copayments applicable to acute care and preventive 
benefits provided under this title. 
(2) COST-SHARING
FOR
LONG-TERM
CARE 
SERVICES.— 
(A) IN GENERAL.— 
(i) payments for home and commu-
nity-based long-term care services are sub-
ject to coinsurance of 20 percent; and 
(ii) payments for nursing facility serv-
ices are subject to coinsurance of 35 per-
cent. 
(B) EXCEPTION.—With respect to the co-
insurance 
established 
under 
subparagraph 
(A)— 
(i) such coinsurance shall not apply to 
an individual with income (as defined by 
the Secretary) of not more than 100 per-
cent of the income official poverty line ap-
plicable to a family of the size involved; 
and 
(ii) in the case of an individual with 
such income that exceeds 100 percent, but 
is less than 200 percent, of such applicable 
poverty line, the coinsurance shall be re-
duced in the same proportion as the pro-
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portion of such income is less than 200 
percent of such applicable poverty line. 
(c) PROHIBITION OF BALANCE BILLING.—As pro-
vided in section 531, no person may impose a charge for 
covered services for which benefits are provided under this 
Act. 
(d) NO DUPLICATE HEALTH INSURANCE.—Each 
State health security program shall prohibit the sale of 
health insurance in the State if payment under the insur-
ance duplicates payment for any items or services for 
which payment may be made under such a program. 
(e) STATE PROGRAM MAY PROVIDE ADDITIONAL 
BENEFITS.—Nothing in this Act shall be construed as 
limiting the benefits that may be made available under a 
State health security program to residents of the State 
at the expense of the State. 
(f) EMPLOYERS MAY PROVIDE ADDITIONAL BENE-
FITS.—Nothing in this Act shall be construed as limiting 
the additional benefits that an employer may provide to 
employees or their dependents, or to former employees or 
their dependents. 
SEC. 202. DEFINITIONS RELATING TO SERVICES. 
(a) COMMUNITY-BASED PRIMARY HEALTH SERV-
ICES.—In this title, the term ‘‘community-based primary 
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health services’’ means ambulatory health services fur-
nished— 
(1) by a rural health clinic; 
(2) by a federally qualified health center (as de-
fined in section 1905(l)(2)(B) of the Social Security 
Act), and which, for purposes of this Act, include 
services furnished by State and local health agencies; 
(3) in a school-based setting; 
(4) by public educational agencies and other 
providers of services to children entitled to assist-
ance under the Individuals with Disabilities Edu-
cation Act for services furnished pursuant to a writ-
ten Individualized Family Services Plan or Indi-
vidual Education Plan under such Act; and 
(5) public and private nonprofit entities receiv-
ing Federal assistance under the Public Health 
Service Act. 
(b) PREVENTIVE SERVICES.— 
(1) IN GENERAL.—In this title, the term ‘‘pre-
ventive services’’ means items and services— 
(A) which— 
(i) are specified in paragraph (2); or 
(ii) the Board determines to be effec-
tive in the maintenance and promotion of 
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health or minimizing the effect of illness, 
disease, or medical condition; and 
(B) which are provided consistent with the 
periodicity schedule established under para-
graph (3). 
(2) SPECIFIED
PREVENTIVE
SERVICES.—The 
services specified in this paragraph are as follows: 
(A) Basic immunizations. 
(B) Prenatal and well-baby care (for in-
fants under 1 year of age). 
(C) Well-child care (including periodic 
physical examinations, hearing and vision 
screening, and developmental screening and ex-
aminations) for individuals under 18 years of 
age. 
(D) Periodic screening mammography, Pap 
smears, and colorectal examinations and exami-
nations for prostate cancer. 
(E) Physical examinations. 
(F) Family planning services. 
(G) Routine eye examinations, eyeglasses, 
and contact lenses. 
(H) Hearing aids, but only upon a deter-
mination of a certified audiologist or physician 
that a hearing problem exists and is caused by 
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a condition that can be corrected by use of a 
hearing aid. 
(3) SCHEDULE.—The Board shall establish, in 
consultation with experts in preventive medicine and 
public health and taking into consideration those 
preventive services recommended by the Preventive 
Services Task Force and published as the Guide to 
Clinical Preventive Services, a periodicity schedule 
for the coverage of preventive services under para-
graph (1). Such schedule shall take into consider-
ation the cost-effectiveness of appropriate preventive 
care and shall be revised not less frequently than 
once every 5 years, in consultation with experts in 
preventive medicine and public health. 
(c) HOME
AND
COMMUNITY-BASED
LONG-TERM 
CARE SERVICES.—In this title, the term ‘‘home and com-
munity-based long-term care services’’ means the following 
services provided to an individual to enable the individual 
to remain in such individual’s place of residence within 
the community: 
(1) Home health aide services. 
(2) Adult day health care, social day care or 
psychiatric day care. 
(3) Medical social work services. 
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