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_addl_service_other19	pbp_b13h_addl_service_other20	pbp_b13h_addl_service_other21	pbp_b13h_addl_service_other22	pbp_b13h_addl_service_other23	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_limit_unit_type_oth19	pbp_b13h_limit_unit_num_oth19	pbp_b13h_limit_unit_per_oth19	pbp_b13h_limit_unit_type_oth20	pbp_b13h_limit_unit_num_oth20	pbp_b13h_limit_unit_per_oth20	pbp_b13h_limit_unit_type_oth21	pbp_b13h_limit_unit_num_oth21	pbp_b13h_limit_unit_per_oth21	pbp_b13h_limit_unit_type_oth22	pbp_b13h_limit_unit_num_oth22	pbp_b13h_limit_unit_per_oth22	pbp_b13h_limit_unit_type_oth23	pbp_b13h_limit_unit_num_oth23	pbp_b13h_limit_unit_per_oth23	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_maxplan_other19_amt	pbp_b13h_maxplan_other19_per	pbp_b13h_maxplan_other20_amt	pbp_b13h_maxplan_other20_per	pbp_b13h_maxplan_other21_amt	pbp_b13h_maxplan_other21_per	pbp_b13h_maxplan_other22_amt	pbp_b13h_maxplan_other22_per	pbp_b13h_maxplan_other23_amt	pbp_b13h_maxplan_other23_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
H0022	001	0	1	48	05	H0022_001_0	6	1	1111010100100001111111111111111111111	Mental Health and Addiction Services from a Certified Provider	Medically Necessary Wheelchair Van	Adult Day Health Services	Alternative Meals Services	Assisted Living Services	Choices Home Care Assistant	Chore Services	Community Transition	Emergency Response Services	Enhanced Community Living Services	Home Care Attendant	Home Delivered Meals	Home Medical Equipment and Supplemental Adaptive and Assistive Serivc	1	0000000000100000000000000000000000000	Home Modification, Maintenance, and Repair	Homemaker Services	Independent Living Assistance	Nutritional Consultation	Out of Home Respite Services	Personal Care Services	Pest Control	Social Work Counseling	Waiver Nursing Services	Waiver Transportation																												3	16	1																																																																																		1	0000000000000000000000000001100000000																																																					10000.00	3	10000.00	3																			1	1000000100000000011111111111111111111	1	0000000000000000000100000000000000000																									
H0028	001	0	1	01	01	H0028_001_0	3																																																																																																																																																																																																																																																			
H0028	004	0	1	01	01	H0028_004_0	3																																																																																																																																																																																																																																																			
H0028	801	0	1	01	01	H0028_801_0	1																																																																																																																																																																																																																																																			
H0028	802	0	1	01	01	H0028_802_0	1																																																																																																																																																																																																																																																			
H0104	012	0	1	04	01	H0104_012_0	3																																																																																																																																																																																																																																																			
H0104	013	0	1	04	01	H0104_013_0	3																																																																																																																																																																																																																																																			
H0104	014	0	1	04	01	H0104_014_0	3																																																																																																																																																																																																																																																			
H0104	015	0	1	04	01	H0104_015_0	4																																																																																																																																																																																																																																																			
H0104	801	0	1	04	01	H0104_801_0	1																																																																																																																																																																																																																																																			
H0104	802	0	1	04	01	H0104_802_0	1																																																																																																																																																																																																																																																			
H0104	804	0	1	04	01	H0104_804_0	1																																																																																																																																																																																																																																																			
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	10																																																																																																																																																																																																																																																			
H0107	002	0	1	04	01	H0107_002_0	10																																																																																																																																																																																																																																																			
H0107	801	0	1	04	01	H0107_801_0	5																																																																																																																																																																																																																																																			
H0107	802	0	1	04	01	H0107_802_0	5																																																																																																																																																																																																																																																			
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	0011111011100001111111111111000000000	Behavioral Health Care 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	Gender Reassignment	2																																																																																																																											2																																																																												2		1	0000001000000000000000000000000000000																									
H0141	004	1	1	01	01	H0141_004_1	3																																																																																																																																																																																																																																																			
H0141	004	2	1	01	01	H0141_004_2	3																																																																																																																																																																																																																																																			
H0141	005	1	1	01	01	H0141_005_1	4																																																																																																																																																																																																																																																			
H0141	005	3	1	01	01	H0141_005_3	4																																																																																																																																																																																																																																																			
H0147	001	0	1	48	05	H0147_001_0	7	1	0010111011010011111111111111111111000	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	0000000000000001000000000011000000000	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	Transportation																																															3	480	4																															1	3	6	1	12	6																															1	0000000000000000001000000000000000000																																			5000.00	6																																							1	0000000011000001111000000000000010000	1	0000001011000001100100000000000000000																									
H0148	001	0	1	48	05	H0148_001_0	2	1	0010011000001011111111111000000000000	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	0000000000000000000001000000000000000																																																																							3	283	3																																																	1	0000000000000000000100000000000000000																																					4285.00	3																																					1	0000000000000000000100000000000000000	2																										
H0148	002	0	1	48	05	H0148_002_0	2	1	0010011000001011111111111000000000000	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	0000000000000000000001000000000000000																																																																							3	283	3																																																	1	0000000000000000000100000000000000000																																					4285.00	3																																					1	0000000000000000000100000000000000000	2																										
H0150	007	0	1	01	01	H0150_007_0	4																																																																																																																																																																																																																																																			
H0150	012	0	1	01	01	H0150_012_0	3																																																																																																																																																																																																																																																			
H0150	024	1	1	01	01	H0150_024_1	4																																																																																																																																																																																																																																																			
H0150	024	2	1	01	01	H0150_024_2	4																																																																																																																																																																																																																																																			
H0150	025	0	1	02	01	H0150_025_0	5																																																																																																																																																																																																																																																			
H0150	804	0	1	01	01	H0150_804_0	4																																																																																																																																																																																																																																																			
H0150	808	0	1	02	01	H0150_808_0	3																																																																																																																																																																																																																																																			
H0150	809	0	1	01	01	H0150_809_0	3																																																																																																																																																																																																																																																			
H0150	810	0	1	01	01	H0150_810_0	3																																																																																																																																																																																																																																																			
H0150	811	0	1	02	01	H0150_811_0	3																																																																																																																																																																																																																																																			
