[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5510 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 5510
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
September 14, 2023
Ms. Salinas (for herself and Mrs. Napolitano) 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
2023''.
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 2024)
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
2024) 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 2024).'';
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 behavioral health services, nonspecialty medical services,
and care coordination services furnished for the prevention, diagnosis,
treatment, or management of a physical 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 2024) 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 2024); 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
2024).''.
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