S 2622 — Quit Because of COVID–19 Act

(a) Contents A State plan for medical assistance must— (1) provide that it shall be in effect in all political subdivisions of the State, and, if administered by them, be mandatory upon them; (2) provide for financial participation by the State equal to not less than 40 per centum of the non-Federal share of the expenditures under the plan with respect to which payments under section 1396b of this title are authorized by this subchapter; and, effective July 1, 1969, provide for financial participation by the State equal to all of such non-Federal share or provide for distribution of funds from Federal or State sources, for carrying out the State plan, on an equalization or other basis which will assure that the lack of adequate funds from local sources will not result in lowering the amount, duration, scope, or quality of care and services available under the plan; (3) provide for granting an opportunity for a fair hearing before the State agency to any individual whose claim for medical assistance under the plan is denied or is not acted upon with reasonable promptness; (4) provide (A) such methods of administration (including methods relating to the establishment and maintenance of personnel standards on a merit basis, except that the Secretary shall exercise no authority with respect to the selection, tenure of office, and compensation of any individual employed in accordance with such methods, including provision for utilization of professional medical personnel in the administration and, where administered locally, supervision of administration of the plan, and, subject to section 1396b(i) of this title, including a specification that the single State agency described in paragraph (5) will ensure necessary transportation for beneficiaries under the State plan to and from providers and a description of the methods that such agency will use to ensure such transportation) as are found by the Secretary to be necessary for the proper and efficient operation of the plan, (B) for the training and effective use of paid subprofessional staff, with particular emphasis on the full-time or part-time employment of recipients and other persons of low income, as community service aides, in the administration of the plan and for the use of nonpaid or partially paid volunteers in a social service volunteer program in providing services to applicants and recipients and in assisting any advisory committees established by the State agency, (C) that each State or local officer, employee, or independent contractor who is responsible for the expenditure of substantial amounts of funds under the State plan, each individual who formerly was such an officer, employee, or contractor, and each partner of such an officer, employee, or contractor shall be prohibited from committing any act, in relation to any activity under the plan, the commission of which, in connection with any activity concerning the United States Government, by an officer or employee of the United States Government, an individual who was such an officer or employee, or a partner of such an officer or employee is prohibited by section 207 or 208 of title 18, and (D) that each State or local officer, employee, or independent contractor who is responsible for selecting, awarding, or otherwise obtaining items and services under the State plan shall be subject to safeguards against conflicts of interest that are at least as stringent as the safeguards that apply under chapter 21 of title 41 to persons described in section 2102(a)(3) of title 41; (5) either provide for the establishment or designation of a single State agency to administer or to supervise the administration of the plan; or provide for the establishment or designation of a single State agency to administer or to supervise the administration of the plan, except that the determination of eligibility for medical assistance under the plan shall be made by the State or local agency administering the State plan approved un...

(a) Computation of amount From the sums appropriated therefor, the Secretary (except as otherwise provided in this section) shall pay to each State which has a plan approved under this subchapter, for each quarter, beginning with the quarter commencing January 1, 1966— (1) an amount equal to the Federal medical assistance percentage (as defined in section 1396d(b) of this title, subject to subsections (g) and (j) of this section and section 1396r–4(f) of this title) of the total amount expended during such quarter as medical assistance under the State plan; plus (2) (A) an amount equal to 75 per centum of so much of the sums expended during such quarter (as found necessary by the Secretary for the proper and efficient administration of the State plan) as are attributable to compensation or training of skilled professional medical personnel, and staff directly supporting such personnel, of the State agency or any other public agency; plus (B) notwithstanding paragraph (1) or subparagraph (A), with respect to amounts expended for nursing aide training and competency evaluation programs, and competency evaluation programs, described in section 1396r(e)(1) of this title (including the costs for nurse aides to complete such competency evaluation programs), regardless of whether the programs are provided in or outside nursing facilities or of the skill of the personnel involved in such programs, an amount equal to 50 percent (or, for calendar quarters beginning on or after July 1, 1988, and before October 1, 1990, the lesser of 90 percent or the Federal medical assistance percentage plus 25 percentage points) of so much of the sums expended during such quarter (as found necessary by the Secretary for the proper and efficient administration of the State plan) as are attributable to such programs; plus (C) an amount equal to 75 percent of so much of the sums expended during such quarter (as found necessary by the Secretary for the proper and efficient