II 

117TH CONGRESS 

2D SESSION S. 4905 

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 SENATE OF THE UNITED STATES 

SEPTEMBER 21, 2022 

Mr. KING introduced the following bill; which was read twice and referred to 

the Committee on Finance 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Primary and Behav3 ioral Health Care Access Act of 2022’’. 

4 SEC. 2. PROHIBITION ON APPLICATION OF COST SHARING 

5 FOR CERTAIN PRIMARY CARE AND BEHAV6 IORAL HEALTH CARE VISITS. 

7 (a) ERISA.— 

8 (1) IN GENERAL.—Subpart B of part 7 of sub9 title B of title I of the Employee Retirement Income 

10 Security Act of 1974 (29 U.S.C. 1185 et seq.) is 

11 amended by inserting after section 720 the following 

12 new section: 

13 ‘‘SEC. 721. COVERAGE OF CERTAIN PRIMARY CARE AND BE14 HAVIORAL HEALTH CARE VISITS. 

15 ‘‘(a) IN GENERAL.—In addition to any item or serv16 ice described in section 2713(a) of the Public Health Serv17 ice Act, a group health plan, and a health insurance issuer 

18 offering group health insurance coverage, shall at a min19 imum provide coverage for and shall not impose any cost20 sharing requirements for, with respect to a plan year— 

21 ‘‘(1) 3 primary care visits; and 

22 ‘‘(2) 3 behavioral health care visits. 

23 ‘‘(b) LIMITATIONS.—A group health plan, and a 

24 health insurance issuer offering group health insurance 

25 coverage, shall ensure that— 


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1 ‘‘(1) the treatment limitations applicable to the 

2 3 primary care visits described in paragraph (1) of 

3 subsection (a) and the 3 behavioral health care visits 

4 described in paragraph (2) of such subsection are no 

5 more restrictive than the treatment limitations ap6 plied to any other primary care visit or behavioral 

7 health care visit covered by the plan or coverage and 

8 that there are no separate treatment limitations that 

9 are applicable only with respect to such 3 primary 

10 or such 3 behavioral health care visits; and 

11 ‘‘(2) the reimbursement rates under such plan 

12 or such coverage for such 3 primary and such 3 be13 havioral health care visits are the same as such rates 

14 for any other primary care visit or behavioral health 

15 care visit covered by the plan or coverage. 

16 ‘‘(c) DEFINITIONS.—For purposes of this section: 

17 ‘‘(1) BEHAVIORAL HEALTH CARE VISIT.—The 

18 term ‘behavioral health care visit’ means a visit by 

19 an individual to a qualified provider during which 

20 services are provided with respect to the diagnosis, 

21 treatment, screening, or prevention of a behavioral 

22 health condition. 

23 ‘‘(2) PRIMARY CARE SERVICE.—The term ‘pri24 mary care service’ means a service identified, as of 

25 January 1, 2009, by one of HCPCS codes 99201 


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1 through 99215 (and as subsequently modified by the 

2 Secretary). 

3 ‘‘(3) PRIMARY CARE VISIT.—The term ‘primary 

4 care visit’ means an in-person visit by an individual 

5 to a qualified provider who is designated by such in6 dividual as the primary care provider for such indi7 vidual, during which such individual receives pri8 mary care services. 

9 ‘‘(4) QUALIFIED PROVIDER.—The term ‘quali10 fied provider’ means— 

11 ‘‘(A) with respect to a primary care visit, 

12 a general practitioner, family physician, general 

13 internist, obstetrician-gynecologist, pediatrician, 

14 geriatric physician, or physician assistant or ad15 vanced practice registered nurse acting in ac16 cordance with State law (including a nurse 

17 practitioner, clinical nurse specialist, and cer18 tified nurse midwife); and 

19 ‘‘(B) with respect to a behavioral health 

20 care visit, an individual employed in a full-time 

21 position (including a fellowship) where the pri22 mary intent and function of such position is the 

23 direct treatment or recovery support of individ24 uals with, or in recovery from, a behavioral 

25 health disorder, such as a physician, physician 


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1 assistant or advanced practice registered nurse 

2 acting in accordance with State law (including 

3 a nurse practitioner, clinical nurse specialist, 

4 and certified nurse midwife), psychiatric nurse, 

5 social worker, marriage and family therapist, 

6 mental health counselor, occupational therapist, 

7 psychologist, psychiatrist, child and adolescent 

8 psychiatrist, or neurologist.’’. 

