Sec. 201. Comprehensive benefits
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Subject to the other provisions of this title and titles IV through IX, individuals enrolled for benefits under the Medicare for All Program are entitled to have payment made by the Secretary to a participating 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, biological products, and medical devices, and all contraceptive items approved by the Food and Drug Administration. Mental health and substance use treatment services, including inpatient care and treatment for co-occurring mental illness and substance use disorders. Laboratory and diagnostic services.
Comprehensive reproductive care, including abortion, contraception, and assistive reproductive technology. Comprehensive maternity and newborn care. Comprehensive gender-affirming health care. Oral health, audiology, and vision services. Rehabilitative and habilitative services, including devices. Emergency services, including transportation. Pediatrics, including early and periodic screening, diagnostic, and treatment services (as defined in section 1905(r) of the Social Security Act ( 42 U.S.C. 1396d(r) )).
Necessary transportation to receive health care items and services for persons with disabilities, older individuals with functional limitations, and low-income individuals (as determined by the Secretary). Services provided by a licensed marriage and family therapist or a licensed mental health counselor. Home- and community-based long-term care services and supports (to be provided in accordance with the requirements for home and community-based settings under sections 441.530 and 441.710 of title 42, Code of Federal Regulations (as in effect on the date of enactment of this Act), including— services described in paragraphs (7), (8), (13), (19), and
(24)of section 1905(a) of the Social Security Act ( 42 U.S.C. 1396d(a) ); home and community-based services described in subsection (c)(4)(B) of section 1915 of the Social Security Act ( 42 U.S.C. 1396n ) (including habilitation services defined in subsection (c)(5) of such section); self-directed home and community-based services described in subsection
(i)of section 1915 of the Social Security Act; self-directed personal assistance services (as defined in subsection (j)(4)(A) of section 1915 of the Social Security Act); and home and community-based attendant services and supports described in subsection
(k)of section 1915 of the Social Security Act. Any item or service described in any of paragraphs
(1)through
(16)that is furnished using telehealth, to the extent practicable. The Secretary shall, at least on an annual 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. 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 integrative 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 the Medicare for All Program at the expense of the State.
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