The information on this page only pertains to the CMSP benefit program. If you’re looking for more information on the Connect to Care program, click the button below:
Advanced Medical Management is responsible for CMSP medical and dental benefits administration. Further information on benefit administration is available at the Advanced Medical Management website at https://cmsp.amm.cc.
To download the CMSP Member Guide, click here.
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A wide array of inpatient and outpatient benefits are provided through the CMSP Benefit. Covered services are subject to prior authorization requirements, medical necessity and clinical guidelines, provider network requirements, and/or benefit limits may apply. Please see sections about emergency services, Share of Cost (SOC) requirements, members, and primary care benefit services.
CMSP Covered Services without a SOC (if applicable):
- Adult Immunizations
- Colorectal Cancer Screening
- EKG, Osteoporosis, & DEXA Scan
- Mental Health Services (mild to moderate)
- Outpatient Substance Use Disorder Services
- Physical Therapy
- Specified Prescription Medications with a $5 Copay per Prescription ($1500 maximum benefit limit)
- Preventative Health Screenings
- Primary Care & Specialist Office Visits
- Routine Screening & Laboratory Testing
- Obesity Counseling (performed by a physician)
- Screenings for HIV, HPV, Hepatitis B & C, & STI Screenings
- Specified Ultrasound of Head, Neck, Trunk, Upper & Lower Extremities
- Specified X-rays of Head, Neck, Chest, Trunk, Upper & Lower Extremities
- Tobacco Use Counseling & Intervention (performed by a physician)
- Various In-Office Minor Medical Procedures
CMSP Covered Services that May Require a SOC (if applicable):
- Acute Inpatient Hospital Care (including acute inpatient rehabilitation & mental health)
- Adult Day Health Care
- Blood & Blood Derivatives
- Chiropractic Services
- Chronic Hemodialysis Services
- Dental Services (including diagnostic & preventative care, oral surgery & selected endodontic, restorative & prosthodontics services)
- Durable Medical Equipment (DME)
- Emergency Ambulance Services & medically necessary transportation from the acute hospital to other facilities for medically necessary, specialized, or tertiary care
- Family Planning Services, including sterilization (when no other coverage, including F-PACT)
- Home Health Agency Services
- Outpatient Hospital & Clinic Services
- Infusion Therapy
- Inpatient & Outpatient Heroin Detoxification Services (excluding methadone maintenance)
- Laboratory and Radiology Services
- Medical Supplies dispensed by Physicians, Licensed Pharmacies, or Durable Medical Equipment dealers & prosthetic or orthotic providers
- Non-Emergency Medical Transportation when medically necessary
- Outpatient Audiology Services (including hearing aids)
- Outpatient Occupational Therapy & Physical Therapy Services
- Outpatient Rehabilitation Services in a Rehabilitation Facility
- Physician Services
- Podiatry Services
- Prescription Drug Services provided by Licensed Pharmacists (CMSP pharmacy services, excluding home infusion therapy, are provided under contract between the CMSP Governing Board & MedImpact)
- Prosthetic & Orthotic Appliances
- Psychiatric Services (inpatient & outpatient) provided by a licensed, in network psychiatrist
- Transplants
- Vision Services including eye exams & prescription glasses