H0150	812	0	1	02	01	H0150_812_0	3																																																																																																																																																																																																																																																			
H0151	001	0	1	01	01	H0151_001_0	2																																																																																																																																																																																																																																																			
H0151	015	0	1	01	01	H0151_015_0	4																																																																																																																																																																																																																																																			
H0151	025	0	1	01	01	H0151_025_0	3																																																																																																																																																																																																																																																			
H0151	027	0	1	01	01	H0151_027_0	3																																																																																																																																																																																																																																																			
H0151	801	0	1	01	01	H0151_801_0	1																																																																																																																																																																																																																																																			
H0151	804	0	1	01	01	H0151_804_0	1																																																																																																																																																																																																																																																			
H0151	805	0	1	01	01	H0151_805_0	1																																																																																																																																																																																																																																																			
H0154	008	0	1	01	01	H0154_008_0	4																																																																																																																																																																																																																																																			
H0154	011	0	1	01	01	H0154_011_0	6																																																																																																																																																																																																																																																			
H0154	012	0	1	01	01	H0154_012_0	7																																																																																																																																																																																																																																																			
H0154	014	0	1	01	01	H0154_014_0	5																																																																																																																																																																																																																																																			
H0154	015	1	1	01	01	H0154_015_1	6																																																																																																																																																																																																																																																			
H0154	015	2	1	01	01	H0154_015_2	6																																																																																																																																																																																																																																																			
H0154	801	0	1	01	01	H0154_801_0	4																																																																																																																																																																																																																																																			
H0154	802	0	1	01	01	H0154_802_0	4																																																																																																																																																																																																																																																			
H0154	803	0	1	01	01	H0154_803_0	4																																																																																																																																																																																																																																																			
H0174	001	0	1	01	01	H0174_001_0	5																																																																																																																																																																																																																																																			
H0192	001	0	1	48	05	H0192_001_0	11	1	0000001010100011111111111111110000000	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 Service	Home Delivered Meals	Non-Medical Transportation	Personal Emergency Response System	Preventive Nursing Services	1	0000000000100000000000001001010000000	Respite Waiver Service	Respite - General Service																																				3	16	1																																								5	2	1							3	2	8				2	14	4																									1	0000000000000000011000000000000000000																																	5000.00	3	15000.00	6																																							2		1	0000001000000000000000000000000000000																									
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H0216	002	0	1	20	08	H0216_002_0	1																																																																																																																																																																																																																																																			
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H1961	014	2	1	01	01	H1961_014_2	6																																																																																																																																																																																																																																																			
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H1977	001	0	1	48	05	H1977_001_0	4	1	0000001010100011111111111111110000000	Adaptive Medical Equipment and Supplies	Adult Day Program	Assistive Technology Devices	Assistive Technology Van Lifts and tie downs	Chore Services	Community Transition Services	Environmental Modification	Expanded Community Living Supports	Fiscal Intermediary Services	Home Delivered Meals	Non-medical Transportation	Personal Emergency Response System	Preventive Nursing Services	1	0000000000100000000000001001010000000	Respite - Waiver Service	Respite - General Service																																				3	16	1																																								5	2	1							3	2	8				2	14	4																									1	0000000000000000011000000000000000000																																	5000.00	3	15000.00	6																																							1	0000000000100000111101111101100000000	1	0000001000000000000000000000000000000																									
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H3054	001	0	1	01	01	H3054_001_0	5																																																																																																																																																																																																																																																			
H3054	003	0	1	01	01	H3054_003_0	5																																																																																																																																																																																																																																																			
H3060	001	0	1	20	08	H3060_001_0	1																																																																																																																																																																																																																																																			
H3060	002	0	1	20	08	H3060_002_0	1																																																																																																																																																																																																																																																			
H3067	001	0	1	48	05	H3067_001_0	3	1	0010111011010011111111111111111110000	Respite Care Services	Adult Day Health Care	Personal Emergency Response System and Medication Monitoring	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	0000000000000001000000000011000000000	Day & Residential Treatment for Pregnant Women	Federally Qualified Health Center/Rural Health Clinic Service	Emergency Custody Order/Temporary Detention Orders (TDOs)	Court Ordered Services	Service Facilitation																																																3	480	4																															1	3	6	1	12	6																															1	0000000000000000001000000000000000000																																			5000.00	6																																							1	0000000011000001111000000000000010000	1	0000001011000001100100000000000000000																									
H3071	001	0	1	01	01	H3071_001_0	14																																																																																																																																																																																																																																																			
H3071	002	0	1	01	01	H3071_002_0	12																																																																																																																																																																																																																																																			
H3107	004	0	1	01	01	H3107_004_0	3																																																																																																																																																																																																																																																			
H3107	008	0	1	01	01	H3107_008_0	2																																																																																																																																																																																																																																																			
H3107	012	0	1	01	01	H3107_012_0	3																																																																																																																																																																																																																																																			
H3107	013	0	1	01	01	H3107_013_0	3																																																																																																																																																																																																																																																			
H3107	014	0	1	01	01	H3107_014_0	3																																																																																																																																																																																																																																																			
H3107	015	0	1	01	01	H3107_015_0	3																																																																																																																																																																																																																																																			
H3107	801	0	1	01	01	H3107_801_0	1																																																																																																																																																																																																																																																			
H3107	803	0	1	01	01	H3107_803_0	1																																																																																																																																																																																																																																																			
