive Nursing Services	1	00000000001000000000000010010100	Respite - Waiver Service	Respite - General Service																															3	16	1																																								5	2	1							3	2	5				2	14	4										1	00000000000000000110000000000000																																	5000.00	3	15000.00	6																													1	00000000001000001111011111011000	1	00000010000000000000000000000000											0.00	9999.00																
H8029	001	0	1	48	05	H8029_001_0	6	1	00000000000000000000010000000000							Substance Abuse Prog., Opiod Treatment Svcs -Substance Abuse							2																																																																																																							2																																																																		2		2																													
H8046	001	0	1	48	05	H8046_001_0	5	1	00100111000001011110000000000000	Hospice	Behavioral Health	Telehealth	Emergency Dental										2																																																																																																							2																																																																		1	00000001000000000000000000000000	1	00000010000001000000000000000000											0.00	6477.00													0.00	6477.00		
H8056	001	0	1	48	05	H8056_001_0	5	1	10111111111100111111111111111111	Adult Day Health Care, AIDS Adult Day Health Care	Nutrition, Wellness Counseling	Assertive Community Treatment, Assisted Living Program	Outpatient Hospitalization, Outpatient Surgery	Community Integration Counseling, Community Transition Services	Day Treatment, Continuing Day Treatment, OMH Licensed CRs	Substance Abuse Prog., Opiod Treatment Svcs - Substance Abuse	Medication Therapy Management	Medicare Pt. A and B Services as Covered by Medicaid	Intensive Psychiatric Rehab. Svcs., Partial Hosp. (Medicaid)	Home Maintenance Services, Moving Assistance	Home visits by Medical Personnel, Respite, Personal Emerg. Response Svcs	Independent Living Skills Training and Development	2		Peer-Delivered Services, Peer Mentoring, Mobile Mental Health	Home and Comm. Support Services, Medical Social Services	Social Day Care, Structured Day Program, Soc. and Environmental Svcs.	Outpat. MH, Outpat. SA, Outpat. Med. Supervised Subst. Withdrawal - SA	Personalized Recovery Oriented Svcs., Pos. Behav. Interventions and Svcs																																																																																																	2																																																																		2		2																													
H8064	002	0	1	04	01	H8064_002_0	6																																																																																																																																																																																																																								
H8091	002	0	1	04	01	H8091_002_0	11																																																																																																																																																																																																																								
H8091	004	0	1	04	01	H8091_004_0	10																																																																																																																																																																																																																								
H8096	001	0	1	20	08	H8096_001_0	1																																																																																																																																																																																																																								
H8096	002	0	1	20	08	H8096_002_0	1																																																																																																																																																																																																																								
H8130	001	0	1	01	01	H8130_001_0	11																																																																																																																																																																																																																								
H8133	001	0	1	01	01	H8133_001_0	15																																																																																																																																																																																																																								
H8133	801	0	1	01	01	H8133_801_0	4																																																																																																																																																																																																																								
H8133	803	0	1	01	01	H8133_803_0	4																																																																																																																																																																																																																								
H8133	805	0	1	01	01	H8133_805_0	4																																																																																																																																																																																																																								
H8145	003	0	1	09	04	H8145_003_0	4																																																																																																																																																																																																																								
H8145	004	0	1	09	04	H8145_004_0	3																																																																																																																																																																																																																								
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H8634	815	0	1	04	01	H8634_815_0	4																																																																																																																																																																																																																								
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H8649	803	0	1	01	01	H8649_803_0	2																																																																																																																																																																																																																								
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