Sec. 201. Comprehensive benefits
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/bill/113/hr/1200/ih/section-201·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Subject to the succeeding provisions 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 services if medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition: Inpatient and outpatient hospital care, including 24-hour-a-day emergency services. Professional services of health care practitioners authorized to provide health care services under State law, including patient education and training in self-management techniques.
Community-based primary health services (as defined in section 202(a)). Preventive services (as defined in section 202(b)). Nursing facility services. Home health services. Home and community-based long-term care services (as defined in section 202(c)) for individuals described in section 203(a). Hospice care. Services in intermediate care facilities for individuals with an intellectual disability. Outpatient prescription drugs and biologics, as specified by the Board consistent with section 615.
Insulin. Medical foods (as defined in section 202(e)). Dental services (as defined in section 202(h)). Mental health and substance abuse treatment services (as defined in section 202(f)). Diagnostic tests. Outpatient physical therapy services, outpatient speech pathology services, and outpatient occupational therapy services in all settings. Durable medical equipment. Home dialysis supplies and equipment. Emergency ambulance service. Prosthetic devices, including replacements of such devices.
Such other medical or health care items or services as the Board may specify. As provided in section 531, no person may impose a charge for covered services for which benefits are provided under this Act. Each State health security program shall prohibit the sale of health insurance in the State if payment under the insurance duplicates payment for any items or services for which payment may be made under such a program. 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.
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. Notwithstanding any other provision of law, a health plan may be provided for under a collective bargaining agreement or a MEWA if such plan is limited to coverage that is supplemental to the coverage provided for under the State-based American Health Security Program and available only to employees or their dependents or to retirees or their dependents.