vide for continuation of benefits under such title or 
plan until the end of the period of stay. 
(b) FEDERAL EMPLOYEES HEALTH BENEFITS PRO-
GRAM.—No benefits shall be made available under chapter 
89 of title 5, United States Code, for any part of a cov-
erage period occurring after December 31, 2008. 
(c) CHAMPUS.—No benefits shall be made available 
under sections 1079 and 1086 of title 10, United States 
Code, for items or services furnished after December 31, 
2008. 
(d) TREATMENT OF BENEFITS FOR VETERANS AND 
NATIVE AMERICANS.—Nothing in this Act shall affect the 
eligibility of veterans for the medical benefits and services 
provided under title 38, United States Code, or of Indians 
for the medical benefits and services provided by or 
through the Indian Health Service. 
TITLE II—COMPREHENSIVE BEN-
EFITS, INCLUDING PREVEN-
TIVE BENEFITS AND BENE-
FITS FOR LONG-TERM CARE 
SEC. 201. COMPREHENSIVE BENEFITS. 
(a) IN GENERAL.—Subject to the succeeding provi-
sions of this title, individuals enrolled for benefits under 
this Act are entitled to have payment made under a State 
health security program for the following items and serv-
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ices if medically necessary or appropriate for the mainte-
nance of health or for the diagnosis, treatment, or rehabili-
tation of a health condition: 
(1) HOSPITAL SERVICES.—Inpatient and out-
patient hospital care, including 24-hour-a-day emer-
gency services. 
(2) 
PROFESSIONAL
SERVICES.—Professional 
services of health care practitioners authorized to 
provide health care services under State law, includ-
ing patient education and training in self-manage-
ment techniques. 
(3) 
COMMUNITY-BASED
PRIMARY
HEALTH 
SERVICES.—Community-based primary health serv-
ices (as defined in section 202(a)). 
(4) PREVENTIVE
SERVICES.—Preventive serv-
ices (as defined in section 202(b)). 
(5) LONG-TERM, ACUTE, AND CHRONIC CARE 
SERVICES.— 
(A) Nursing facility services. 
(B) Home health services. 
(C) Home and community-based long-term 
care services (as defined in section 202(c)) for 
individuals described in section 203(a). 
(D) Hospice care. 
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(E) Services in intermediate care facilities 
for individuals with mental retardation. 
(6) PRESCRIPTION DRUGS, BIOLOGICALS, INSU-
LIN, MEDICAL FOODS.— 
(A) Outpatient prescription drugs and bio-
logics, as specified by the Board consistent with 
section 615. 
(B) Insulin. 
(C) Medical foods (as defined in section 
202(e)). 
(7) DENTAL SERVICES.—Dental services (as de-
fined in section 202(h)). 
(8) MENTAL HEALTH AND SUBSTANCE ABUSE 
TREATMENT
SERVICES.—Mental health and sub-
stance abuse treatment services (as defined in sec-
tion 202(f)). 
(9) DIAGNOSTIC TESTS.—Diagnostic tests. 
(10) OTHER ITEMS AND SERVICES.— 
(A) OUTPATIENT
THERAPY.—Outpatient 
physical therapy services, outpatient speech pa-
thology services, and outpatient occupational 
therapy services in all settings. 
(B) DURABLE MEDICAL EQUIPMENT.—Du-
rable medical equipment. 
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(C) HOME DIALYSIS.—Home dialysis sup-
plies and equipment. 
(D) AMBULANCE.—Emergency ambulance 
service. 
(E) PROSTHETIC DEVICES.—Prosthetic de-
vices, including replacements of such devices. 
(F) ADDITIONAL ITEMS AND SERVICES.— 
Such other medical or health care items or serv-
ices as the Board may specify. 
(b) COST-SHARING.— 
(1) IN GENERAL.—Except as provided in this 
subsection, there are no deductibles, coinsurance, or 
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. 
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(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-
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. 
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(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 
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-
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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 
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-
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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 
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 
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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. 
(4) Care coordination services, as defined in 
subsection (g)(1). 
(5) Respite care, including training for informal 
caregivers. 
(6) Personal assistance services, and home-
maker services (including meals) incidental to the 
provision of personal assistance services. 