H3107	804	0	1	01	01	H3107_804_0	1																																																																																																																																																																																																																																																			
H3113	001	0	1	01	01	H3113_001_0	3																																																																																																																																																																																																																																																			
H3113	005	0	1	01	01	H3113_005_0	3																																																																																																																																																																																																																																																			
H3113	007	0	1	01	01	H3113_007_0	2																																																																																																																																																																																																																																																			
H3113	008	0	1	01	01	H3113_008_0	3																																																																																																																																																																																																																																																			
H3113	009	0	1	01	01	H3113_009_0	4																																																																																																																																																																																																																																																			
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H3132	001	0	1	01	01	H3132_001_0	10																																																																																																																																																																																																																																																			
H3152	022	0	1	01	01	H3152_022_0	6																																																																																																																																																																																																																																																			
H3152	045	0	1	01	01	H3152_045_0	4																																																																																																																																																																																																																																																			
H3152	046	0	1	01	01	H3152_046_0	4																																																																																																																																																																																																																																																			
H3152	048	0	1	01	01	H3152_048_0	6																																																																																																																																																																																																																																																			
H3152	077	0	1	01	01	H3152_077_0	5																																																																																																																																																																																																																																																			
H3152	080	0	1	01	01	H3152_080_0	4																																																																																																																																																																																																																																																			
H3152	082	0	1	01	01	H3152_082_0	5																																																																																																																																																																																																																																																			
H3152	801	0	1	01	01	H3152_801_0	3																																																																																																																																																																																																																																																			
H3152	804	0	1	01	01	H3152_804_0	2																																																																																																																																																																																																																																																			
H3154	004	0	1	01	01	H3154_004_0	9																																																																																																																																																																																																																																																			
H3154	013	0	1	01	01	H3154_013_0	6																																																																																																																																																																																																																																																			
H3154	022	0	1	01	01	H3154_022_0	9																																																																																																																																																																																																																																																			
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H3154	028	0	1	01	01	H3154_028_0	6																																																																																																																																																																																																																																																			
H3154	801	0	1	02	01	H3154_801_0	4																																																																																																																																																																																																																																																			
H3154	802	0	1	02	01	H3154_802_0	6																																																																																																																																																																																																																																																			
H3154	805	0	1	02	01	H3154_805_0	4																																																																																																																																																																																																																																																			
H3156	029	0	1	01	01	H3156_029_0	2																																																																																																																																																																																																																																																			
H3156	030	0	1	01	01	H3156_030_0	4																																																																																																																																																																																																																																																			
H3156	033	0	1	01	01	H3156_033_0	2																																																																																																																																																																																																																																																			
H3156	034	0	1	01	01	H3156_034_0	5																																																																																																																																																																																																																																																			
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H3156	036	0	1	01	01	H3156_036_0	3																																																																																																																																																																																																																																																			
H3156	801	0	1	01	01	H3156_801_0	1																																																																																																																																																																																																																																																			
H3156	803	0	1	01	01	H3156_803_0	1																																																																																																																																																																																																																																																			
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H3204	008	0	1	01	01	H3204_008_0	4																																																																																																																																																																																																																																																			
H3204	801	0	1	01	01	H3204_801_0	4																																																																																																																																																																																																																																																			
H3204	802	0	1	01	01	H3204_802_0	3																																																																																																																																																																																																																																																			
H3204	803	0	1	01	01	H3204_803_0	3																																																																																																																																																																																																																																																			
H3204	808	0	1	02	01	H3204_808_0	3																																																																																																																																																																																																																																																			
H3204	809	0	1	02	01	H3204_809_0	3																																																																																																																																																																																																																																																			
H3204	810	0	1	02	01	H3204_810_0	3																																																																																																																																																																																																																																																			
H3206	001	0	1	04	01	H3206_001_0	7																																																																																																																																																																																																																																																			
H3206	002	0	1	04	01	H3206_002_0	8																																																																																																																																																																																																																																																			
H3206	003	0	1	04	01	H3206_003_0	5																																																																																																																																																																																																																																																			
H3206	801	0	1	04	01	H3206_801_0	3																																																																																																																																																																																																																																																			
H3206	802	0	1	04	01	H3206_802_0	3																																																																																																																																																																																																																																																			
H3206	803	0	1	04	01	H3206_803_0	3																																																																																																																																																																																																																																																			
