[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9133 Introduced in House (IH)]
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118th CONGRESS
2d Session
H. R. 9133
To amend the Employee Retirement Income Security Act of 1974, title
XXVII of the Public Health Service Act, and the Internal Revenue Code
of 1986 to require group health plans and health insurance issuers
offering group or individual health insurance coverage to provide for 3
primary care visits and 3 behavioral health care visits without
application of any cost-sharing requirement.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 25, 2024
Ms. Underwood (for herself, Ms. Schrier, and Ms. Porter) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committees on Education and the
Workforce, and 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 the Employee Retirement Income Security Act of 1974, title
XXVII of the Public Health Service Act, and the Internal Revenue Code
of 1986 to require group health plans and health insurance issuers
offering group or individual health insurance coverage to provide for 3
primary care visits and 3 behavioral health care visits without
application of any cost-sharing requirement.
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 ``Primary and Behavioral Health Care
Access Act of 2024''.
SEC. 2. PROHIBITION ON APPLICATION OF COST SHARING FOR CERTAIN PRIMARY
CARE AND BEHAVIORAL HEALTH CARE VISITS.
(a) ERISA.--
(1) In general.--Subpart B of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1185 et seq.) is amended by adding at the end the
following new section:
``SEC. 721. COVERAGE OF CERTAIN PRIMARY CARE AND BEHAVIORAL HEALTH CARE
VISITS.
``(a) In General.--In addition to any item or service described in
section 2713(a) of the Public Health Service Act, a group health plan,
and a health insurance issuer offering group health insurance coverage,
shall at a minimum provide coverage for and shall not impose any cost-
sharing requirements for, with respect to a plan year--
``(1) 3 primary care visits; and
``(2) 3 behavioral health care visits.
``(b) Limitations.--A group health plan, and a health insurance
issuer offering group health insurance coverage, shall ensure that--
``(1) the treatment limitations applicable to the 3 primary
care visits described in paragraph (1) of subsection (a) and
the 3 behavioral health care visits described in paragraph (2)
of such subsection are no more restrictive than the treatment
limitations applied to any other primary care visit or
behavioral health care visit covered by the plan or coverage
and that there are no separate treatment limitations that are
applicable only with respect to such 3 primary or such 3
behavioral health care visits; and
``(2) the reimbursement rates under such plan or such
coverage for such 3 primary and such 3 behavioral health care
visits are the same as such rates for any other primary care
visit or behavioral health care visit covered by the plan or
coverage.
``(c) Definitions.--For purposes of this section:
``(1) Behavioral health care visit.--The term `behavioral
health care visit' means a visit by an individual to a
qualified provider during which services are provided with
respect to the diagnosis, treatment, screening, or prevention
of a behavioral health condition.
``(2) Primary care service.--The term `primary care
service' means a service identified, as of January 1, 2009, by
one of HCPCS codes 99201 through 99215 (and as subsequently
modified by the Secretary).
``(3) Primary care visit.--The term `primary care visit'
means an in-person visit by an individual to a qualified
provider who is designated by such individual as the primary
care provider for such individual, during which such individual
receives primary care services.
``(4) Qualified provider.--The term `qualified provider'
means--
``(A) with respect to a primary care visit, a
general practitioner, family physician, general
internist, obstetrician-gynecologist, pediatrician,
geriatric physician, or physician assistant or advanced
practice registered nurse acting in accordance with
State law (including a nurse practitioner, clinical
nurse specialist, and certified nurse midwife); and
``(B) with respect to a behavioral health care
visit, an individual employed in a full-time position
(including a fellowship) where the primary intent and
function of such position is the direct treatment or
recovery support of individuals with, or in recovery
from, a behavioral health disorder, such as a
physician, physician assistant or advanced practice
registered nurse acting in accordance with State law
(including a nurse practitioner, clinical nurse
specialist, and certified nurse midwife), psychiatric
nurse, social worker, marriage and family therapist,
mental health counselor, occupational therapist,
psychologist, psychiatrist, child and adolescent
psychiatrist, or neurologist.''.
(2) Conforming amendment.--The table of contents in section
1 of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1001 et seq.) is amended by inserting after the item
relating to section 720 the following new item:
``Sec. 721. Coverage of certain primary care and behavioral health care
visits.''.
(b) PHSA.--Part D of title XXVII of the Public Health Service Act
(42 U.S.C. 300gg et seq.) is amended by adding at the end the following
new section:
``SEC. 2799A-6. COVERAGE OF CERTAIN PRIMARY CARE AND BEHAVIORAL HEALTH
CARE VISITS.
``(a) In General.--In addition to any item or service described in
section 2713(a), a group health plan, and a health insurance issuer
offering group or individual health insurance coverage, shall at a
minimum provide coverage for and shall not impose any cost-sharing
requirements for, with respect to a plan year--
``(1) 3 primary care visits; and
``(2) 3 behavioral health care visits.
``(b) Limitations.--A group health plan, and a health insurance
issuer offering group or individual health insurance coverage, shall
ensure that--
``(1) the treatment limitations applicable to the 3 primary
care visits described in paragraph (1) of subsection (a) and
the 3 behavioral health care visits described in paragraph (2)
of such subsection are no more restrictive than the treatment
limitations applied to any other primary care visit or
behavioral health care visit covered by the plan or coverage
and that there are no separate treatment limitations that are
applicable only with respect to such 3 primary or such 3
behavioral health care visits; and
``(2) the reimbursement rates under such plan or such
coverage for such 3 primary and such 3 behavioral health care
visits are the same as such rates for any other primary care
visit or behavioral health care visit covered by the plan or
coverage.