9 (2) CONFORMING AMENDMENT.—The table of 

10 contents in section 1 of the Employee Retirement 

11 Income Security Act of 1974 (29 U.S.C. 1001 et 

12 seq.) is amended by inserting after the item relating 

13 to section 720 the following new item: 

‘‘Sec. 721. Coverage of certain primary care and behavioral health care visits.’’. 

14 (b) PHSA.—Part D of title XXVII of the Public 

15 Health Service Act (42 U.S.C. 300gg et seq.) is amended 

16 by inserting after section 2799A–5 the following new sec17 tion: 

18 ‘‘SEC. 2799A–6. COVERAGE OF CERTAIN PRIMARY CARE AND 

19 BEHAVIORAL HEALTH CARE VISITS. 

20 ‘‘(a) IN GENERAL.—In addition to any item or serv21 ice described in section 2713(a), a group health plan, and 

22 a health insurance issuer offering group or individual 

23 health insurance coverage, shall at a minimum provide 

24 coverage for and shall not impose any cost-sharing re25 quirements for, with respect to a plan year— 


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1 ‘‘(1) 3 primary care visits; and 

2 ‘‘(2) 3 behavioral health care visits. 

3 ‘‘(b) LIMITATIONS.—A group health plan, and a 

4 health insurance issuer offering group or individual health 

5 insurance coverage, shall ensure that— 

6 ‘‘(1) the treatment limitations applicable to the 

7 3 primary care visits described in paragraph (1) of 

8 subsection (a) and the 3 behavioral health care visits 

9 described in paragraph (2) of such subsection are no 

10 more restrictive than the treatment limitations ap11 plied to any other primary care visit or behavioral 

12 health care visit covered by the plan or coverage and 

13 that there are no separate treatment limitations that 

14 are applicable only with respect to such 3 primary 

15 or such 3 behavioral health care visits; and 

16 ‘‘(2) the reimbursement rates under such plan 

17 or such coverage for such 3 primary and such 3 be18 havioral health care visits are the same as such rates 

19 for any other primary care visit or behavioral health 

20 care visit covered by the plan or coverage. 

21 ‘‘(c) DEFINITIONS.—For purposes of this section: 

22 ‘‘(1) BEHAVIORAL HEALTH CARE VISIT.—The 

23 term ‘behavioral health care visit’ means a visit by 

24 an individual to a qualified provider during which 

25 services are provided with respect to the diagnosis, 


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1 treatment, screening, or prevention of a behavioral 

2 health condition. 

3 ‘‘(2) PRIMARY CARE SERVICE.—The term ‘pri4 mary care service’ means a service identified, as of 

5 January 1, 2009, by one of HCPCS codes 99201 

6 through 99215 (and as subsequently modified by the 

7 Secretary). 

8 ‘‘(3) PRIMARY CARE VISIT.—The term ‘primary 

9 care visit’ means an in-person visit by an individual 

10 to a qualified provider who is designated by such in11 dividual as the primary care provider for such indi12 vidual, during which such individual receives pri13 mary care services. 

14 ‘‘(4) QUALIFIED PROVIDER.—The term ‘quali15 fied provider’ means— 

16 ‘‘(A) with respect to a primary care visit, 

17 a general practitioner, family physician, general 

18 internist, obstetrician-gynecologist, pediatrician, 

19 geriatric physician, or physician assistant or ad20 vanced practice registered nurse acting in ac21 cordance with State law (including a nurse 

22 practitioner, clinical nurse specialist, and cer23 tified nurse midwife); and 

24 ‘‘(B) with respect to a behavioral health 

25 care visit, an individual employed in a full-time 


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1 position (including a fellowship) where the pri2 mary intent and function of such position is the 

3 direct treatment or recovery support of individ4 uals with, or in recovery from, a behavioral 

5 health disorder, such as a physician, physician 

6 assistant or advanced practice registered nurse 

7 acting in accordance with State law (including 

8 a nurse practitioner, clinical nurse specialist, 

9 and certified nurse midwife), psychiatric nurse, 

10 social worker, marriage and family therapist, 

11 mental health counselor, occupational therapist, 

12 psychologist, psychiatrist, child and adolescent 

13 psychiatrist, or neurologist.’’. 