(d) HOME HEALTH SERVICES.— 
(1) IN
GENERAL.—The term ‘‘home health 
services’’ means items and services described in sec-
tion 1861(m) of the Social Security Act and includes 
home infusion services. 
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(2) HOME
INFUSION
SERVICES.—The term 
‘‘home infusion services’’ includes the nursing, phar-
macy, and related services that are necessary to con-
duct the home infusion of a drug regimen safely and 
effectively under a plan established and periodically 
reviewed by a physician and that are provided in 
compliance with quality assurance requirements es-
tablished by the Secretary. 
(e) MEDICAL FOODS.—In this title, the term ‘‘med-
ical foods’’ means foods which are formulated to be con-
sumed or administered enterally under the supervision of 
a physician and which are intended for the specific dietary 
management of a disease or condition for which distinctive 
nutritional requirements, based on recognized scientific 
principles, are established by medical evaluation. 
(f) MENTAL
HEALTH
AND
SUBSTANCE
ABUSE 
TREATMENT SERVICES.— 
(1) SERVICES
DESCRIBED.—In this title, the 
term ‘‘mental health and substance abuse treatment 
services’’ means the following services related to the 
prevention, diagnosis, treatment, and rehabilitation 
of mental illness and promotion of mental health: 
(A) INPATIENT HOSPITAL SERVICES.—In-
patient hospital services furnished primarily for 
the diagnosis or treatment of mental illness or 
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substance abuse for up to 60 days during a 
year, reduced by a number of days determined 
by the Secretary so that the actuarial value of 
providing such number of days of services 
under this paragraph to the individual is equal 
to the actuarial value of the days of inpatient 
residential services furnished to the individual 
under subparagraph (B) during the year after 
such services have been furnished to the indi-
vidual for 120 days during the year (rounded to 
the nearest day), but only if (with respect to 
services furnished to an individual described in 
section 204(b)(1)) such services are furnished 
in conformity with the plan of an organized sys-
tem of care for mental health and substance 
abuse services in accordance with section 
204(b)(2). 
(B) INTENSIVE RESIDENTIAL SERVICES.— 
Intensive residential services (as defined in 
paragraph (2)) furnished to an individual for 
up to 120 days during any calendar year, ex-
cept that— 
(i) such services may be furnished to 
the individual for additional days during 
the year if necessary for the individual to 
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complete a course of treatment to the ex-
tent that the number of days of inpatient 
hospital services described in subparagraph 
(A) that may be furnished to the individual 
during the year (as reduced under such 
subparagraph) is not less than 15; and 
(ii) reduced by a number of days de-
termined by the Secretary so that the actu-
arial value of providing such number of 
days of services under this paragraph to 
the individual is equal to the actuarial 
value of the days of intensive community- 
based services furnished to the individual 
under subparagraph (D) during the year 
after such services have been furnished to 
the individual for 90 days (or, in the case 
of services described in subparagraph 
(D)(ii), for 180 days) during the year 
(rounded to the nearest day). 
(C) OUTPATIENT
SERVICES.—Outpatient 
treatment services of mental illness or sub-
stance abuse (other than intensive community- 
based services under subparagraph (D)) for an 
unlimited number of days during any calendar 
year furnished in accordance with standards es-
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tablished by the Secretary for the management 
of such services, and, in the case of services fur-
nished to an individual described in section 
204(b)(1) who is not an inpatient of a hospital, 
in conformity with the plan of an organized sys-
tem of care for mental health and substance 
abuse services in accordance with section 
204(b)(2). 
(D) INTENSIVE COMMUNITY-BASED SERV-
ICES.—Intensive community-based services (as 
described in paragraph (3))— 
(i) for an unlimited number of days 
during any calendar year, in the case of 
services described in section 1861(ff)(2)(E) 
that are furnished to an individual who is 
a seriously mentally ill adult, a seriously 
emotionally disturbed child, or an adult or 
child with serious substance abuse disorder 
(as determined in accordance with criteria 
established by the Secretary); 
(ii) in the case of services described in 
section 1861(ff)(2)(C), for up to 180 days 
during any calendar year, except that such 
services may be furnished to the individual 
for a number of additional days during the 
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