[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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