Title I, SEC. 1141. EXCLUSIONS. 
      (a) Medical Necessity. The comprehensive benefit package does not include 

        (1) an item or service (other than services referred to in paragraph 
      (2)) that is not medically necessary or appropriate; or 

        (2) an item or service that the National Health Board may determine is 
      not medically necessary or appropriate in a regulation promulgated under 
      section 1154. 

      (b) Additional Exclusions. The comprehensive benefit package does not 
    include the following items and services: 

        (1) Custodial care, except in the case of hospice care under section 
      1117. 

        (2) Surgery and other procedures performed solely for cosmetic purposes 
      and hospital or other services incident thereto, unless 

          (A) required to correct a congenital anomaly; or 

          (B) required to restore or correct a part of the body that has been 
        altered as a result of 

            (i) accidental injury; 

            (ii) disease; or 

            (iii) surgery that is otherwise covered under this subtitle. 

        (3) Hearing aids. 

        (4) Eyeglasses and contact lenses for individuals at least 18 years of 
      age. 

        (5) In vitro fertilization services. 

        (6) Sex change surgery and related services. 

        (7) Private duty nursing. 

        (8) Personal comfort items, except in the case of hospice care under 
      section 1117. 

        (9) Any dental procedures involving orthodontic care, inlays, gold or 
      platinum fillings, bridges, crowns, pin/post retention, dental implants, 
      surgical periodontal procedures, or the preparation of the mouth for the 
      fitting or continued use of dentures, except as specifically described in 
      section 1126.