administration of the State plan) as are attributable to preadmission screening and resident review activities conducted by the State under section 1396r(e)(7) of this title; plus (D) for each calendar quarter during— (i) fiscal year 1991, an amount equal to 90 percent, (ii) fiscal year 1992, an amount equal to 85 percent, (iii) fiscal year 1993, an amount equal to 80 percent, and (iv) fiscal year 1994 and thereafter, an amount equal to 75 percent, of so much of the sums expended during such quarter (as found necessary by the Secretary for the proper and efficient administration of the State plan) as are attributable to State activities under section 1396r(g) of this title; plus (E) an amount equal to 75 percent of so much of the sums expended during such quarter (as found necessary by the Secretary for the proper and efficient administration of the State plan) as are attributable to translation or interpretation services in connection with the enrollment of, retention of, and use of services under this subchapter by, children of families for whom English is not the primary language; plus (3) an amount equal to— (A) (i) 90 per centum of so much of the sums expended during such quarter as are attributable to the design, development, or installation of such mechanized claims processing and information retrieval systems as the Secretary determines are likely to provide more efficient, economical, and effective administration of the plan and to be compatible with the claims processing and information retrieval systems utilized in the administration of subchapter XVIII, including the State’s share of the cost of installing such a system to be used jointly in the administration of such State’s plan and the plan of any other State approved under this subchapter, (ii) 90 per centum of so much of the sums expended during any such quarter in the fiscal year ending June 30, 1972, or the fiscal year ending June 30, 1973, as are attributable to the design, development, or installation of cost dete...

For purposes of this subchapter— (a) Medical assistance The term “medical assistance” means payment of part or all of the cost of the following care and services or the care and services themselves, or both (if provided in or after the third month before the month in which the recipient makes application for assistance or, in the case of medicare cost-sharing with respect to a qualified medicare beneficiary described in subsection (p)(1), if provided after the month in which the individual becomes such a beneficiary) for individuals, and, with respect to physicians’ or dentists’ services, at the option of the State, to individuals (other than individuals with respect to whom there is being paid, or who are eligible, or would be eligible if they were not in a medical institution, to have paid with respect to them a State supplementary payment and are eligible for medical assistance equal in amount, duration, and scope to the medical assistance made available to individuals described in section 1396a(a)(10)(A) of this title) not receiving aid or assistance under any plan of the State approved under subchapter I, X, XIV, or XVI, or part A of subchapter IV, and with respect to whom supplemental security income benefits are not being paid under subchapter XVI, who are— (i) under the age of 21, or, at the option of the State, under the age of 20, 19, or 18 as the State may choose, (ii) relatives specified in section 606(b)(1) 1 of this title with whom a child is living if such child is (or would, if needy, be) a dependent child under part A of subchapter IV, (iii) 65 years of age or older, (iv) blind, with respect to States eligible to participate in the State plan program established under subchapter XVI, (v) 18 years of age or older and permanently and totally disabled, with respect to States eligible to participate in the State plan program established under subchapter XVI, (vi) persons essential (as described in the second sentence of this subsection) to individuals receiving aid or assistance under State plans approved under subchapter I, X, XIV, or XVI, (vii) blind or disabled as defined in section 1382c of this title, with respect to States not eligible to participate in the State plan program established under subchapter XVI, (viii) pregnant women, (ix) individuals provided extended benefits under section 1396r–6 of this title, (x) individuals described in section 1396a(u)(1) of this title, (xi) individuals described in section 1396a(z)(1) of this title, (xii) employed individuals with a medically improved disability (as defined in subsection (v)), (xiii) individuals described in section 1396a(aa) of this title, (xiv) individuals described in section 1396a(a)(10)(A)(i)(VIII) or 1396a(a)(10)(A)(i)(IX) of this title, (xv) individuals described in section 1396a(a)(10)(A)(ii)(XX) of this title, (xvi) individuals described in section 1396a(ii) of this title, (xvii) individuals who are eligible for home and community-based services under needs-based criteria established under paragraph (1)(A) of section 1396n(i) of this title, or who are eligible for home and community-based services under paragraph (6) of such section, and who will receive home and community-based services pursuant to a State plan amendment under such subsection, or (xviii) individuals who, but for earnings in excess of the limit established under subsection (q)(2)(B), would be considered to be receiving supplemental security income, and who are at least 16 years of age, but whose income and resources are insufficient to meet all of such cost— (1) inpatient hospital services (other than services in an institution for mental diseases); (2) (A) outpatient hospital services, (B) consistent with State law permitting such services, rural health clinic services (as defined in subsection (l)(1)) and any other ambulatory services which are offered by a rural health clinic (as defined in subsection (l)(1)) and which are otherwise included in the plan, and (C) Federally...

