| 1 | 251C00000X | Day Training, Developmentally Disabled Services | | | | No |
| 2 | 251E00000X | Home Health | | | | No |
| 3 | 320800000X | Community Based Residential Treatment Facility, Mental Illness | | | | No |
| 4 | 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | | No |
| 5 | 332B00000X | Durable Medical Equipment & Medical Supplies | | | | No |
| 6 | 332BC3200X | Durable Medical Equipment & Medical Supplies | Customized Equipment | | | No |
| 7 | 332BD1200X | Durable Medical Equipment & Medical Supplies | Dialysis Equipment & Supplies | | | No |
| 8 | 332BN1400X | Durable Medical Equipment & Medical Supplies | Nursing Facility Supplies | | | Yes |
| 9 | 332BP3500X | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | | | No |
| 10 | 332BX2000X | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | | | No |
| 11 | 253Z00000X | In Home Supportive Care | | | | No |
| 12 | 174200000X | Meals | | | | No |
| 13 | 251S00000X | Community/Behavioral Health | | | | No |
| 14 | 251X00000X | Supports Brokerage | | | | No |