H3233	001	0	1	01	01	H3233_001_0	9																																																																																																																																																																																																																																																			
H3233	002	0	1	01	01	H3233_002_0	9																																																																																																																																																																																																																																																			
H3233	801	0	1	01	01	H3233_801_0	2																																																																																																																																																																																																																																																			
H3233	802	0	1	01	01	H3233_802_0	2																																																																																																																																																																																																																																																			
H3233	803	0	1	01	01	H3233_803_0	2																																																																																																																																																																																																																																																			
H3233	804	0	1	01	01	H3233_804_0	2																																																																																																																																																																																																																																																			
H3237	001	0	1	48	05	H3237_001_0	4	1	0010011000001011111111111000000000000	Nursing Facility Resident Chiropractic Care & Foot Care	Nursing Facility Resident Vision & Dental	Nursing Facility Resident Acupuncture	Nursing Facility Resident Hearing Exams & Hearing Aids	Multipurpose Senior Services Program (MSSP)	Non-Emergency Medical Transportation	In-Home Supportive Services (IHSS)	Acupuncture (Pregnant Women)	Transgender Services	Incontinence Cream and Diapers				1	0000000000000000000001000000000000000																																																																							3	283	3																																																	1	0000000000000000000100000000000000000																																					4285.00	3																																					1	0000000000000000000100000000000000000	2																										
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H3251	804	0	1	01	01	H3251_804_0	2																																																																																																																																																																																																																																																			
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H3291	001	0	1	01	01	H3291_001_0	6																																																																																																																																																																																																																																																			
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H3328	801	0	1	02	01	H3328_801_0	5																																																																																																																																																																																																																																																			
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H3328	803	0	1	02	01	H3328_803_0	5																																																																																																																																																																																																																																																			
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H6988	801	0	1	01	01	H6988_801_0	3																																																																																																																																																																																																																																																			
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H7003	002	0	1	20	08	H7003_002_0	1																																																																																																																																																																																																																																																			
H7006	001	0	1	04	01	H7006_001_0	6																																																																																																																																																																																																																																																			
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H7020	001	0	1	01	01	H7020_001_0	4																																																																																																																																																																																																																																																			
H7020	801	0	1	01	01	H7020_801_0	3																																																																																																																																																																																																																																																			
H7020	802	0	1	02	01	H7020_802_0	3																																																																																																																																																																																																																																																			
H7020	803	0	1	01	01	H7020_803_0	3																																																																																																																																																																																																																																																			
H7020	804	0	1	02	01	H7020_804_0	3																																																																																																																																																																																																																																																			
H7020	805	0	1	01	01	H7020_805_0	3																																																																																																																																																																																																																																																			
H7020	806	0	1	02	01	H7020_806_0	3																																																																																																																																																																																																																																																			
H7114	001	0	1	20	08	H7114_001_0	1																																																																																																																																																																																																																																																			
H7114	002	0	1	20	08	H7114_002_0	1																																																																																																																																																																																																																																																			
H7115	001	0	1	01	01	H7115_001_0	7																																																																																																																																																																																																																																																			
H7115	801	0	1	01	01	H7115_801_0	4																																																																																																																																																																																																																																																			
H7115	802	0	1	01	01	H7115_802_0	4																																																																																																																																																																																																																																																			
H7115	803	0	1	01	01	H7115_803_0	4																																																																																																																																																																																																																																																			
H7149	001	0	1	01	01	H7149_001_0	5																																																																																																																																																																																																																																																			
H7149	004	0	1	01	01	H7149_004_0	6																																																																																																																																																																																																																																																			
H7149	005	0	1	01	01	H7149_005_0	5																																																																																																																																																																																																																																																			
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	5	1	1111010100100001111111111111111111111	Mental Health and Addiction Services from a Certified Provider	Medically Necessary Wheelchair Van	Adult Day Health Services	Alternative Meals Services	Assisted Living Services	Choices Home Care Assistant	Chore Services	Community Transition	Emergency Response Services	Enhanced Community Living Services	Home Care Attendant	Home Delivered Meals	Home Medical Equipment and Supplemental Adaptive and Assistive Services	1	0000000000100000000000000000000000000	Home Modification, Maintenance and Repair	Homemaker Services	Independent Living Assistance	Nutritional Consultation	Out of Home Respite Services	Personal Care Services	Pest Control	Social Work Counseling	Waiver Nursing Services	Waiver Transportation																												3	16	1																																																																																		1	0000000000000000000000000001100000000																																																					10000.00	3	10000.00	3																			1	1000000100000000011111111111111111111	1	0000000000000000000100000000000000000																									
H7173	001	0	1	01	01	H7173_001_0	6																																																																																																																																																																																																																																																			
H7187	003	0	1	01	01	H7187_003_0	3																																																																																																																																																																																																																																																			
H7187	009	0	1	01	01	H7187_009_0	3																																																																																																																																																																																																																																																			
H7187	010	0	1	01	01	H7187_010_0	3																																																																																																																																																																																																																																																			
H7187	011	0	1	01	01	H7187_011_0	3																																																																																																																																																																																																																																																			
H7195	001	0	1	20	08	H7195_001_0	2																																																																																																																																																																																																																																																			
H7195	002	0	1	20	08	H7195_002_0	2																																																																																																																																																																																																																																																			
