II 

116TH CONGRESS 

2D SESSION S. 4761 

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 30 (legislative day, SEPTEMBER 29), 2020 

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 2020’’. 

4 SEC. 2. PROHIBITION ON APPLICATION OF COST SHARING 

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

7 (a) ERISA.—Subpart B of part 7 of subtitle B of 

8 title I of the Employee Retirement Income Security Act 

9 of 1974 (29 U.S.C. 1185 et seq.) is amended by adding 

10 at the end the following new section: 

11 ‘‘SEC. 716. COVERAGE OF CERTAIN PRIMARY CARE AND BE12 HAVIORAL HEALTH CARE VISITS. 

13 ‘‘(a) IN GENERAL.—In addition to any item or serv14 ice described in section 2713(a) of the Public Health Serv15 ice Act, a group health plan, and a health insurance issuer 

16 offering group health insurance coverage, shall at a min17 imum provide coverage for and shall not impose any cost18 sharing requirements for, with respect to a plan year— 

19 ‘‘(1) 3 primary care visits; and 

20 ‘‘(2) 3 behavioral health care visits. 

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

22 health insurance issuer offering group health insurance 

23 coverage, shall ensure that— 

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

25 3 primary care visits described in paragraph (1) of 

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


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

2 more restrictive than the treatment limitations ap3 plied to any other primary care visit or behavioral 

4 health care visit covered by the plan or coverage and 

5 that there are no separate treatment limitations that 

6 are applicable only with respect to such 3 primary 

7 or such 3 behavioral health care visits; and 

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

9 or such coverage for such 3 primary and such 3 be10 havioral health care visits are the same as such rates 

11 for any other primary care visit or behavioral health 

12 care visit covered by the plan or coverage. 

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

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

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

16 an individual to a qualified provider during which 

17 services are provided with respect to the diagnosis, 

18 treatment, screening, or prevention of a behavioral 

19 health condition. 

20 ‘‘(2) PRIMARY CARE SERVICE.—The term ‘pri21 mary care service’ means a service identified, as of 

22 January 1, 2020, by one of Healthcare Common 

23 Procedure Coding System codes 99201 through 

24 99215 (and as subsequently modified by the Sec25 retary of Health and Human Services). 


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

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

3 to a qualified provider who is designated by such in4 dividual as the primary care provider for such indi5 vidual, during which such individual receives pri6 mary care services. 

7 ‘‘(4) QUALIFIED PROVIDER.—The term ‘quali8 fied provider’ means— 

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

10 a general practitioner, family physician, general 

11 internist, obstetrician-gynecologist, pediatrician, 

12 geriatric physician, or advanced practice reg13 istered nurse acting in accordance with State 

14 law (including a nurse practitioner, clinical 

15 nurse specialist, and certified nurse midwife); 

16 and 

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

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

19 position (including a fellowship) where the pri20 mary intent and function of such position is the 

21 direct treatment or recovery support of individ22 uals with, or in recovery from, a behavioral 

23 health disorder, such as a physician, advanced 

24 practice registered nurse acting in accordance 

25 with State law (including a nurse practitioner, 


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1 clinical nurse specialist, and certified nurse 

2 midwife), psychiatric nurse, social worker, mar3 riage and family therapist, mental health coun4 selor, occupational therapist, psychologist, psy5 chiatrist, child and adolescent psychiatrist, or 

6 neurologist.’’. 

7 (b) PHSA.—Subpart II of part A of title XXVII of 

8 the Public Health Service Act (42 U.S.C. 300gg–11 et 

9 seq.) is amended by adding at the end the following new 

10 section: 

11 ‘‘SEC. 2730. COVERAGE OF CERTAIN PRIMARY CARE AND 

12 BEHAVIORAL HEALTH CARE VISITS. 

13 ‘‘(a) IN GENERAL.—In addition to any item or serv14 ice described in section 2713(a), a group health plan, and 

15 a health insurance issuer offering group or individual 

16 health insurance coverage, shall at a minimum provide 

17 coverage for and shall not impose any cost-sharing re18 quirements for, with respect to a plan year— 

19 ‘‘(1) 3 primary care visits; and 

20 ‘‘(2) 3 behavioral health care visits. 

