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6.2.7

Over-the-counter medications (Section 2110(a)(7))

6.2.8

Laboratory and radiological services (Section 2110(a)(8))

6.2.9

Prenatal care and prepregnancy family services and supplies (Section 2110(a)(9))

6.2.10

Inpatient mental health services, other than services described in 6.2.18., but including services furnished in a state-operated mental hospital and including residential or other 24-hour therapeutically planned structural services (Section 2110(a)(10))

6.2.11

Outpatient mental health services, other than services described in 6.2.19, but including services furnished in a state-operated mental hospital and including community-based services (Section 2110(a)(11)

6.2.12

Durable medical equipment and other medically-related or remedial devices (such as prosthetic devices, implants, eyeglasses, hearing aids, dental devices, and adaptive devices) (Section 2110(a)(12))

6.2.13

Disposable medical supplies (Section 2110(a)(13))

6.2.14

Home and community-based health care services (See instructions) (Section 2110(a)(14))

6.2.15

Nursing care services (See instructions) (Section 2110(a)(15)) See Physician Services in Attachment 3

6.2.16

Abortion only if necessary to save the life of the mother or if the pregnancy is the result of an act of rape or incest (Section 2110(a)(16)

6.2.17

Dental services (Section 2110(a)(17))

6.2.18

Inpatient substance abuse treatment services and residential substance abuse treatment services (Section 2110(a)(18))

6.2.19

Outpatient substance abuse treatment services (Section 2110(a)(19))

6.2.20

Case management services (Section 2110(a)(20))

6.2.21

Care coordination services (Section 2110(a)(21)) See Case Management services in Attachment 3.

WISCONSIN

Effective Date:

Approval Date: 29