``(c) Definitions.--For purposes of this section:
``(1) Behavioral health care visit.--The term `behavioral
health care visit' means a visit by an individual to a
qualified provider during which services are provided with
respect to the diagnosis, treatment, screening, or prevention
of a behavioral health condition.
``(2) Primary care service.--The term `primary care
service' means a service identified, as of January 1, 2009, by
one of HCPCS codes 99201 through 99215 (and as subsequently
modified by the Secretary).
``(3) Primary care visit.--The term `primary care visit'
means an in-person visit by an individual to a qualified
provider who is designated by such individual as the primary
care provider for such individual, during which such individual
receives primary care services.
``(4) Qualified provider.--The term `qualified provider'
means--
``(A) with respect to a primary care visit, a
general practitioner, family physician, general
internist, obstetrician-gynecologist, pediatrician,
geriatric physician, or physician assistant or advanced
practice registered nurse acting in accordance with
State law (including a nurse practitioner, clinical
nurse specialist, and certified nurse midwife); and
``(B) with respect to a behavioral health care
visit, an individual employed in a full-time position
(including a fellowship) where the primary intent and
function of such position is the direct treatment or
recovery support of individuals with, or in recovery
from, a behavioral health disorder, such as a
physician, physician assistant or advanced practice
registered nurse acting in accordance with State law
(including a nurse practitioner, clinical nurse
specialist, and certified nurse midwife), psychiatric
nurse, social worker, marriage and family therapist,
mental health counselor, occupational therapist,
psychologist, psychiatrist, child and adolescent
psychiatrist, or neurologist.''.
(c) IRC.--
(1) In general.--Subchapter B of chapter 100 of subtitle K
of the Internal Revenue Code of 1986 is amended by adding at
the end the following new section:
``SEC. 9821. COVERAGE OF CERTAIN PRIMARY CARE AND BEHAVIORAL HEALTH
CARE VISITS.
``(a) In General.--In addition to any item or service described in
section 2713(a) of the Public Health Service Act, a group health plan
shall at a minimum provide coverage for and shall not impose any cost-
sharing requirements for, with respect to a plan year--
``(1) 3 primary care visits; and
``(2) 3 behavioral health care visits.
``(b) Limitations.--A group health plan shall ensure that--
``(1) the treatment limitations applicable to the 3 primary
care visits described in paragraph (1) of subsection (a) and
the 3 behavioral health care visits described in paragraph (2)
of such subsection are no more restrictive than the treatment
limitations applied to any other primary care visit or
behavioral health care visit covered by the plan and that there
are no separate treatment limitations that are applicable only
with respect to such 3 primary or such 3 behavioral health care
visits; and
``(2) the reimbursement rates under such plan for such 3
primary and such 3 behavioral health care visits are the same
as such rates for any other primary care visit or behavioral
health care visit covered by the plan.
``(c) Definitions.--For purposes of this section:
``(1) Behavioral health care visit.--The term `behavioral
health care visit' means a visit by an individual to a
qualified provider during which services are provided with
respect to the diagnosis, treatment, screening, or prevention
of a behavioral health condition.
``(2) Primary care service.--The term `primary care
service' means a service identified, as of January 1, 2009, by
one of HCPCS codes 99201 through 99215 (and as subsequently
modified by the Secretary).
``(3) Primary care visit.--The term `primary care visit'
means an in-person visit by an individual to a qualified
provider who is designated by such individual as the primary
care provider for such individual, during which such individual
receives primary care services.
``(4) Qualified provider.--The term `qualified provider'
means--
``(A) with respect to a primary care visit, a
general practitioner, family physician, general
internist, obstetrician-gynecologist, pediatrician,
geriatric physician, or physician assistant or advanced
practice registered nurse acting in accordance with
State law (including a nurse practitioner, clinical
nurse specialist, and certified nurse midwife); and
``(B) with respect to a behavioral health care
visit, an individual employed in a full-time position
(including a fellowship) where the primary intent and
function of such position is the direct treatment or
recovery support of individuals with, or in recovery
from, a behavioral health disorder, such as a
physician, physician assistant or advanced practice
registered nurse acting in accordance with State law
(including a nurse practitioner, clinical nurse
specialist, and certified nurse midwife), psychiatric
nurse, social worker, marriage and family therapist,
mental health counselor, occupational therapist,
psychologist, psychiatrist, child and adolescent
psychiatrist, or neurologist.''.
(2) High deductible health plans.--Section 223(c)(2)(C) of
the Internal Revenue Code of 1986 is amended by inserting ``or
for the visits described in section 9821'' before the period.
(3) Conforming amendment.--The table of sections for
subchapter B of chapter 100 of the Internal Revenue Code of
1986 is amended by inserting after the item relating to section
9820 the following new item:
``Sec. 9821. Coverage of certain primary care and behavioral health
care visits.''.
(d) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after the date that is
2 years after the date of the enactment of this Act.
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