Benefit Grids - Partners Health Management

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.

Medicaid Benefit Grids

Medicaid Adult Mental Health/Substance Use Services Grid
Medicaid Child Mental Health/Substance Use Services Benefit Grid
Medicaid MH, SU, I/DD Specialty Services Benefit Grid
Medicaid Adult and Child B3 Services Benefit Grid
Medicaid Inpatient Services Benefit Grid

State Benefit Grids

State Adult Mental Health/Substance Use Services Benefit Grid
State Child Mental Health/Substance Use Services Benefit Grid
State MH, SU, I/DD Specialty Services Benefit Grid
State Intellectual and Developmental Disabilities Benefit Grid
State Inpatient & Crisis Service Benefit Grid

Updated: March 7, 2023