complete a course of treatment to the ex-
tent that the number of days of inpatient 
hospital services described in subparagraph 
(A) that may be furnished to the individual 
during the year (as reduced under such 
subparagraph) is not less than 15; and 
(ii) reduced by a number of days de-
termined by the Secretary so that the actu-
arial value of providing such number of 
days of services under this paragraph to 
the individual is equal to the actuarial 
value of the days of intensive community- 
based services furnished to the individual 
under subparagraph (D) during the year 
after such services have been furnished to 
the individual for 90 days (or, in the case 
of services described in subparagraph 
(D)(ii), for 180 days) during the year 
(rounded to the nearest day). 
(C) OUTPATIENT
SERVICES.—Outpatient 
treatment services of mental illness or sub-
stance abuse (other than intensive community- 
based services under subparagraph (D)) for an 
unlimited number of days during any calendar 
year furnished in accordance with standards es-
tablished by the Secretary for the management 
of such services, and, in the case of services fur-
nished to an individual described in section 
204(b)(1) who is not an inpatient of a hospital, 
in conformity with the plan of an organized sys-
tem of care for mental health and substance 
abuse services in accordance with section 
204(b)(2). 
(D) INTENSIVE COMMUNITY-BASED SERV-
ICES.—Intensive community-based services (as 
described in paragraph (3))— 
(i) for an unlimited number of days 
during any calendar year, in the case of 
services described in section 1861(ff)(2)(E) 
that are furnished to an individual who is 
a seriously mentally ill adult, a seriously 
emotionally disturbed child, or an adult or 
child with serious substance abuse disorder 
(as determined in accordance with criteria 
established by the Secretary); 
(ii) in the case of services described in 
section 1861(ff)(2)(C), for up to 180 days 
during any calendar year, except that such 
services may be furnished to the individual 
for a number of additional days during the
year equal to the difference between the 
total number of days of intensive residen-
tial services which the individual may re-
ceive during the year under part A (as de-
termined under subparagraph (B)) and the 
number of days of such services which the 
individual has received during the year; or 
(iii) in the case of any other such 
services, for up to 90 days during any cal-
endar year, except that such services may 
be furnished to the individual for the num-
ber of additional days during the year de-
scribed in clause (ii). 
(2) INTENSIVE
RESIDENTIAL
SERVICES
DE-
FINED.— 
(A) IN
GENERAL.—Subject to subpara-
graphs (B) and (C), the term ‘‘intensive resi-
dential services’’ means inpatient services pro-
vided in any of the following facilities: 
(i) Residential detoxification centers. 
(ii) Crisis residential programs or 
mental illness residential treatment pro-
grams. 
(iii) Therapeutic family or group 
treatment homes.
(iv) Residential centers for substance 
abuse treatment. 
(B) REQUIREMENTS FOR FACILITIES.—No 
service may be treated as an intensive residen-
tial service under subparagraph (A) unless the 
facility at which the service is provided— 
(i) is legally authorized to provide 
such service under the law of the State (or 
under a State regulatory mechanism pro-
vided by State law) in which the facility is 
located or is certified to provide such serv-
ice by an appropriate accreditation entity 
approved by the State in consultation with 
the Secretary; and 
(ii) meets such other requirements as 
the Secretary may impose to assure the 
quality of the intensive residential services 
provided. 
(C) SERVICES
FURNISHED
TO
AT-RISK 
CHILDREN.—In the case of services furnished 
to an individual described in section 204(b)(1), 
no service may be treated as an intensive resi-
dential service under this subsection unless the 
service is furnished in conformity with the plan 
of an organized system of care for mental
health and substance abuse services in accord-
ance with section 204(b)(2). 
(D) MANAGEMENT STANDARDS.—No serv-
ice may be treated as an intensive residential 
service under subparagraph (A) unless the serv-
ice is furnished in accordance with standards 
established by the Secretary for the manage-
ment of such services. 
(3) INTENSIVE
COMMUNITY-BASED
SERVICES 
DEFINED.— 
(A) IN
GENERAL.—The term ‘‘intensive 
community-based services’’ means the items 
and services described in subparagraph (B) pre-
scribed by a physician (or, in the case of serv-
ices furnished to an individual described in sec-
tion 204(b)(1), by an organized system of care 
for mental health and substance abuse services 
in accordance with such section) and provided 
under a program described in subparagraph 
(D) under the supervision of a physician (or, to 
the extent permitted under the law of the State 
in which the services are furnished, a non-phy-
sician mental health professional) pursuant to 
an individualized, written plan of treatment es-
tablished and periodically reviewed by a physi-
cian (in consultation with appropriate staff par-
ticipating in such program) which sets forth the 
physician’s diagnosis, the type, amount, fre-
quency, and duration of the items and services 
provided under the plan, and the goals for 
treatment under the plan, but does not include 
any item or service that is not furnished in ac-
cordance with standards established by the Sec-
retary for the management of such services. 
(B) ITEMS AND SERVICES DESCRIBED.— 
The items and services described in this sub-
paragraph are— 
(i) partial hospitalization services con-
sisting of the items and services described 
in subparagraph (C); 
(ii) psychiatric rehabilitation services; 
(iii) day treatment services for indi-
viduals under 19 years of age; 
(iv) in-home services; 
(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: 
(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 
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 assure 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, 
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 
and monitoring the provision and quality 
of services under any plan. 
(B) INDEPENDENCE.—State health secu-
rity programs shall establish safeguards to as-
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. 
(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. 
(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.