(v) case management services, includ-
ing collateral services designated as such 
case management services by the Sec-
retary; 
(vi) ambulatory detoxification services; 
and 
(vii) such other items and services as 
the Secretary may provide (but in no event 
to include meals and transportation), 
that are reasonable and necessary for the diag-
nosis or active treatment of the individual’s 
condition, reasonably expected to improve or 
maintain the individual’s condition and func-
tional level and to prevent relapse or hos-
pitalization, and furnished pursuant to such 
guidelines relating to frequency and duration of 
services as the Secretary shall by regulation es-
tablish (taking into account accepted norms of 
medical practice and the reasonable expectation 
of patient improvement). 
(C) ITEMS
AND
SERVICES
INCLUDED
AS 
PARTIAL
HOSPITALIZATION
SERVICES.—For 
purposes of subparagraph (B)(i), partial hos-
pitalization services consist of the following: 
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(i) Individual and group therapy with 
physicians or psychologists (or other men-
tal health professionals to the extent au-
thorized under State law). 
(ii) Occupational therapy requiring 
the skills of a qualified occupational thera-
pist. 
(iii) Services of social workers, trained 
psychiatric nurses, behavioral aides, and 
other staff trained to work with psychiatric 
patients (to the extent authorized under 
State law). 
(iv) Drugs and biologicals furnished 
for therapeutic purposes (which cannot, as 
determined in accordance with regulations, 
be self-administered). 
(v) Individualized activity therapies 
that are not primarily recreational or di-
versionary. 
(vi) Family counseling (the primary 
purpose of which is treatment of the indi-
vidual’s condition). 
(vii) Patient training and education 
(to the extent that training and edu-
cational activities are closely and clearly 
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related to the individual’s care and treat-
ment). 
(viii) Diagnostic services. 
(D) PROGRAMS
DESCRIBED.—A program 
described in this subparagraph is a program 
(whether facility-based or freestanding) which is 
furnished by an entity— 
(i) legally authorized to furnish such a 
program under State law (or the State reg-
ulatory mechanism provided by State law) 
or certified to furnish such a program by 
an appropriate accreditation entity ap-
proved by the State in consultation with 
the Secretary; and 
(ii) meeting such other requirements 
as the Secretary may impose to ensure the 
quality of the intensive community-based 
services provided. 
(g) CARE COORDINATION SERVICES.— 
(1) IN GENERAL.—In this title, the term ‘‘care 
coordination services’’ means services provided by 
care coordinators (as defined in paragraph (2)) to 
individuals described in paragraph (3) for the co-
ordination and monitoring of home and community- 
based long-term care services to ensure appropriate, 
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cost-effective utilization of such services in a com-
prehensive and continuous manner, and includes— 
(A) transition management between inpa-
tient facilities and community-based services, 
including assisting patients in identifying and 
gaining access to appropriate ancillary services; 
and 
(B) evaluating and recommending appro-
priate treatment services, in cooperation with 
patients and other providers and in conjunction 
with any quality review program or plan of care 
under section 205. 
(2) CARE COORDINATOR.— 
(A) IN GENERAL.—In this title, the term 
‘‘care coordinator’’ means an individual or non-
profit or public agency or organization which 
the State health security program determines— 
(i) is capable of performing directly, 
efficiently, and effectively the duties of a 
care coordinator described in paragraph 
(1); and 
(ii) demonstrates capability in estab-
lishing and periodically reviewing and re-
vising plans of care, and in arranging for 
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and monitoring the provision and quality 
of services under any plan. 
(B) INDEPENDENCE.—State health secu-
rity programs shall establish safeguards to en-
sure that care coordinators have no financial in-
terest in treatment decisions or placements. 
Care coordination may not be provided through 
any structure or mechanism through which 
quality review is performed. 
(3) ELIGIBLE INDIVIDUALS.—An individual de-
scribed in this paragraph is an individual described 
in section 203 (relating to individuals qualifying for 
long-term and chronic care services). 
(h) DENTAL SERVICES.— 
(1) IN GENERAL.—In this title, subject to sub-
section (b), the term ‘‘dental services’’ means the 
following: 
(A) Emergency dental treatment, including 
extractions, for bleeding, pain, acute infections, 
and injuries to the maxillofacial region. 
(B) Prevention and diagnosis of dental dis-
ease, including examinations of the hard and 
soft tissues of the oral cavity and related struc-
tures, radiographs, dental sealants, fluorides, 
and dental prophylaxis. 
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(C) Treatment of dental disease, including 
non-cast fillings, periodontal maintenance serv-
ices, and endodontic services. 
(D) Space maintenance procedures to pre-
vent orthodontic complications. 
(E) Orthodontic treatment to prevent se-
vere malocclusions. 
(F) Full dentures. 
(G) Medically necessary oral health care. 
(H) Any items and services for special 
needs patients that are not described in sub-
paragraphs (A) through (G) and that— 
(i) are required to provide such pa-
tients the items and services described in 
subparagraphs (A) through (G); 
(ii) are required to establish oral func-
tion (including general anesthesia for indi-
viduals with physical or emotional limita-
tions that prevent the provision of dental 
care without such anesthesia); 
(iii) consist of orthodontic care for se-
vere dentofacial abnormalities; or 
(iv) consist of prosthetic dental de-
vices for genetic or birth defects or fitting 
for such devices. 
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(I) Any dental care for individuals with a 
seizure disorder that is not described in sub-
paragraphs (A) through (H) and that is re-
quired because of an illness, injury, disorder, or 
other health condition that results from such 
seizure disorder. 
(2) LIMITATIONS.—Dental services are subject 
to the following limitations: 
(A) PREVENTION AND DIAGNOSIS.— 
(i) 
EXAMINATIONS
AND
PROPHY-
LAXIS.—The examinations and prophylaxis 
described in paragraph (1)(B) are covered 
only consistent with a periodicity schedule 
established by the Board, which schedule 
may provide for special treatment of indi-
viduals less than 18 years of age and of 
special needs patients. 
(ii) DENTAL SEALANTS.—The dental 
sealants described in such paragraph are 
not covered for individuals 18 years of age 
or older. Such sealants are covered for in-
dividuals less than 10 years of age for pro-
tection of the first permanent molars. Such 
sealants are covered for individuals 10 
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years of age or older for protection of the 
second permanent molars. 
(B) TREATMENT OF DENTAL DISEASE.— 
Prior to January 1, 2022, the items and serv-
ices described in paragraph (1)(C) are covered 
only for individuals less than 18 years of age 
and special needs patients. On or after such 
date, such items and services are covered for all 
individuals enrolled for benefits under this Act, 
except that endodontic services are not covered 
for individuals 18 years of age or older. 
(C) SPACE MAINTENANCE.—The items and 
services described in paragraph (1)(D) are cov-
ered only for individuals at least 3 years of age, 
but less than 13 years of age and— 
(i) are limited to posterior teeth; 
(ii) involve maintenance of a space or 
spaces for permanent posterior teeth that 
would otherwise be prevented from normal 
eruption if the space were not maintained; 
and 
(iii) do not include a space maintainer 
that is placed within 6 months of the ex-
pected eruption of the permanent posterior 
tooth concerned. 
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