Medically Necessary X X X Non- emergency Transport Nurse Midwife X X X X Services Practitioner X X X X Services X X X X Orthotic Services Outpatient X X X X Hospital Outpatient X X X X Surgery Oxygen and Respiratory X X X X Therapy Equipment Personal Care X X Pharmacy X X X X Physician X X X X X X X X Podiatry Private Duty X X Nursing Prosthetics X X X X X X X X Rehabilitation Dialysis X X X X Services Skilled Nursing X X Limited Limited Facility Speech and Hearing X X X X Services Targeted Case X X Management
Medically Necessary Non- emergency X X X Transport Nurse Midwife Services X X X X Practitioner Services X X X X Orthotic Services X X X X Outpatient Hospital X X X X Outpatient Surgery X X X X Oxygen and Respiratory Therapy Equipment X X X X Personal Care X X Pharmacy X X X X Physician X X X X Podiatry X X X X Private Duty Nursing X X Prosthetics X X X X Rehabilitation X X X X Dialysis Services X X X X Skilled Nursing Facility X X Limited Limited Speech and Hearing Services X X X X Targeted Case Management X X
1115%20MassHealth%20Demonstration%20STC%206-27-18.docx