H7200	006	0	1	01	01	H7200_006_0	7																																																																																																																																																																																																																																																			
H7200	007	0	1	01	01	H7200_007_0	8																																																																																																																																																																																																																																																			
H7200	013	0	1	01	01	H7200_013_0	7																																																																																																																																																																																																																																																			
H7220	002	0	1	01	01	H7220_002_0	9																																																																																																																																																																																																																																																			
H7220	003	0	1	01	01	H7220_003_0	12																																																																																																																																																																																																																																																			
H7220	004	0	1	02	01	H7220_004_0	10																																																																																																																																																																																																																																																			
H7220	801	0	1	02	01	H7220_801_0	3																																																																																																																																																																																																																																																			
H7220	802	0	1	02	01	H7220_802_0	3																																																																																																																																																																																																																																																			
H7220	804	0	1	01	01	H7220_804_0	3																																																																																																																																																																																																																																																			
H7220	805	0	1	01	01	H7220_805_0	3																																																																																																																																																																																																																																																			
H7245	001	0	1	01	01	H7245_001_0	6																																																																																																																																																																																																																																																			
H7245	002	0	1	02	01	H7245_002_0	8																																																																																																																																																																																																																																																			
H7245	003	0	1	01	01	H7245_003_0	6																																																																																																																																																																																																																																																			
H7301	002	0	1	04	01	H7301_002_0	6																																																																																																																																																																																																																																																			
H7301	006	0	1	04	01	H7301_006_0	4																																																																																																																																																																																																																																																			
H7301	007	0	1	04	01	H7301_007_0	7																																																																																																																																																																																																																																																			
H7301	008	0	1	04	01	H7301_008_0	7																																																																																																																																																																																																																																																			
H7301	801	0	1	04	01	H7301_801_0	2																																																																																																																																																																																																																																																			
H7301	803	0	1	04	01	H7301_803_0	2																																																																																																																																																																																																																																																			
H7419	001	0	1	48	05	H7419_001_0	6	1	0011111011100001111111111111000000000	Behavioral Health Care 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	Gender Reassignment	2																																																																																																																											2																																																																												2		1	0000001000000000000000000000000000000																									
H7501	001	0	1	20	08	H7501_001_0	1																																																																																																																																																																																																																																																			
H7501	002	0	1	20	08	H7501_002_0	1																																																																																																																																																																																																																																																			
H7522	001	0	1	04	01	H7522_001_0	7																																																																																																																																																																																																																																																			
H7522	801	0	1	04	01	H7522_801_0	5																																																																																																																																																																																																																																																			
H7522	802	0	1	04	01	H7522_802_0	5																																																																																																																																																																																																																																																			
H7522	803	0	1	04	01	H7522_803_0	5																																																																																																																																																																																																																																																			
H7542	001	0	1	48	05	H7542_001_0	10	1	0000010111111011111111111111110000000	Palliative Care	Outpatient Mental Health Services	Infusion Centers	Residential Personal Care Services	Nursing Home Transition Services	Respite Care	Adult Day Health Services & Nursing Services	Environmental Modifications	Telemedicine	Companion Services	Adult Day Health Transportation	Two (2) Additional Prescription Drugs	Personal Emergency Response System	1	0000000000000000000110001000110000000	Meal Benefit	Oral Nutritional Supplements (Cans)																																																															1	1	4	1	14	4										3	28	2										5	2	1	6																											1	0000000000000000000000100000000000000																																											7500.00	6																															1	0000000111110000001111101111110000000	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	6																																																																																																																																																																																																																																																			
H7680	001	0	1	01	01	H7680_001_0	10																																																																																																																																																																																																																																																			
H7680	002	0	1	01	01	H7680_002_0	7																																																																																																																																																																																																																																																			
H7680	801	0	1	01	01	H7680_801_0	4																																																																																																																																																																																																																																																			
H7680	802	0	1	01	01	H7680_802_0	4																																																																																																																																																																																																																																																			
H7680	803	0	1	01	01	H7680_803_0	4																																																																																																																																																																																																																																																			
H7680	804	0	1	01	01	H7680_804_0	4																																																																																																																																																																																																																																																			
H7680	805	0	1	01	01	H7680_805_0	4																																																																																																																																																																																																																																																			
H7680	806	0	1	01	01	H7680_806_0	5																																																																																																																																																																																																																																																			
H7728	002	0	1	04	01	H7728_002_0	9																																																																																																																																																																																																																																																			
H7728	801	0	1	04	01	H7728_801_0	4																																																																																																																																																																																																																																																			
H7728	802	0	1	04	01	H7728_802_0	4																																																																																																																																																																																																																																																			
H7728	803	0	1	04	01	H7728_803_0	4																																																																																																																																																																																																																																																			
H7787	001	0	1	04	01	H7787_001_0	5																																																																																																																																																																																																																																																			
