| Chapter | Chapter Title | Doc. Link |
| 1 | Requirements for Providers |  |
| 2 | Health Care Programs & Services |  |
| 3 | Intentionally Left Blank | |
| 4 | Billing Policy |  |
| 5 | Authorization |  |
| 6 | Physician & Professional Services |  |
| 7 | Anesthesia Services |  |
| 8 | Clinic Services |  |
| 9 | Children's Services |  |
| 9A | Immunizations and Vaccinations |  |
| 10 | Reproductive Health/OB Gyn |  |
| 11 | Laboratory, Pathology, Radiology, Diagnostic Services |  |
| 12 | Ambulatory Surgical Services |  |
| 13 | Inpatient Hospital Authorization |  |
| 14 | Hospital Services |  |
| 15 | Chemical Dependency |  |
| - | Rule 25 CPA Process |  |
| - | CPA form for CD treatment |  |
| 16 | Mental Health Services |  |
| - | General Mental Health Grid |  |
| - | Telemental Health Grid |  |
| - | Telemental Consent Form |  |
| - | Children's Therapeutic Services & Support |  |
| 17 | Rehabilitative Services |  |
| 18 | Chiropractic Services |  |
| 19 | Dental Services |  |
| 20 | Eyeglass & Vision Care Services |  |
| 21 | Transportation Services |  |
| 22 | Pharmacy Services |  |
| 22A | Medication Therapy Management Services (MTMS) | |
| - | Formulary Exception Form |  |
| - | Formulary Exception Form - Part D |  |
| 23 | Equipment & Supplies |  |
| - | MHCP Home Trial Log for Stander (PW 2008 208) |  |
| 24 | Personal Care Assistant (PCA Services) |  |
| 24A | Home Care Services |  |
| - | Tele Health Grid |  |
| - | Tele Health Consent Form |  |
| 25 | Intentionally Left Blank | |
| 26 | HCBS Waivered Services |  |
| 26A | Elderly Waiver Program |  |
| 27 | Long Term Care |  |
| 28 | Hospice Services |  |
| 29 | Intentionally Left Blank | |
| 30 | Intentionally Left Blank | |
| 31 | Federal Indian Health Services |  |