CMSP Standard Benefits
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Summary of Benefits

A wide array of inpatient and outpatient benefits are provided through the CMSP Standard Benefit. Covered services are subject to prior authorization requirements, medical necessity and clinical guidelines, provider network requirements, and/or benefit limits may apply. For members with a monthly Share of Cost (SOC), these requirements also apply. For undocumented members, these services are available to the extent they are medically necessary to address an emergency medical condition.  

  • Acute inpatient hospital care
  • Adult day health care services
  • Audiology services
  • Blood and blood derivatives
  • Chronic hemodialysis services
  • Limited dental services
  • Durable medical equipment (DME)
  • Emergency air and ground ambulance services
  • Hearing aids
  • Home health agency services
  • Hospital outpatient services and outpatient clinic services
  • Infusion therapy
  • Laboratory and radiology services
  • Medical supplies dispensed by physicians, licensed pharmacies or DME dealers
  • Non-emergency medical transportation when medically necessary
  • Occupational therapy services
  • Inpatient and outpatient heroin detoxification services (excluding methadone maintenance)
  • Pharmaceutical services provided by network pharmacies
  • Physical therapy services
  • Physician services
  • Podiatry services
  • Prosthetic and orthotic appliances
  • Psychiatry services (inpatient and outpatient provided by a licensed, in-network psychiatrist)
  • Speech therapy services

Specific services that are NOT covered by the program include:

  • Pregnancy-related services (contact your county eligibility office); infertility services (contact F-PACT); long-term care facility services (contact your county eligibility office); chiropractic services; acupuncture services; optometry services (including eyeglasses and contact lenses); mental health and substance abuse counseling services provided by a psychologist, MFT, LCSW, or substance use disorder counselor; cosmetic services; sexual reassignment services; public transportation such as airplane, bus, car, or taxi rides; and, methadone maintenance services
  • All services provided outside of the State of California and designated border state areas
  • Services provided by providers that do not participate in the CMSP network administered by Advanced Medical Management (excluding emergency services) and the MedImpact Healthcare Systems pharmacy network
  • Organ transplants for persons who are eligible for CMSP emergency services only under aid code 50

If a CMSP member needs or desires medical care which is not covered by CMSP, the member must pay for the care or make other arrangements with the provider.

Treatment Authorization

CMSP is administered by Advanced Medical Management. Please note the following requirements for treatment authorization:

Claims for CMSP services are subject to treatment authorization requirements and utilization limits administered by Advanced Medical Management or its subcontractors on behalf of CMSP. In general, all medical and dental service authorizations are to be sent to Advanced Medical Management. The CMSP Provider Operations Manual (POM) is provided by Advanced Medical Management to all providers that contract to be a part of the CMSP provider network. The POM describes how to obtain service authorizations and how to bill for services.

Prior authorization for CMSP prescription drug services that are delivered through a retail pharmacy are handled by MedImpact Healthcare Systems, Inc. (MedImpact).


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