14 (c) IRC.— 

15 (1) IN GENERAL.—Subchapter B of chapter 

16 100 of subtitle K of the Internal Revenue Code of 

17 1986 is amended by inserting after section 9820 the 

18 following new section: 

19 ‘‘SEC. 9821. COVERAGE OF CERTAIN PRIMARY CARE AND 

20 BEHAVIORAL HEALTH CARE VISITS. 

21 ‘‘(a) IN GENERAL.—In addition to any item or serv22 ice described in section 2713(a) of the Public Health Serv23 ice Act, a group health plan shall at a minimum provide 

24 coverage for and shall not impose any cost-sharing re25 quirements for, with respect to a plan year— 


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1 ‘‘(1) 3 primary care visits; and 

2 ‘‘(2) 3 behavioral health care visits. 

3 ‘‘(b) LIMITATIONS.—A group health plan shall ensure 

4 that— 

5 ‘‘(1) the treatment limitations applicable to the 

6 3 primary care visits described in paragraph (1) of 

7 subsection (a) and the 3 behavioral health care visits 

8 described in paragraph (2) of such subsection are no 

9 more restrictive than the treatment limitations ap10 plied to any other primary care visit or behavioral 

11 health care visit covered by the plan and that there 

12 are no separate treatment limitations that are appli13 cable only with respect to such 3 primary or such 3 

14 behavioral health care visits; and 

15 ‘‘(2) the reimbursement rates under such plan 

16 for such 3 primary and such 3 behavioral health 

17 care visits are the same as such rates for any other 

18 primary care visit or behavioral health care visit cov19 ered by the plan. 

20 ‘‘(c) DEFINITIONS.—For purposes of this section: 

21 ‘‘(1) BEHAVIORAL HEALTH CARE VISIT.—The 

22 term ‘behavioral health care visit’ means a visit by 

23 an individual to a qualified provider during which 

24 services are provided with respect to the diagnosis, 


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•S 4905 IS

1 treatment, screening, or prevention of a behavioral 

2 health condition. 

3 ‘‘(2) PRIMARY CARE SERVICE.—The term ‘pri4 mary care service’ means a service identified, as of 

5 January 1, 2009, by one of HCPCS codes 99201 

6 through 99215 (and as subsequently modified by the 

7 Secretary). 

8 ‘‘(3) PRIMARY CARE VISIT.—The term ‘primary 

9 care visit’ means an in-person visit by an individual 

10 to a qualified provider who is designated by such in11 dividual as the primary care provider for such indi12 vidual, during which such individual receives pri13 mary care services. 

14 ‘‘(4) QUALIFIED PROVIDER.—The term ‘quali15 fied provider’ means— 

16 ‘‘(A) with respect to a primary care visit, 

17 a general practitioner, family physician, general 

18 internist, obstetrician-gynecologist, pediatrician, 

19 geriatric physician, or physician assistant or ad20 vanced practice registered nurse acting in ac21 cordance with State law (including a nurse 

22 practitioner, clinical nurse specialist, and cer23 tified nurse midwife); and 

24 ‘‘(B) with respect to a behavioral health 

25 care visit, an individual employed in a full-time 


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1 position (including a fellowship) where the pri2 mary intent and function of such position is the 

3 direct treatment or recovery support of individ4 uals with, or in recovery from, a behavioral 

5 health disorder, such as a physician, physician 

6 assistant or advanced practice registered nurse 

7 acting in accordance with State law (including 

8 a nurse practitioner, clinical nurse specialist, 

9 and certified nurse midwife), psychiatric nurse, 

10 social worker, marriage and family therapist, 

11 mental health counselor, occupational therapist, 

12 psychologist, psychiatrist, child and adolescent 

13 psychiatrist, or neurologist.’’. 

14 (2) HIGH DEDUCTIBLE HEALTH PLANS.—Sec15 tion 223(c)(2)(C) of the Internal Revenue Code of 

16 1986 is amended by inserting ‘‘or for the visits de17 scribed in section 9821’’ before the period. 

18 (3) CONFORMING AMENDMENT.—The table of 

19 sections for subchapter B of chapter 100 of the In20 ternal Revenue Code of 1986 is amended by insert21 ing after the item relating to section 9820 the fol22 lowing new item: 

‘‘Sec. 9821. Coverage of certain primary care and behavioral health care visits.’’. 

23 (d) EFFECTIVE DATE.—The amendments made by 

24 this section shall apply with respect to plan years beginVerDate Sep 11 2014 01:25 Sep 24, 2022 Jkt 029200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S4905.IS S4905

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1 ning on or after the date that is 2 years after the date 

2 of the enactment of this Act. 

Æ 


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