H7787	002	0	1	04	01	H7787_002_0	5																																																																																																																																																																																																																																																			
H7833	001	0	1	48	05	H7833_001_0	5	1	0011111101001001111111111111111111100	Nursing Services for Waiver Clients	Minor Home Modifications for Waiver Clients	Emergency Response Services for Waiver Clients	Assisted Living Services for Waiver Clients	Adult Foster Care for Waiver Clients	Transitional Assistance Services for Waiver Clients	Respite Care for Waiver Clients	Behavioral Health Care Services	Employment Assistance for Waiver Clients	Supported Employment for Waiver Clients	Cognitive Rehabilitation Therapy for Waiver Clients	Adaptive Aids and Medical Supplies for Waiver Clients	Home-Delivered Meals for Waiver Clients	1	0000000000000000000001000000000000000	Personal Assistance Services	Dental Services for Waiver Clients	Occupational Therapy for Waiver Clients	Speech, Hearing and Language Therapy for Waiver Clients	Support Consultation for Waiver Clients	Habilitation Services	Care Planning																																																																2	30	4																																																	1	0000000000000000100010000010010000000																															7500.00	6							2500.00	6											10000.00	3					5000.00	3																	1	0000000000000001111111011111011111000	2																										
H7844	001	0	1	48	05	H7844_001_0	5	1	0000001010100011111111111111110000000	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	0000000000100000000000001001010000000	Respite - Waiver Service	Respite - General Service																																				3	16	1																																								5	2	1							3	2	8				2	14	4																									1	0000000000000000011000000000000000000																																	5000.00	3	15000.00	6																																							1	0000000000100000111101111101100000000	1	0000001000000000000000000000000000000																									
H7855	001	0	1	20	08	H7855_001_0	1																																																																																																																																																																																																																																																			
H7855	002	0	1	20	08	H7855_002_0	2																																																																																																																																																																																																																																																			
H7885	001	0	1	48	05	H7885_001_0	4	1	0010011000001011111111111000000000000	Nursing Facility Resident Chiropractic Care & Foot Care	Nursing Facility Resident Vision & Dental	Nursing Facility Resident Acupuncture	Nursing Facility Resident Hearing Exams & Hearing Aids	Care Planning and Management	Non-Emergency Medical Transportation	In-Home Supportive Services (IHSS)	Acupuncture (Pregnant Women)	Transgender Services	Incontinence Creams and Diapers				1	0000000000000000000001000000000000000																																																																							3	283	3																																																	1	0000000000000000000100000000000000000																																					4285.00	3																																					1	0000000000000000000100000000000000000	2																										
H7890	001	0	1	48	05	H7890_001_0	4	1	0010011000001011111111111000000000000	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	0000000000000000000001000000000000000																																																																							3	283	3																																																	1	0000000000000000000100000000000000000																																					4285.00	3																																					1	0000000000000000000100000000000000000	2																										
H7903	001	0	1	01	01	H7903_001_0	5																																																																																																																																																																																																																																																			
H7917	008	0	1	04	01	H7917_008_0	4																																																																																																																																																																																																																																																			
H7917	009	0	1	04	01	H7917_009_0	4																																																																																																																																																																																																																																																			
H7917	010	0	1	04	01	H7917_010_0	4																																																																																																																																																																																																																																																			
H7917	011	0	1	04	01	H7917_011_0	5																																																																																																																																																																																																																																																			
H7917	012	0	1	04	01	H7917_012_0	6																																																																																																																																																																																																																																																			
H7917	013	0	1	04	01	H7917_013_0	4																																																																																																																																																																																																																																																			
H7917	014	0	1	04	01	H7917_014_0	5																																																																																																																																																																																																																																																			
H7917	015	0	1	04	01	H7917_015_0	4																																																																																																																																																																																																																																																			
H7917	030	0	1	04	01	H7917_030_0	4																																																																																																																																																																																																																																																			
H7917	031	0	1	04	01	H7917_031_0	5																																																																																																																																																																																																																																																			
H7917	032	0	1	04	01	H7917_032_0	5																																																																																																																																																																																																																																																			
H7917	033	0	1	04	01	H7917_033_0	5																																																																																																																																																																																																																																																			
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	1																																																																																																																																																																																																																																																			
H7960	001	0	1	01	01	H7960_001_0	8																																																																																																																																																																																																																																																			
H7960	002	0	1	01	01	H7960_002_0	7																																																																																																																																																																																																																																																			
H7971	001	0	1	04	01	H7971_001_0	10																																																																																																																																																																																																																																																			
H7971	801	0	1	04	01	H7971_801_0	7																																																																																																																																																																																																																																																			
H7971	802	0	1	04	01	H7971_802_0	6																																																																																																																																																																																																																																																			
H8016	001	0	1	48	05	H8016_001_0	2	1	0010011000001011111111111000000000000	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	0000000000000000000001000000000000000																																																																							3	283	3																																																	1	0000000000000000000100000000000000000																																					4285.00	3																																					1	0000000000000000000100000000000000000	2																										
H8026	001	0	1	48	05	H8026_001_0	12	1	0000001010100011111111111111111100000	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	0000000000100000000000001001011000000	Respite - Waiver Service	Respite - General Service	Respite - Supplemental General Service Benefit	Cell Phone Benefit																																		3	16	1																																								5	2	1							3	2	8				2	14	4	3	12	3																						1	0000000000000000011000000000000000000																																	5000.00	3	15000.00	6																																							1	0000000000100000111101111001100000000	1	0000001000000000000000000000000000000																									
H8029	001	0	1	48	05	H8029_001_0	9	1	0011111111110011111111111111111111110	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 Svc - 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	Comprehensive Psychiatric Emergency Program (CPEP)	Crisis Intervention	Residential Addiction Services																																																																																																																		2																																																																												2		2																										
H8046	001	0	1	48	05	H8046_001_0	5	1	0010011100001001111000000000000000000	Hospice	Behavioral Health	Telehealth	Emergency Dental										1	0010000000000000000000000000000000000														1	12	4																																																																																																										2																																																																												1	0000000100000000000000000000000000000	1	0000001000001000000000000000000000000											0.00	6962.00											0.00	6962.00	
H8056	001	0	1	48	05	H8056_001_0	8	1	0011111111110011111111111111111111110	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	Comprehensive Psychiatric Emergency Program	Crisis Intervention Services	Residential Addiction Services																																																																																																																		2																																																																												2		2																										
H8064	002	0	1	04	01	H8064_002_0	9																																																																																																																																																																																																																																																			
H8067	001	0	1	01	01	H8067_001_0	6																																																																																																																																																																																																																																																			