(a) Requirement for rebate agreement (1) In general In order for payment to be available under section 1396b(a) of this title or under part B of subchapter XVIII for covered outpatient drugs of a manufacturer, the manufacturer must have entered into and have in effect a rebate agreement described in subsection (b) with the Secretary, on behalf of States (except that, the Secretary may authorize a State to enter directly into agreements with a manufacturer), and must meet the requirements of paragraph (5) (with respect to drugs purchased by a covered entity on or after the first day of the first month that begins after November 4, 1992) and paragraph (6). Any agreement between a State and a manufacturer prior to April 1, 1991, shall be deemed to have been entered into on January 1, 1991, and payment to such manufacturer shall be retroactively calculated as if the agreement between the manufacturer and the State had been entered into on January 1, 1991. If a manufacturer has not entered into such an agreement before March 1, 1991, such an agreement, subsequently entered into, shall become effective as of the date on which the agreement is entered into or, at State option, on any date thereafter on or before the first day of the calendar quarter that begins more than 60 days after the date the agreement is entered into. (2) Effective date Paragraph (1) shall first apply to drugs dispensed under this subchapter on or after January 1, 1991. (3) Authorizing payment for drugs not covered under rebate agreements Paragraph (1), and section 1396b(i)(10)(A) of this title, shall not apply to the dispensing of a single source drug or innovator multiple source drug if (A)(i) the State has made a determination that the availability of the drug is essential to the health of beneficiaries under the State plan for medical assistance; (ii) such drug has been given a rating of 1–A by the Food and Drug Administration; and (iii)(I) the physician has obtained approval for use of the drug in advance of its dispensing in accordance with a prior authorization program described in subsection (d), or (II) the Secretary has reviewed and approved the State’s determination under subparagraph (A); or (B) the Secretary determines that in the first calendar quarter of 1991, there were extenuating circumstances. The preceding sentence shall not apply to a single source drug or innovator multiple source drug of a manufacturer for any period described in section 5000D(c)(1) of the Internal Revenue Code of 1986 with respect to the manufacturer. (4) Effect on existing agreements In the case of a rebate agreement in effect between a State and a manufacturer on November 5, 1990, such agreement, for the initial agreement period specified therein, shall be considered to be a rebate agreement in compliance with this section with respect to that State, if the State agrees to report to the Secretary any rebates paid pursuant to the agreement and such agreement provides for a minimum aggregate rebate of 10 percent of the State’s total expenditures under the State plan for coverage of the manufacturer’s drugs under this subchapter. If, after the initial agreement period, the State establishes to the satisfaction of the Secretary that an agreement in effect on November 5, 1990, provides for rebates that are at least as large as the rebates otherwise required under this section, and the State agrees to report any rebates under the agreement to the Secretary, the agreement shall be considered to be a rebate agreement in compliance with the section for the renewal periods of such agreement. (5) Limitation on prices of drugs purchased by covered entities (A) Agreement with Secretary A manufacturer meets the requirements of this paragraph if the manufacturer has entered into an agreement with the Secretary that meets the requirements of section 256b of this title with respect to covered outpatient drugs purchased by a covered entity on or after the first day of the first month...

