‘‘(A) BASIC BENEFITS.—A State plan shall 
provide for health benefits that are at least ac-
tuarially equivalent to the standard Blue Cross/ 
Blue Shield preferred provider option service 
benefit plan, described in and offered under sec-
tion 8903(1) of title 5, United States Code. 
‘‘(B) ITEMS AND SERVICES.—A State plan 
shall include benefits for at least the following 
items and services: 
‘‘(i) Inpatient and outpatient hospital 
services, 
including 
emergency 
services 
available 24 hours a day. 
‘‘(ii) Long-term, acute, and chronic 
care services, including skilled nursing fa-
cility services, intermediate care facility 
services, home health services, home and 
community-based long-term care services, 
hospice care, and services in intermediate 
care facilities for individuals diagnosed 
with mental retardation. 
‘‘(iii) Professional services of health 
care practitioners authorized to provide 
health care services under State law. 
‘‘(iv) 
Community-based 
primary 
health care services, including rural health 
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clinic services and federally qualified health 
center services. 
‘‘(v) Laboratory, x-ray services, and 
diagnostic tests. 
‘‘(vi) Preventive care, including pre-
natal, well-baby, and well-child care, appro-
priate immunizations, pap smears, screen-
ing 
mammography, 
colorectal 
cancer 
screening, physical examinations, and fam-
ily planning. 
‘‘(vii) 
Prescription 
drugs 
and 
biologicals, including insulin and medical 
foods. 
‘‘(viii) Mental health services. 
‘‘(ix) Substance use disorder services. 
‘‘(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. 
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‘‘(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 2203(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. 
‘‘(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-
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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 prior to and under the proposed sys-
tem, including an identification and calculation 
of the amount of funding to be provided by 
Federal, State, and local governments under the 
plan and an assurance that the amount of ex-
penditures made by the State and local govern-
ments will not be reduced as a result of the im-
plementation of the plan; and 
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‘‘(B) a description (and an estimate of the 
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. 
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‘‘(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 2203(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 
will be obtained by not later than 1 year after the 
date of the Secretary’s approval of the plan. Any ap-
proval of a grant is conditioned upon the timely 
completion of such approvals and commitments. 
‘‘(g) EVALUATION.—A State plan shall provide for a 
process for its evaluation, and shall comply with any eval-
uation, reporting, or data collection requirements imposed 
by the Secretary. 
‘‘(h) CONSTRUCTION.—Nothing in this title shall be 
construed as preempting State laws that provide greater 
protections or benefits than the protections or benefits re-
quired under this title. 
‘‘SEC. 2205. INTERSTATE ARRANGEMENTS. 
‘‘(a) IN GENERAL.—One or more contiguous States 
in a geographic region may file a joint application for 
planning and demonstration grants under this title. 
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‘‘(b) CONGRESSIONAL APPROVAL.—Congress hereby 
authorizes and approves States entering into Interstate 
Compacts in order to conduct joint health care programs 
under such a grant. 
‘‘(c) REFERENCES TO STATE.—In the case of a joint 
application described in subsection (a), any reference in 
this title to a State is deemed to refer to all of the States 
that have filed the application, and the approval of a grant 
with respect to such a joint application shall be counted 
as 1 State for purposes of applying sections 2202(c) and 
2203(b). 
‘‘SEC. 2206. DEFINITIONS. 
‘‘In this title: 
‘‘(1) ELIGIBLE
STATE
RESIDENT.—The term 
‘eligible State resident’ means any resident of the 
United States who is a citizen or national of the 
United States, or lawful resident alien, and who re-
sides in any particular State. Such term may in-
clude, at the option of a State, the following: 
‘‘(A) State employees and dependents of 
such employees. 
‘‘(B) Employees, and dependents of such 
employees, working in a work site of a business 
located in the State. 
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‘‘(C) One or more classes of non-
immigrants (as defined in section 101(a)(15) of 
the Immigration and Nationality Act) specified 
in the State plan. 
‘‘(2) LAWFUL
RESIDENT
ALIEN.—The term 
‘lawful resident alien’ means an alien lawfully admit-
ted for permanent residence and any other alien law-
fully residing permanently in the United States 
under color of law, including an alien granted asy-
lum or with lawful temporary resident status under 
section 210, 210A, or 245A of the Immigration and 
Nationality Act. 
‘‘(3) SECRETARY.—The term ‘Secretary’ means 
the Secretary of Health and Human Services. 
‘‘(4) SINGLE PAYER SYSTEM.—The term ‘single 
payer system’ means an approach to health care fi-
nancing with only 1 source of money for paying 
health care providers. The payer may be either a 
governmental unit or other entity (such as an insur-
ance company). The elements of a single payer sys-
tem offer administrative simplicity for patients and 
providers, and savings in overhead costs. 
‘‘(5) STATE.—Subject to section 2205(c), the 
term ‘State’ means a State, the District of Colum-
bia, the Commonwealth of Puerto Rico, the United 
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States Virgin Islands, Guam, American Samoa, and 
the Commonwealth of the Northern Mariana Is-
lands. 
‘‘(6) STATE
PLAN.—The term ‘State plan’ 
means a comprehensive health care plan of a State 
participating in a State Comprehensive Health Care 
and Cost Containment demonstration project under 
this title that meets the requirements of section 
2204.’’. 
Æ 
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