H.R. 1096

119 HR 1096 IH: Helping Out Patients for Emotional and Mental Wellbeing Act
 U.S. House of Representatives
 2025-02-06
 text/xml
 EN
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 I  119th CONGRESS  1st Session  H. R. 1096  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.
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  .
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).
 .