(a) General background and description A State child health plan shall include a description, consistent with the requirements of this subchapter, of— (1) the extent to which, and manner in which, children in the State, including targeted low-income children and other classes of children classified by income and other relevant factors, currently have creditable health coverage (as defined in section 1397jj(c)(2) of this title); (2) current State efforts to provide or obtain creditable health coverage for uncovered children, including the steps the State is taking to identify and enroll all uncovered children who are eligible to participate in public health insurance programs and health insurance programs that involve public-private partnerships; (3) how the plan is designed to be coordinated with such efforts to increase coverage of children under creditable health coverage; (4) the child health assistance provided under the plan for targeted low-income children, including the proposed methods of delivery, and utilization control systems; (5) eligibility standards consistent with subsection (b); (6) outreach activities consistent with subsection (c); and (7) methods (including monitoring) used— (A) to assure the quality and appropriateness of care, particularly with respect to well-baby care, well-child care, and immunizations provided under the plan; (B) to assure access to covered services, including emergency services and services described in paragraphs (5) and (6) of section 1397cc(c) of this title; and (C) to ensure that the State agency involved is in compliance with subparagraphs (A), (B), and (C) of section 1320a–7n(b)(2) of this title. (b) General description of eligibility standards and methodology (1) Eligibility standards (A) In general The plan shall include a description of the standards used to determine the eligibility of targeted low-income children for child health assistance under the plan. Such standards may include (to the extent consistent with this subchapter) those relating to the geographic areas to be served by the plan, age, income and resources (including any standards relating to spenddowns and disposition of resources), residency, disability status (so long as any standard relating to such status does not restrict eligibility), access to or coverage under other health coverage, and duration of eligibility. Such standards may not discriminate on the basis of diagnosis. (B) Limitations on eligibility standards Such eligibility standards— (i) shall, within any defined group of covered targeted low-income children, not cover such children with higher family income without covering children with a lower family income; (ii) may not deny eligibility based on a child having a preexisting medical condition; (iii) may not apply a waiting period (including a waiting period to carry out paragraph (3)(C)) in the case of a targeted low-income pregnant woman provided pregnancy-related assistance under section 1397ll of this title; (iv) at State option, may not apply a waiting period in the case of a child provided dental-only supplemental coverage under section 1397jj(b)(5) of this title; and (v) shall, beginning January 1, 2014, use modified adjusted gross income and household income (as defined in section 36B(d)(2) of the Internal Revenue Code of 1986) to determine eligibility for child health assistance under the State child health plan or under any waiver of such plan and for any other purpose applicable under the plan or waiver for which a determination of income is required, including with respect to the imposition of premiums and cost-sharing, consistent with section 1396a(e)(14) of this title. (2) Methodology The plan shall include a description of methods of establishing and continuing eligibility and enrollment. (3) Eligibility screening; coordination with other health coverage programs The plan shall include a description of procedures to be used to ensure— (A) through both intake and followup scr...