H8091	002	0	1	04	01	H8091_002_0	9																																																																																																																																																																																																																																																			
H8091	004	0	1	04	01	H8091_004_0	8																																																																																																																																																																																																																																																			
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	7																																																																																																																																																																																																																																																			
H8133	001	0	1	01	01	H8133_001_0	6																																																																																																																																																																																																																																																			
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H8133	006	0	1	01	01	H8133_006_0	11																																																																																																																																																																																																																																																			
H8133	007	0	1	01	01	H8133_007_0	16																																																																																																																																																																																																																																																			
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H8133	801	0	1	01	01	H8133_801_0	5																																																																																																																																																																																																																																																			
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H8145	003	0	1	09	04	H8145_003_0	4																																																																																																																																																																																																																																																			
H8145	004	0	1	09	04	H8145_004_0	3																																																																																																																																																																																																																																																			
H8145	006	0	1	09	04	H8145_006_0	3																																																																																																																																																																																																																																																			
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H8145	011	0	1	09	04	H8145_011_0	4																																																																																																																																																																																																																																																			
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H8145	021	0	1	09	04	H8145_021_0	4																																																																																																																																																																																																																																																			
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H8145	091	0	1	09	04	H8145_091_0	3																																																																																																																																																																																																																																																			
H8145	093	0	1	09	04	H8145_093_0	3																																																																																																																																																																																																																																																			
H8145	097	0	1	09	04	H8145_097_0	2																																																																																																																																																																																																																																																			
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H8145	108	0	1	09	04	H8145_108_0	2																																																																																																																																																																																																																																																			
H8145	120	0	1	09	04	H8145_120_0	2																																																																																																																																																																																																																																																			
H8145	121	0	1	09	04	H8145_121_0	2																																																																																																																																																																																																																																																			
H8145	122	0	1	09	04	H8145_122_0	3																																																																																																																																																																																																																																																			
H8145	123	0	1	09	04	H8145_123_0	3																																																																																																																																																																																																																																																			
H8145	125	0	1	09	04	H8145_125_0	3																																																																																																																																																																																																																																																			
H8145	126	0	1	09	04	H8145_126_0	2																																																																																																																																																																																																																																																			
H8145	155	0	1	09	04	H8145_155_0	2																																																																																																																																																																																																																																																			
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H8146	003	0	1	01	01	H8146_003_0	6																																																																																																																																																																																																																																																			
H8146	004	0	1	01	01	H8146_004_0	6																																																																																																																																																																																																																																																			
H8146	005	0	1	01	01	H8146_005_0	6																																																																																																																																																																																																																																																			
H8146	006	0	1	01	01	H8146_006_0	6																																																																																																																																																																																																																																																			
H8146	007	0	1	01	01	H8146_007_0	6																																																																																																																																																																																																																																																			
H8146	008	0	1	01	01	H8146_008_0	6																																																																																																																																																																																																																																																			
H8146	009	0	1	01	01	H8146_009_0	6																																																																																																																																																																																																																																																			
H8146	010	0	1	01	01	H8146_010_0	6																																																																																																																																																																																																																																																			
H8146	011	0	1	01	01	H8146_011_0	6																																																																																																																																																																																																																																																			
H8146	012	0	1	01	01	H8146_012_0	6																																																																																																																																																																																																																																																			
H8146	013	0	1	01	01	H8146_013_0	7																																																																																																																																																																																																																																																			
H8146	014	0	1	01	01	H8146_014_0	6																																																																																																																																																																																																																																																			
H8170	001	0	1	01	01	H8170_001_0	5																																																																																																																																																																																																																																																			
H8170	002	0	1	01	01	H8170_002_0	5																																																																																																																																																																																																																																																			
H8189	001	0	1	01	01	H8189_001_0	4																																																																																																																																																																																																																																																			
H8197	001	0	1	48	05	H8197_001_0	5	1	0011011101001001111111111111111111110	Nursing Services for Waiver Clients	Minor Home Modifications for Waiver Clients	Emergency Response Services for Waiver Clients	Assisted Living Services for Waiver Clients	Adult Foster Care for Waiver Clients	Transitional Assistance Services for Waiver Clients	Respite Care for Waiver Clients	Behavioral Health Care Services	Employment Assistance for Waiver Clients	Supported Employment for Waiver Clients	Cognitive Rehabilitation Therapy for Waiver Clients	Adaptive Aids and Medical Supplies for Waiver Clients	Home-Delivered Meals for Waiver Clients	1	0000000000000000000001000000000000000	Personal Assistance Services	Dental Services for Waiver Clients	Occupational Therapy for Waiver Clients	Speech, Hearing and Language Therapy for Waiver Clients	Support Consultation for Waiver Clients	Habilitation Services	Emergency Response Services	Home Visits																																																															2	30	4																																																	1	0000000000000000100010000010010000000																															7500.00	6							2500.00	6											10000.00	3					5000.00	3																	1	0000000000000001111111011111011111000	2																										
