‘‘(x) Vision services, including routine 
eye examinations, eyeglasses, and contact 
lenses. 
‘‘(xi) Hearing services, including hear-
ing aids. 
‘‘(xii) Dental services, including rou-
tine check ups. 
‘‘(xiii) Durable medical equipment, in-
cluding home dialysis supplies and equip-
ment. 
‘‘(xiv) Emergency ambulance services. 
‘‘(xv) Prosthetics. 
‘‘(xvi) Outpatient therapy, including 
physical therapy, occupational therapy, and 
speech language pathology services and re-
lated services. 
‘‘(2) ASSURANCE THAT BENEFITS ARE NOT RE-
DUCED
FOR
INDIVIDUALS
COVERED
UNDER
FED-
ERAL PROGRAMS.—Insofar as the State under the 
plan incorporates funding provided by Federal pro-
grams described in section 2202(f), the State plan 
may not provide for a reduction in benefits (includ-
ing coverage, access, availability, duration, and bene-
ficiary rights, and, if applicable, vaccine benefits 
under section 1928) otherwise provided for under
such programs or an increase in cost-sharing and 
premiums otherwise provided for under such pro-
grams. 
‘‘(3) CONTINUATION
OF
BENEFITS
FOR
CER-
TAIN ALIENS.—Nothing in this title shall be con-
strued as affecting the access of aliens described in 
section 2204(1)(D) to health care services provided 
under law for such aliens as of the date of the enact-
ment of this title. 
‘‘(c) QUALITY ASSURANCE.— 
‘‘(1) IN GENERAL.—A State plan shall provide, 
and describe, mechanisms to be used to assure, mon-
itor, and maintain the quality of items and services 
furnished under the plan. 
‘‘(2) HEALTH OUTCOMES.—A State plan shall 
describe the plan’s projected effect on health out-
comes in the State, including estimates of health 
benefits, decreased morbidity and mortality, and im-
proved productivity resulting from reduction in the 
number of individuals without health benefits. 
‘‘(d) PROGRAMS
FOR
MEDICAL
EDUCATION.—A 
State plan shall describe health professions training and 
graduate medical education activities applicable under the 
plan, and shall provide, under the State plan, for payment 
from Federal, State, and local governments for such train-
ing and education activities in the amounts that would 
otherwise be payable by such governments but for the 
State’s universal, comprehensive health care system under 
the State plan. 
‘‘(e) FINANCING.— 
‘‘(1) BUDGET.—A State plan shall incorporate 
a budget which contains— 
‘‘(A) detailed projections of health care ex-
penditures presently and under the proposed 
system, including an identification and calcula-
tion of the amount of funding to be provided by 
the Federal, State, and local governments under 
the plan and an assurance that the amount of 
expenditures made by the State and local gov-
ernments will not be reduced as a result of the 
implementation of the plan; and 
‘‘(B) a description (and an estimate of 
costs) of transitional activities to be undertaken 
in implementing the proposed system. 
‘‘(2) COST CONTAINMENT.—A State plan shall 
describe the means to be used to contain costs under 
the plan, including when and how the plan will in-
crease efficiencies. 
‘‘(3) FEDERAL EXPENDITURE LIMIT.—A State 
plan shall contain assurances that aggregate Federal
expenditures on health care (including Federal ex-
penditures under titles 5, 10, and 38 of the United 
States Code, and under this Act) under the plan will 
not exceed aggregate Federal expenditures that 
would have been incurred in the absence of such 
plan. 
‘‘(f) IMPLEMENTATION.— 
‘‘(1) IN GENERAL.—A State plan shall describe 
the method (including a timetable and period of 
transition) for implementing the plan. 
‘‘(2) COORDINATION.—A State plan shall iden-
tify all Federal, State, and local programs that pro-
vide health care services in the State and describe 
how such programs would be incorporated in, or co-
ordinated with, the health coverage system under the 
plan. 
‘‘(3) FEDERAL WAIVERS REQUIRED.—A State 
plan shall identify any waivers of Federal law re-
quired to implement the plan, including the use of 
any pooled Federal funds and other waivers de-
scribed in section 2202(f). 
‘‘(4) APPROVAL
OF
STATE
LEGISLATURE.—A 
State plan shall provide that State approvals and 
commitments (including approval of the State legis-
lature) necessary for the implementation of the plan