Clinical Coverage Policies

  • 3A, Home Health Services
  • 3B, PACE (Program of All-Inclusive Care for the Elderly)
  • 3D, Hospice Services
  • 3G-1, Private Duty Nursing for Beneficiaries Age 21 and Older
  • 3G-2, Private Duty Nursing for Beneficiaries Under 21 years of Age
  • 3H-1, Home Infusion Therapy
  • 3K-1, Community Alternatives Program for Children (CAP/C) 
  • 3K-2, Community Alternatives Program for Disabled Adults (CAP/DA)
  • 3L, State Plan Personal Care Services (PCS)
  • 4A, Dental Services
  • 4B, Orthodontic Services

1-I, Dietary Evaluation and Counseling and Medical Lactation Services

More information can be found on the main EPSDT web page

  • 2A-1, Acute Inpatient Hospital Services
  • 2A-2, Long Term Care Hospital Services
  • 2A-3, Out-of-State Services
  • 2B-1, Nursing Facility Services
  • 2B-2, Geropsychiatric Units in Nursing Facilities
  • 1S-1, Genotyping and Phenotyping for HIV Drug Resistance Testing
  • 1S-2, HIV Tropism Assay
  • 1S-3, Laboratory Services
  • 1S-4, Genetic Testing
  • 1S-8, Drug Testing for Opioid Treatment and Controlled Substance Monitoring
  • 1M-2, Childbirth Education
  • 1M-3, Health and Behavior Intervention
  • 1M-4, Home Visit for Newborn Care and Assessment
  • 1M-5, Home Visit for Postnatal Assessment and Follow-up Care
  • 1M-6, Maternal Care Skilled Nurse Home Visit
  • 5A-1, Physical Rehabilitation Equipment and Supplies
  • 5A-2, Respiratory Equipment and Supplies
  • 5A-3, Nursing Equipment and Supplies
  • 5B, Orthotics & Prosthetics