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this Act are entitled to have payment made under a State
health security program for the following items and serv-
ices if medically necessary and 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.
(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
AND
CHRONIC
CARE
SERV-
ICES.—
(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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(6) PRESCRIPTION DRUGS, BIOLOGICALS, INSU-
LIN, MEDICAL FOODS.—
(A) Outpatient prescription drugs and
biologicals, as specified by the Board consistent
with section 515.
(B) Insulin.
(C) Medical foods (as defined in section
202(d)).
(7) DENTAL SERVICES.—Dental services (as de-
fined in section 202(h)).
(8) 
MENTAL
HEALTH
SERVICES.—Mental
health services (as defined in section 202(e)).
(9) SUBSTANCE
ABUSE
TREATMENT
SERV-
ICES.—Substance abuse treatment services (as de-
fined in section 202(f)).
(10) DIAGNOSTIC TESTS.—Diagnostic tests.
(11) 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.
(C) HOME DIALYSIS.—Home dialysis sup-
plies and equipment.
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(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
services as the Board may specify.
(b) COST-SHARING.—There are no deductibles, coin-
surance, or copayments applicable to acute care benefits
provided under this title.
(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.
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(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, 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
written Individualized Family Services Plan or
Individual Education Plan under such Act; and
(5) public and private non-profit entities receiv-
ing Federal assistance under the Public Health
Service Act.
(b) PREVENTIVE SERVICES.—
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(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 one 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.
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(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
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
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to remain in such individual’s place of residence within
the community:
(1) Homemaker services, including meals.
(2) Home health aide services.
(3) Heavy chores.
(4) Adult day health care, social day care or
psychiatric day care.
(5) Medical social work services.
(6) Care coordination services, as defined in
subsection (g)(1).
(7) Respite care, including training for informal
caregivers.
(d) MEDICAL FOODS.—In this title, the term ‘‘medi-
cal foods’’ means foods which are formulated to be
consumed or administered enterally under the supervision
of a physician and which are intended for the specific die-
tary management of a disease or condition for which
distinctive nutritional requirements, based on recognized
scientific principles, are established by medical evaluation.
(e) MENTAL HEALTH SERVICES.—In this title, the
term ‘‘mental health services’’ means services related to
the prevention, diagnosis, treatment, and rehabilitation of
mental illness and promotion of mental health, including
the following services:
(1) Crisis intervention.