H8213	001	0	1	48	05	H8213_001_0	8	1	0000010111111011111111111111110000000	Palliative Care	Outpatient Mental Health Services	Infusion Centers	Residential Personal Care Services	Nursing Home Transition Services	Respite Care	Adult Day Care Services & Nursing Services	Environmental Modifications	Telemedicine	Companion Services	Adult Day Health Transportation	Two (2) Additional Prescription Drugs	Personal Emergency Response System	1	0000000000000000000110001000110000000	Meal Benefit	Oral Nutritional Supplements (Cans)																																																															1	1	4	1	14	4										3	28	2										5	2	1	6																											1	0000000000000000000000100000000000000																																											7500.00	6																															2		2																										
H8237	001	0	1	01	01	H8237_001_0	8																																																																																																																																																																																																																																																			
H8237	003	0	1	02	01	H8237_003_0	9																																																																																																																																																																																																																																																			
H8258	001	0	1	48	05	H8258_001_0	4	1	0010011000001011111111111000000000000	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	0000000000000000000001000000000000000																																																																							3	283	3																																																	1	0000000000000000000100000000000000000																																					4285.00	3																																					1	0000000000000000000100000000000000000	2																										
H8266	001	0	1	01	01	H8266_001_0	9																																																																																																																																																																																																																																																			
H8266	002	0	1	01	01	H8266_002_0	6																																																																																																																																																																																																																																																			
H8289	001	0	1	01	01	H8289_001_0	5																																																																																																																																																																																																																																																			
H8289	002	0	1	01	01	H8289_002_0	6																																																																																																																																																																																																																																																			
H8420	001	0	1	48	05	H8420_001_0	3	1	0011111111110011111111111111111111110	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 Svc - Substance Abuse	Medication Therapy Management	Medicare Pt. A and B Services 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	Comprehensive Psychiatric Emergency Program (CPEP)	Crisis Intervention	Residential Addiction Services																																																																																																																		2																																																																												2		2																										
H8423	001	0	1	48	05	H8423_001_0	5	1	0011011101001001111111111111111111000	Nursing Services for Waiver Clients	Minor Home Modifications for Waiver Clients	Emergency Response Services for Waiver Clients	Assisted Living Services for Waiver Clients	Adult Foster Care for Waiver Clients	Transitional Assistance Services for Waiver Clients	Respite Care for Waiver Clients	Behavorial Health Care Services	Employment Assistance for Waiver Clients	Supported Employment for Waiver Clients	Cognitive Rehabilitation Therapy for Waiver Clients	Adaptive Aids and Medical Supplies for Waiver Clients	Home-Delivered Meals for Waiver Clients	1	0000000000000000000001000000000000000	Personal Assistance Services	Dental Services for Waiver Clients	Occupational Therapy for Waiver Clients	Speech, Hearing and Language Therapy for Waiver Clients	Support Consultation for Waiver Clients	Habilitation Services																																																																	2	30	4																																																	1	0000000000000000100010000010010000000																															7500.00	6							2500.00	6											10000.00	3					5000.00	3																	1	0000000000000001111111011111011111000	2																										
H8424	001	0	1	20	08	H8424_001_0	3																																																																																																																																																																																																																																																			
H8424	002	0	1	20	08	H8424_002_0	3																																																																																																																																																																																																																																																			
H8432	002	0	1	01	01	H8432_002_0	7																																																																																																																																																																																																																																																			
H8432	003	0	1	01	01	H8432_003_0	7																																																																																																																																																																																																																																																			
H8432	004	0	1	01	01	H8432_004_0	7																																																																																																																																																																																																																																																			
H8432	801	0	1	01	01	H8432_801_0	3																																																																																																																																																																																																																																																			
H8432	802	0	1	01	01	H8432_802_0	3																																																																																																																																																																																																																																																			
H8452	001	0	1	48	05	H8452_001_0	4	1	1111010100100001111111111111111111111	Mental Health and Addiction Services from a Certified Provider	Medically Necessary Wheelchair Van	Adult Day Health Services	Alternative Meals Services	Assisted Living Services	Choices Home Care Assistant	Chore Services	Community Transition	Emergency Response Services	Enhanced Community Living Services	Home Care Attendant	Home Delivered Meals	Home Medical Equipment and Supplemental Adaptive and Assistive Service	1	0000000000100000000000000000000000000	Home Modification, Maintenance, and Repair	Homemaker Services	Independent Living Assistance	Nutritional Consultation	Out of Home Respite Services	Personal Care Services	Pest Control	Social Work Counseling	Waiver Nursing Services	Waiver Transportation																												3	16	1																																																																																		1	0000000000000000000000000001100000000																																																					10000.00	3	10000.00	3																			1	1000000100000000011111111111111111111	1	0000000000000000000100000000000000000																									
H8490	001	0	1	48	05	H8490_001_0	10	1	0011111111110011111111111111111111110	Adult Day Health Care, AIDS Adult Day Health Care	Nutrition and Wellness Counseling	Assertive Community Treatment, Assisted Living Program	Outpatient Hospitalization, Outpatient Surgery	Community Integ. Counseling and  Community Trans. Svcs.	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 Psych. Rehab. Svcs and Partial Hosp (Medicaid)	Home Maintenance Services, Moving Assistance	Home visits by medical personnel, respite, PERS	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	Comprehensive Psychiatric Emergency Program (CPEP)	Crisis Intervention	Residential Addiction Services																																																																																																																		2																																																																												2		2																										
H8506	001	0	1	01	01	H8506_001_0	4																																																																																																																																																																																																																																																			
H8552	020	0	1	04	01	H8552_020_0	10																																																																																																																																																																																																																																																			
H8552	021	0	1	04	01	H8552_021_0	10																																																																																																																																																																																																																																																			
H8552	801	0	1	04	01	H8552_801_0	4																																																																																																																																																																																																																																																			
H8552	802	0	1	04	01	H8552_802_0	4																																																																																																																																																																																																																																																			
H8552	803	0	1	04	01	H8552_803_0	4																																																																																																																																																																																																																																																			
H8554	001	0	1	01	01	H8554_001_0	13																																																																																																																																																																																																																																																			
H8554	002	0	1	01	01	H8554_002_0	12																																																																																																																																																																																																																																																			
H8578	001	0	1	01	01	H8578_001_0	6																																																																																																																																																																																																																																																			
H8578	003	0	1	01	01	H8578_003_0	5																																																																																																																																																																																																																																																			
H8578	004	0	1	01	01	H8578_004_0	6																																																																																																																																																																																																																																																			
H8578	007	0	1	01	01	H8578_007_0	6																																																																																																																																																																																																																																																			
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