(a) Required scope of health insurance coverage The child health assistance provided to a targeted low-income child under the plan in the form described in paragraph (1) of section 1397aa(a) of this title shall consist, consistent with paragraphs (5), (6), (7), and (8) of subsection (c), of any of the following: (1) Benchmark coverage Health benefits coverage that is at least equivalent to the benefits coverage in a benchmark benefit package described in subsection (b). (2) Benchmark-equivalent coverage Health benefits coverage that meets the following requirements: (A) Inclusion of basic services The coverage includes benefits for items and services within each of the categories of basic services described in subsection (c)(1). (B) Aggregate actuarial value equivalent to benchmark package The coverage has an aggregate actuarial value that is at least actuarially equivalent to one of the benchmark benefit packages. (C) Substantial actuarial value for additional services included in benchmark package With respect to each of the categories of additional services described in subsection (c)(2) for which coverage is provided under the benchmark benefit package used under subparagraph (B), the coverage has an actuarial value that is equal to at least 75 percent of the actuarial value of the coverage of that category of services in such package. (3) Existing comprehensive State-based coverage Health benefits coverage under an existing comprehensive State-based program, described in subsection (d)(1). (4) Secretary-approved coverage Any other health benefits coverage that the Secretary determines, upon application by a State, provides appropriate coverage for the population of targeted low-income children proposed to be provided such coverage. (b) Benchmark benefit packages The benchmark benefit packages are as follows: (1) FEHBP-equivalent children’s health insurance coverage The standard Blue Cross/Blue Shield preferred provider option service benefit plan, described in and offered under section 8903(1) of title 5. (2) State employee coverage A health benefits coverage plan that is offered and generally available to State employees in the State involved. (3) Coverage offered through HMO The health insurance coverage plan that— (A) is offered by a health maintenance organization (as defined in section 2791(b)(3) of the Public Health Service Act [42 U.S.C. 300gg–91(b)(3)]), and (B) has the largest insured commercial, non-medicaid enrollment of covered lives of such coverage plans offered by such a health maintenance organization in the State involved. (c) Categories of services; determination of actuarial value of coverage (1) Categories of basic services For purposes of this section, the categories of basic services described in this paragraph are as follows: (A) Inpatient and outpatient hospital services. (B) Physicians’ surgical and medical services. (C) Laboratory and x-ray services. (D) Well-baby and well-child care, including age-appropriate immunizations. (E) Mental health and substance use disorder services (as defined in paragraph (5)). (2) Categories of additional services For purposes of this section, the categories of additional services described in this paragraph are as follows: (A) Coverage of prescription drugs. (B) Vision services. (C) Hearing services. (3) Treatment of other categories Nothing in this subsection shall be construed as preventing a State child health plan from providing coverage of benefits that are not within a category of services described in paragraph (1) or (2). (4) Determination of actuarial value The actuarial value of coverage of benchmark benefit packages, coverage offered under the State child health plan, and coverage of any categories of additional services under benchmark benefit packages and under coverage offered by such a plan, shall be set forth in an actuarial opinion in an actuarial report that has been prepared— (A) by an individual who is a member of the American Academy of Act...

(a) Appropriation; total allotment For the purpose of providing allotments to States under this section, subject to subsection (d), there is appropriated, out of any money in the Treasury not otherwise appropriated— (1) for fiscal year 1998, $4,295,000,000; (2) for fiscal year 1999, $4,275,000,000; (3) for fiscal year 2000, $4,275,000,000; (4) for fiscal year 2001, $4,275,000,000; (5) for fiscal year 2002, $3,150,000,000; (6) for fiscal year 2003, $3,150,000,000; (7) for fiscal year 2004, $3,150,000,000; (8) for fiscal year 2005, $4,050,000,000; (9) for fiscal year 2006, $4,050,000,000; (10) for fiscal year 2007, $5,000,000,000; (11) for fiscal year 2008, $5,000,000,000.1 (12) for fiscal year 2009, $10,562,000,000; (13) for fiscal year 2010, $12,520,000,000; (14) for fiscal year 2011, $13,459,000,000; (15) for fiscal year 2012, $14,982,000,000; (16) for fiscal year 2013, $17,406,000,000; (17) for fiscal year 2014, $19,147,000,000; (18) for fiscal year 2015, for purposes of making 2 semi-annual allotments— (A) $2,850,000,000 for the period beginning on October 1, 2014, and ending on March 31, 2015, and (B) $2,850,000,000 for the period beginning on April 1, 2015, and ending on September 30, 2015; (19) for fiscal year 2016, $19,300,000,000; (20) for fiscal year 2017, for purposes of making 2 semi-annual allotments— (A) $2,850,000,000 for the period beginning on October 1, 2016, and ending on March 31, 2017; and (B) $2,850,000,000 for the period beginning on April 1, 2017, and ending on September 30, 2017; (21) for fiscal year 2018, $21,500,000,000; (22) for fiscal year 2019, $22,600,000,000; (23) for fiscal year 2020, $23,700,000,000; (24) for fiscal year 2021, $24,800,000,000; (25) for fiscal year 2022, $25,900,000,000; (26) for fiscal year 2023, for purposes of making two semi-annual allotments— (A) $2,850,000,000 for the period beginning on October 1, 2022, and ending on March 31, 2023; and (B) $2,850,000,000 for the period beginning on April 1, 2023, and ending on