| Respite Care | 385H00000X | |
| Respite Care - Respite Care, Intellectual and/or Developmental Disabilities, Child — Respite Care, Intellectual and/or Developmental Disabilities, Child | 385HR2060X | |
| Respite Care - Respite Care, Physical Disabilities, Child — Respite Care, Physical Disabilities, Child | 385HR2065X | |
| In Home Supportive Care | 253Z00000X | |
| Nursing Facility/Intermediate Care Facility | 313M00000X | |
| Skilled Nursing Facility | 314000000X | |
| Skilled Nursing Facility - Nursing Care, Pediatric — Nursing Care, Pediatric | 3140N1450X | |
| Durable Medical Equipment & Medical Supplies | 332B00000X | |
| Non-emergency Medical Transport (VAN) | 343900000X | |
| Home Health | 251E00000X | Primary |