HR 1096

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IN THE HOUSE OF REPRESENTATIVES

February 6, 2025

Ms. Salinas (for herself, Mrs. Watson Coleman, Ms. Norton, Mr. Doggett, and Mr. Goldman of New York) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

A BILL

To amend title XVIII of the Social Security Act to require coverage of 3 primary care visits without cost sharing each year under the Medicare program.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the “Helping Out Patients for Emotional and Mental Wellbeing Act” or the “HOPE and Mental Wellbeing Act of 2025”.

SEC. 2. REQUIRING COVERAGE OF 3 PRIMARY CARE VISITS WITHOUT COST SHARING EACH YEAR UNDER MEDICARE.

(a) Medicare.—

(1) In general.—Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended—

(A) in subsection (a)(1)—

(i) by striking “and” before “(HH)”; and

(ii) by inserting before the semicolon at the end the following: “, and (II) with respect to the first 3 primary care visits (as defined in section 1861(nnn)) furnished to an individual during a year (beginning with 2026) for which payment may be made under a specified outpatient payment provision described in subsection (cc)(2), the amounts paid shall be 100 percent of the lesser of the actual charge or the payment amount otherwise recognized under such respective specified outpatient payment provision for such visit”; and

(B) in subsection (b), in the first sentence—

(i) by striking “and” before “(13)”;

(ii) in paragraph (13), by striking “..” and inserting a period; and

(iii) by inserting before the period at the end the following: “, and (13) shall not apply with respect to the first 3 primary care visits (as defined in section 1861(nnn)) furnished to an individual during a year (beginning with 2026) for which payment may be made under a specified outpatient payment provision described in subsection (cc)(2)”.

(2) Medicare advantage.—Section 1852(a)(1)(B) of the Social Security Act (42 U.S.C. 1395w-22(a)(1)(B)) is amended—

(A) in clause (iv)—

(i) by redesignating subclause (VIII) as subclause (IX); and

(ii) by inserting after subclause (VII) the following new subclause:

“(VIII) the first 3 primary care visits (as defined in section 1861(nnn)) furnished to an enrollee during a year (beginning with 2026).”; and

(B) in clause (v), by striking “and (VII)” and inserting “(VII), and (VIII)”.

(3) Definition.—Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection: “(nnn) Primary Care Visit.—The term ‘primary care visit’ means outpatient mental and behavioral health services, nonspecialty medical services, and care coordination services furnished for the prevention, diagnosis, treatment, or management of a physical, mental, or behavioral health condition.”.

(b) Medicaid.—

(1) In general.—Section 1916 of the Social Security Act (42 U.S.C. 1396o) is amended—

(A) in subsection (a)(2)—

(i) in subparagraph (I), by striking “or” at the end;

(ii) in subparagraph (J), by striking “; and” at the end and inserting “, or”; and

(iii) by adding at the end the following new subparagraph:

“(K) the first 3 primary care visits (as defined in section 1861(nnn)) furnished to an individual during a year (beginning with 2026) for which payment may be made under this title; and”; and

(B) in subsection (b)(2)—

(i) in subparagraph (I), by striking “or” at the end;

(ii) in subparagraph (J), by striking “; and” at the end and inserting “, or”; and

(iii) by adding at the end the following new subparagraph:

“(K) the first 3 primary care visits (as defined in section 1861(nnn)) furnished to an individual during a year (beginning with 2026); and”.

(2) Application to alternative cost sharing.—Section 1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 1396o- 1(b)(3)(B)) is amended by adding at the end the following new clause:

“(xv) The first 3 primary care visits (as defined in section 1861(nnn)) furnished to an individual during a year (beginning with 2026).”. <all>