Sec. 201. Comprehensive benefits
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/bill/118/hr/3421/ih/section-201·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Subject to the other provisions of this title and titles IV through IX, individuals enrolled for benefits under this Act are entitled to have payment made by the Secretary to an eligible provider 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: Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs.
Ambulatory patient services. Primary and preventive services, including chronic disease management. Prescription drugs and medical devices, including outpatient prescription drugs, medical devices, and biological products, and all contraceptive items approved by the Food and Drug Administration. Mental health and substance use treatment services, including inpatient care. Laboratory and diagnostic services. Comprehensive reproductive care, including abortion, contraception, and assistive reproductive technology.
Maternity and newborn care. Comprehensive gender affirming health care. Oral health, audiology, and vision services. Rehabilitative and habilitative services and devices. Emergency services and transportation. Early and periodic screening, diagnostic, and treatment services, as described in sections 1902(a)(10)(A), 1902(a)(43), 1905(a)(4)(B), and 1905(r) of the Social Security Act ( 42 U.S.C. 1396a(a)(10)(A) ; 1396a(a)(43); 1396d(a)(4)(B); 1396d(r)). Necessary transportation to receive health care services for persons with disabilities, older individuals with functional limitations, or low-income individuals (as determined by the Secretary).
Long-term care services and support (as described in section 204). Hospice care. Services provided by a licensed marriage and family therapist or a licensed mental health counselor. Any service described in a preceding paragraph that is furnished via telehealth, to the extent practical. The Secretary shall, at least annually, and on a regular basis, evaluate whether the benefits package should be improved to promote the health of beneficiaries, account for changes in medical practice or new information from medical research, or respond to other relevant developments in health science, and shall make recommendations to Congress regarding any such improvements.
Such recommendations may not include a recommendation to eliminate any benefit. The Committee on Energy and Commerce and the Committee on Ways and Means of the House of Representatives shall, not less frequently than annually, hold a hearing on the recommendations submitted by the Secretary under subsection (b). Paragraph
(1)is enacted— as an exercise of rulemaking power of the House of Representatives, and, as such, shall be considered as part of the rules of the House, and such rules shall supersede any other rule of the House only to the extent that rule is inconsistent therewith; and with full recognition of the constitutional right of either House to change such rules (so far as relating to the procedure in such House) at any time, in the same manner, and to the same extent as in the case of any other rule of the House. In carrying out subsection (b), the Secretary shall consult with the persons described in paragraph
(2)with respect to— identifying specific complementary and integrative medicine practices that are appropriate to include in the benefits package; and identifying barriers to the effective provision and integration of such practices into the delivery of health care, and identifying mechanisms for overcoming such barriers. In accordance with paragraph (1), the Secretary shall consult with— the Director of the National Center for Complementary and Integrative Health; the Commissioner of Food and Drugs; institutions of higher education, private research institutes, and individual researchers with extensive experience in complementary and alternative medicine and the integration of such practices into the delivery of health care; nationally recognized providers of complementary and integrative medicine; and such other officials, entities, and individuals with expertise on complementary and integrative medicine as the Secretary determines appropriate. Individual States may provide additional benefits for the residents of such States, as determined by such State, and may provide benefits to individuals not eligible for benefits under this Act, at the expense of the State, subject to the requirements specified in section 1102.
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Sec. 201
Comprehensive benefits
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