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

22 health insurance issuer offering group or individual health 

23 insurance coverage, shall ensure that— 

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

25 3 primary care visits described in paragraph (1) of 


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•S 4761 IS

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

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

3 more restrictive than the treatment limitations ap4 plied to any other primary care visit or behavioral 

5 health care visit covered by the plan or coverage and 

6 that there are no separate treatment limitations that 

7 are applicable only with respect to such 3 primary 

8 or such 3 behavioral health care visits; and 

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

10 or such coverage for such 3 primary and such 3 be11 havioral health care visits are the same as such rates 

12 for any other primary care visit or behavioral health 

13 care visit covered by the plan or coverage. 

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

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

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

17 an individual to a qualified provider during which 

18 services are provided with respect to the diagnosis, 

19 treatment, screening, or prevention of a behavioral 

20 health condition. 

21 ‘‘(2) PRIMARY CARE SERVICE.—The term ‘pri22 mary care service’ means a service identified, as of 

23 January 1, 2020, by one of Healthcare Common 

24 Procedure Coding System codes 99201 through 


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1 99215 (and as subsequently modified by the Sec2 retary). 

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 advanced practice reg15 istered nurse acting in accordance with State 

16 law (including a nurse practitioner, clinical 

17 nurse specialist, and certified nurse midwife); 

18 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, advanced 


kjohnson on DSK79L0C42PROD with BILLS
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•S 4761 IS

1 practice registered nurse acting in accordance 

2 with State law (including a nurse practitioner, 

3 clinical nurse specialist, and certified nurse 

4 midwife), psychiatric nurse, social worker, mar5 riage and family therapist, mental health coun6 selor, occupational therapist, psychologist, psy7 chiatrist, child and adolescent psychiatrist, or 

8 neurologist.’’. 

9 (c) IRC.— 

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

11 100 of subtitle K of the Internal Revenue Code of 

12 1986 is amended by adding at the end the following 

13 new section: 

14 ‘‘SEC. 9816. COVERAGE OF CERTAIN PRIMARY CARE AND 

15 BEHAVIORAL HEALTH CARE VISITS. 

16 ‘‘(a) IN GENERAL.—In addition to any item or serv17 ice described in section 2713(a) of the Public Health Serv18 ice Act, a group health plan shall at a minimum provide 

19 coverage for and shall not impose any cost-sharing re20 quirements 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 shall ensure 

24 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 and that there 

8 are no separate treatment limitations that are appli9 cable only with respect to such 3 primary or such 3 

10 behavioral health care visits; and 

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

12 for such 3 primary and such 3 behavioral health 

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

14 primary care visit or behavioral health care visit cov15 ered by the plan. 

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, 2020, by one of Healthcare Common 


kjohnson on DSK79L0C42PROD with BILLS
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•S 4761 IS

1 Procedure Coding System codes 99201 through 

2 99215 (and as subsequently modified by the Sec3 retary of Health and Human Services). 

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

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

6 to a qualified provider who is designated by such in7 dividual as the primary care provider for such indi8 vidual, during which such individual receives pri9 mary care services. 

10 ‘‘(4) QUALIFIED PROVIDER.—The term ‘quali11 fied provider’ means— 

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

13 a general practitioner, family physician, general 

14 internist, obstetrician-gynecologist, pediatrician, 

15 geriatric physician, or advanced practice reg16 istered nurse acting in accordance with State 

17 law (including a nurse practitioner, clinical 

18 nurse specialist, and certified nurse midwife); 

19 and 

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

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

22 position (including a fellowship) where the pri23 mary intent and function of such position is the 

24 direct treatment or recovery support of individ25 uals with, or in recovery from, a behavioral 


kjohnson on DSK79L0C42PROD with BILLS
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•S 4761 IS

1 health disorder, such as a physician, advanced 

2 practice registered nurse acting in accordance 

3 with State law (including a nurse practitioner, 

4 clinical nurse specialist, and certified nurse 

5 midwife), psychiatric nurse, social worker, mar6 riage and family therapist, mental health coun7 selor, occupational therapist, psychologist, psy8 chiatrist, child and adolescent psychiatrist, or 

9 neurologist.’’. 

10 (2) HIGH DEDUCTIBLE HEALTH PLANS.—Sec11 tion 223(c)(2)(C) of the Internal Revenue Code of 

12 1986 is amended by inserting ‘‘or for the visits de13 scribed in section 9816(a)’’ before the period. 

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

15 this section shall apply with respect to plan years begin16 ning on or after the date that is 2 years after the date 

17 of the enactment of this Act. 

Æ 


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