119-hr1096

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1096 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 1096

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.

_______________________________________________________________________

 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).''.
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