The following Benefit Grids outline service codes, service limits, level of care and documentation requirements needed for service authorization requests (SARs). They also outline requirements for unmanaged services.
Please note that new benefit plans effective April 1, 2023 for Tailored Plan/PIHP/State funds will be available for view March 1, 2023.
State Benefit Grids
Updated: March 7, 2023