September 30, 2023; (27) for each of fiscal years 2024 through 2028, such sums as are necessary to fund allotments to States under subsections (c) and (m); and (28) for fiscal year 2029, for purposes of making two semi-annual allotments— (A) $7,650,000,000 for the period beginning on October 1, 2028, and ending on March 31, 2029; and (B) $7,650,000,000 for the period beginning on April 1, 2029, and ending on September 30, 2029. (b) Allotments to 50 States and District of Columbia (1) In general Subject to paragraph (4) and subsections (d) and (m), of the amount available for allotment under subsection (a) for a fiscal year, reduced by the amount of allotments made under subsection (c) (determined without regard to paragraph (4) thereof) for the fiscal year, the Secretary shall allot to each State (other than a State described in such subsection) with a State child health plan approved under this subchapter the same proportion as the ratio of— (A) the product of (i) the number of children described in paragraph (2) for the State for the fiscal year and (ii) the State cost factor for that State (established under paragraph (3)); to (B) the sum of the products computed under subparagraph (A). (2) Number of children (A) In general The number of children described in this paragraph for a State for— (i) each of fiscal years 1998 and 1999 is equal to the number of low-income children in the State with no health insurance coverage for the fiscal year; (ii) fiscal year 2000 is equal to— (I) 75 percent of the number of low-income children in the State for the fiscal year with no health insurance coverage, plus (II) 25 percent of the number of low-income children in the State for the fiscal year; and (iii) each succeeding fiscal year is equal to— (I) 50 percent of the number of low-income children in the State for the fiscal year with no health insurance coverage, plus (II) 50 percent of the number of low-income children in the State for the fiscal year. (B) Determination ...

(a) Payments (1) In general Subject to the succeeding provisions of this section, the Secretary shall pay to each State with a plan approved under this subchapter, from its allotment under section 1397dd of this title, an amount for each quarter equal to the enhanced FMAP (or, in the case of expenditures described in subparagraph (D)(iv), the higher of 75 percent or the sum of the enhanced FMAP plus 5 percentage points) of expenditures in the quarter— (A) for child health assistance under the plan for targeted low-income children in the form of providing medical assistance for which payment is made on the basis of an enhanced FMAP under the fourth sentence of section 1396d(b) of this title; (B) (C) for child health assistance under the plan for targeted low-income children in the form of providing health benefits coverage that meets the requirements of section 1397cc of this title; and (D) only to the extent permitted consistent with subsection (c)— (i) for payment for other child health assistance for targeted low-income children; (ii) for expenditures for health services initiatives under the plan for improving the health of children (including targeted low-income children and other low-income children); (iii) for expenditures for outreach activities as provided in section 1397bb(c)(1) of this title under the plan; (iv) for translation or interpretation services in connection with the enrollment of, retention of, and use of services under this subchapter by, individuals for whom English is not their primary language (as found necessary by the Secretary for the proper and efficient administration of the State plan); and (v) for other reasonable costs incurred by the State to administer the plan. (2) Order of payments Payments under paragraph (1) from a State’s allotment shall be made in the following order: (A) First, for expenditures for items described in paragraph (1)(A). (B) Second, for expenditures for items described in paragraph (1)(B). (C) Third, for expenditures for items described in paragraph (1)(C). (D) Fourth, for expenditures for items described in paragraph (1)(D). (3) Performance bonus payment to offset additional Medicaid and CHIP child enrollment costs resulting from enrollment and retention efforts (A) In general In addition to the payments made under paragraph (1), for each fiscal year (beginning with fiscal year 2009 and ending with fiscal year 2013), the Secretary shall pay from amounts made available under subparagraph (E), to each State that meets the condition under paragraph (4) for the fiscal year, an amount equal to the amount described in subparagraph (B) for the State and fiscal year. The payment under this paragraph shall be made, to a State for a fiscal year, as a single payment not later than the last day of the first calendar quarter of the following fiscal year. (B) Amount for above baseline Medicaid child enrollment costs Subject to subparagraph (E), the amount described in this subparagraph for a State for a fiscal year is equal to the sum of the following amounts: (i) First tier above baseline Medicaid enrollees An amount equal to the number of first tier above baseline child enrollees (as determined under subparagraph (C)(i)) under subchapter XIX for the State and fiscal year, multiplied by 15 percent of the projected per capita State Medicaid expenditures (as determined under subparagraph (D)) for the State and fiscal year under subchapter XIX. (ii) Second tier above baseline Medicaid enrollees An amount equal to the number of second tier above baseline child enrollees (as determined under subparagraph (C)(ii)) under subchapter XIX for the State and fiscal year, multiplied by 62.5 percent of the projected per capita State Medicaid expenditures (as determined under subparagraph (D)) for the State and fiscal year under subchapter XIX. (C) Number of first and second tier above baseline child enrollees; baseline number of child enrollees For purposes of this paragraph: (i) First tier abo...

