Us Congress 2025-2026 Regular Session

Us Congress House Bill HB1096 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	I
2	2	119THCONGRESS
3	3	1
4	4	STSESSION H. R. 1096
5	5	To amend title XVIII of the Social Security Act to require coverage of
6	6	3 primary care visits without cost sharing each year under the Medicare
7	7	program.
8	8	IN THE HOUSE OF REPRESENTATIVES
9	9	FEBRUARY6, 2025
10	10	Ms. S
11	11	ALINAS(for herself, Mrs. WATSONCOLEMAN, Ms. NORTON, Mr. DOG-
12	12	GETT, and Mr. GOLDMANof New York) introduced the following bill;
13	13	which was referred to the Committee on Energy and Commerce, and in
14	14	addition to the Committee on Ways and Means, for a period to be subse-
15	15	quently determined by the Speaker, in each case for consideration of such
16	16	provisions as fall within the jurisdiction of the committee concerned
17	17	A BILL
18	18	To amend title XVIII of the Social Security Act to require
19	19	coverage of 3 primary care visits without cost sharing
20	20	each year under the Medicare program.
21	21	Be it enacted by the Senate and House of Representa-1
22	22	tives of the United States of America in Congress assembled, 2
23	23	SECTION 1. SHORT TITLE. 3
24	24	This Act may be cited as the ‘‘Helping Out Patients 4
25	25	for Emotional and Mental Wellbeing Act’’ or the ‘‘HOPE 5
26	26	and Mental Wellbeing Act of 2025’’. 6
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29	29	•HR 1096 IH
30	30	SEC. 2. REQUIRING COVERAGE OF 3 PRIMARY CARE VISITS 1
31	31	WITHOUT COST SHARING EACH YEAR UNDER 2
32	32	MEDICARE. 3
33	33	(a) M
34	34	EDICARE.— 4
35	35	(1) I
36	36	N GENERAL.—Section 1833 of the Social 5
37	37	Security Act (42 U.S.C. 1395l) is amended— 6
38	38	(A) in subsection (a)(1)— 7
39	39	(i) by striking ‘‘and’’ before ‘‘(HH)’’; 8
40	40	and 9
41	41	(ii) by inserting before the semicolon 10
42	42	at the end the following: ‘‘, and (II) with 11
43	43	respect to the first 3 primary care visits 12
44	44	(as defined in section 1861(nnn)) fur-13
45	45	nished to an individual during a year (be-14
46	46	ginning with 2026) for which payment may 15
47	47	be made under a specified outpatient pay-16
48	48	ment provision described in subsection 17
49	49	(cc)(2), the amounts paid shall be 100 per-18
50	50	cent of the lesser of the actual charge or 19
51	51	the payment amount otherwise recognized 20
52	52	under such respective specified outpatient 21
53	53	payment provision for such visit’’; and 22
54	54	(B) in subsection (b), in the first sen-23
55	55	tence— 24
56	56	(i) by striking ‘‘and’’ before ‘‘(13)’’; 25
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59	59	•HR 1096 IH
60	60	(ii) in paragraph (13), by striking ‘‘..’’ 1
61	61	and inserting a period; and 2
62	62	(iii) by inserting before the period at 3
63	63	the end the following: ‘‘, and (13) shall not 4
64	64	apply with respect to the first 3 primary 5
65	65	care visits (as defined in section 6
66	66	1861(nnn)) furnished to an individual dur-7
67	67	ing a year (beginning with 2026) for which 8
68	68	payment may be made under a specified 9
69	69	outpatient payment provision described in 10
70	70	subsection (cc)(2)’’. 11
71	71	(2) M
72	72	EDICARE ADVANTAGE .—Section 12
73	73	1852(a)(1)(B) of the Social Security Act (42 U.S.C. 13
74	74	1395w–22(a)(1)(B)) is amended— 14
75	75	(A) in clause (iv)— 15
76	76	(i) by redesignating subclause (VIII) 16
77	77	as subclause (IX); and 17
78	78	(ii) by inserting after subclause (VII) 18
79	79	the following new subclause: 19
80	80	‘‘(VIII) the first 3 primary care 20
81	81	visits (as defined in section 21
82	82	1861(nnn)) furnished to an enrollee 22
83	83	during a year (beginning with 23
84	84	2026).’’; and 24
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87	87	•HR 1096 IH
88	88	(B) in clause (v), by striking ‘‘and (VII)’’ 1
89	89	and inserting ‘‘(VII), and (VIII)’’. 2
90	90	(3) D
91	91	EFINITION.—Section 1861 of the Social 3
92	92	Security Act (42 U.S.C. 1395x) is amended by add-4
93	93	ing at the end the following new subsection: 5
94	94	‘‘(nnn) P
95	95	RIMARYCAREVISIT.—The term ‘primary 6
96	96	care visit’ means outpatient mental and behavioral health 7
97	97	services, nonspecialty medical services, and care coordina-8
98	98	tion services furnished for the prevention, diagnosis, treat-9
99	99	ment, or management of a physical, mental, or behavioral 10
100	100	health condition.’’. 11
101	101	(b) M
102	102	EDICAID.— 12
103	103	(1) I
104	104	N GENERAL.—Section 1916 of the Social 13
105	105	Security Act (42 U.S.C. 1396o) is amended— 14
106	106	(A) in subsection (a)(2)— 15
107	107	(i) in subparagraph (I), by striking 16
108	108	‘‘or’’ at the end; 17
109	109	(ii) in subparagraph (J), by striking 18
110	110	‘‘; and’’ at the end and inserting ‘‘, or’’; 19
111	111	and 20
112	112	(iii) by adding at the end the fol-21
113	113	lowing new subparagraph: 22
114	114	‘‘(K) the first 3 primary care visits (as de-23
115	115	fined in section 1861(nnn)) furnished to an in-24
116	116	dividual during a year (beginning with 2026) 25
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119	119	•HR 1096 IH
120	120	for which payment may be made under this 1
121	121	title; and’’; and 2
122	122	(B) in subsection (b)(2)— 3
123	123	(i) in subparagraph (I), by striking 4
124	124	‘‘or’’ at the end; 5
125	125	(ii) in subparagraph (J), by striking 6
126	126	‘‘; and’’ at the end and inserting ‘‘, or’’; 7
127	127	and 8
128	128	(iii) by adding at the end the fol-9
129	129	lowing new subparagraph: 10
130	130	‘‘(K) the first 3 primary care visits (as de-11
131	131	fined in section 1861(nnn)) furnished to an in-12
132	132	dividual during a year (beginning with 2026); 13
133	133	and’’. 14
134	134	(2) A
135	135	PPLICATION TO ALTERNATIVE COST SHAR -15
136	136	ING.—Section 1916A(b)(3)(B) of the Social Security 16
137	137	Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended by 17
138	138	adding at the end the following new clause: 18
139	139	‘‘(xv) The first 3 primary care visits 19
140	140	(as defined in section 1861(nnn)) fur-20
141	141	nished to an individual during a year (be-21
142	142	ginning with 2026).’’. 22
143	143	Æ
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