LD 130
pg. 4
Page 3 of 22 An Act To Establish a Single-payor Health Care System Page 5 of 22
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LR 241
Item 1

 
agency shall adopt rules establishing the premium to be paid
by persons eligible under this paragraph and the method of
payment.

 
D.__To establish eligibility, each person must apply for a
plan card, pay to the fund the premium determined applicable
pursuant to section 374, subsection 1, paragraph B and
satisfy the application requirements established by the
agency.

 
3.__Health care benefits.__As provided in this subsection, the
plan must provide coverage for health care services from
participating providers within this State if those services are
necessary or appropriate for the prevention, diagnosis or
treatment of, or maintenance or rehabilitation following, injury,
disability or disease.__The agency shall adopt rules regarding
provision of the following covered health care services:

 
A.__Hospital services;

 
B.__Medical and other professional services furnished by
participating providers;

 
C.__Laboratory tests and imaging procedures;

 
D.__Home health care for persons requiring services
performed by or under the supervision of professional or
technical personnel, including, but not limited to, home
care for acute illness, personal care attendant services and
the medical component of home care for chronic illness.__
Notwithstanding any other provision of law, the plan may use
copayments for permanent care services;

 
E.__Rehabilitative services for persons receiving
therapeutic care;

 
F.__Prescription drugs and devices.__Unless the prescribing
practitioner certifies that a more expensive drug is
medically necessary, the plan may cover only part of the
cost of a drug dispensed in a package or form of dosage or
administration when the agency determines that a less
expensive package or form of dosage or administration is
available that is pharmaceutically equivalent in its
therapeutic effect.__If a plan member chooses to purchase a
more expensive drug under this paragraph, the plan member is
responsible for paying the amount not covered by the plan;

 
G.__Mental health services;

 
H.__Substance abuse treatment;


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