I 

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. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Helping Out Patients 

5 for Emotional and Mental Wellbeing Act’’ or the ‘‘HOPE 

6 and Mental Wellbeing Act of 2023’’. 


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1 SEC. 2. REQUIRING COVERAGE OF 3 PRIMARY CARE VISITS 

2 WITHOUT COST SHARING EACH YEAR UNDER 

3 MEDICARE. 

4 (a) MEDICARE.— 

5 (1) IN GENERAL.—Section 1833 of the Social 

6 Security Act (42 U.S.C. 1395l) is amended— 

7 (A) in subsection (a)(1)— 

8 (i) by striking ‘‘and’’ before ‘‘(HH)’’; 

9 and 

10 (ii) by inserting before the semicolon 

11 at the end the following: ‘‘, and (II) with 

12 respect to the first 3 primary care visits 

13 (as defined in section 1861(nnn)) fur14 nished to an individual during a year (be15 ginning with 2024) for which payment may 

16 be made under a specified outpatient pay17 ment provision described in subsection 

18 (cc)(2), the amounts paid shall be 100 per19 cent of the lesser of the actual charge or 

20 the payment amount otherwise recognized 

21 under such respective specified outpatient 

22 payment provision for such visit’’; and 

23 (B) in subsection (b), in the first sen24 tence— 

25 (i) by striking ‘‘and’’ before ‘‘(13)’’; 


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1 (ii) in paragraph (13), by striking ‘‘..’’ 

2 and inserting a period; and 

3 (iii) by inserting before the period at 

4 the end the following: ‘‘, and (13) shall not 

5 apply with respect to the first 3 primary 

6 care visits (as defined in section 

7 1861(nnn)) furnished to an individual dur8 ing a year (beginning with 2024) for which 

9 payment may be made under a specified 

10 outpatient payment provision described in 

11 subsection (cc)(2)’’. 

12 (2) MEDICARE ADVANTAGE.—Section 

13 1852(a)(1)(B) of the Social Security Act (42 U.S.C. 

14 1395w–22(a)(1)(B)) is amended— 

15 (A) in clause (iv)— 

16 (i) by redesignating subclause (VIII) 

17 as subclause (IX); and 

18 (ii) by inserting after subclause (VII) 

19 the following new subclause: 

20 ‘‘(VIII) the first 3 primary care 

21 visits (as defined in section 

22 1861(nnn)) furnished to an enrollee 

23 during a year (beginning with 

24 2024).’’; and 


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1 (B) in clause (v), by striking ‘‘and (VII)’’ 

2 and inserting ‘‘(VII), and (VIII)’’. 

3 (3) DEFINITION.—Section 1861 of the Social 

4 Security Act (42 U.S.C. 1395x) is amended by add5 ing at the end the following new subsection: 

6 ‘‘(nnn) PRIMARY CARE VISIT.—The term ‘primary 

7 care visit’ means outpatient behavioral health services, 

8 nonspecialty medical services, and care coordination serv9 ices furnished for the prevention, diagnosis, treatment, or 

10 management of a physical or behavioral health condi11 tion.’’. 

12 (b) MEDICAID.— 

13 (1) IN GENERAL.—Section 1916 of the Social 

14 Security Act (42 U.S.C. 1396o) is amended— 

15 (A) in subsection (a)(2)— 

16 (i) in subparagraph (I), by striking 

17 ‘‘or’’ at the end; 

18 (ii) in subparagraph (J), by striking 

19 ‘‘; and’’ at the end and inserting ‘‘, or’’; 

20 and 

21 (iii) by adding at the end the fol22 lowing new subparagraph: 

23 ‘‘(K) the first 3 primary care visits (as de24 fined in section 1861(nnn)) furnished to an in25 dividual during a year (beginning with 2024) 


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1 for which payment may be made under this 

2 title; and’’; and 

3 (B) in subsection (b)(2)— 

4 (i) in subparagraph (I), by striking 

5 ‘‘or’’ at the end; 

6 (ii) in subparagraph (J), by striking 

7 ‘‘; and’’ at the end and inserting ‘‘, or’’; 

8 and 

9 (iii) by adding at the end the fol10 lowing new subparagraph: 

11 ‘‘(K) the first 3 primary care visits (as de12 fined in section 1861(nnn)) furnished to an in13 dividual during a year (beginning with 2024); 

14 and’’. 

15 (2) APPLICATION TO ALTERNATIVE COST SHAR16 ING.—Section 1916A(b)(3)(B) of the Social Security 

17 Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended by 

18 adding at the end the following new clause: 

19 ‘‘(xv) The first 3 primary care visits 

20 (as defined in section 1861(nnn)) fur21 nished to an individual during a year (be22 ginning with 2024).’’. 

Æ 


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