(a) Child health assistance For purposes of this subchapter, the term “child health assistance” means payment for part or all of the cost of health benefits coverage for targeted low-income children that includes any of the following (and includes, in the case described in section 1397ee(a)(1)(D)(i) of this title, payment for part or all of the cost of providing any of the following), as specified under the State plan: (1) Inpatient hospital services. (2) Outpatient hospital services. (3) Physician services. (4) Surgical services. (5) Clinic services (including health center services) and other ambulatory health care services. (6) Prescription drugs and biologicals and the administration of such drugs and biologicals, only if such drugs and biologicals are not furnished for the purpose of causing, or assisting in causing, the death, suicide, euthanasia, or mercy killing of a person. (7) Over-the-counter medications. (8) Laboratory and radiological services. (9) Prenatal care and prepregnancy family planning services and supplies. (10) Inpatient mental health services, other than services described in paragraph (18) but including services furnished in a State-operated mental hospital and including residential or other 24-hour therapeutically planned structured services. (11) Outpatient mental health services, other than services described in paragraph (19) but including services furnished in a State-operated mental hospital and including community-based services. (12) Durable medical equipment and other medically-related or remedial devices (such as prosthetic devices, implants, eyeglasses, hearing aids, dental devices, and adaptive devices). (13) Disposable medical supplies. (14) Home and community-based health care services and related supportive services (such as home health nursing services, home health aide services, personal care, assistance with activities of daily living, chore services, day care services, respite care services, training for family members, and minor modifications to the home). (15) Nursing care services (such as nurse practitioner services, nurse midwife services, advanced practice nurse services, private duty nursing care, pediatric nurse services, and respiratory care services) in a home, school, or other setting. (16) Abortion only if necessary to save the life of the mother or if the pregnancy is the result of an act of rape or incest. (17) Dental services. (18) Inpatient substance use treatment services and residential substance use treatment services. (19) Outpatient substance use treatment services. (20) Case management services. (21) Care coordination services. (22) Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders. (23) Hospice care (concurrent, in the case of an individual who is a child, with care related to the treatment of the child’s condition with respect to which a diagnosis of terminal illness has been made.1 (24) Any other medical, diagnostic, screening, preventive, restorative, remedial, therapeutic, or rehabilitative services (whether in a facility, home, school, or other setting) if recognized by State law and only if the service is— (A) prescribed by or furnished by a physician or other licensed or registered practitioner within the scope of practice as defined by State law, (B) performed under the general supervision or at the direction of a physician, or (C) furnished by a health care facility that is operated by a State or local government or is licensed under State law and operating within the scope of the license. (25) Premiums for private health care insurance coverage. (26) Medical transportation. (27) Enabling services (such as transportation, translation, and outreach services) only if designed to increase the accessibility of primary and preventive health care services for eligible low-income individuals. (28) Any other health care services or items specified by the Secretary and not excluded under this s...