SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Primary and Behav-
ioral Health Care Access Act of 2021’’. 
SEC. 2. PROHIBITION ON APPLICATION OF COST SHARING 
FOR CERTAIN PRIMARY CARE AND BEHAV-
IORAL HEALTH CARE VISITS. 
(a) ERISA.— 
(1) IN GENERAL.—Subpart B of part 7 of sub-
title B of title I of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1185 et seq.) is 
amended by adding at the end the following new sec-
tion: 
‘‘SEC. 721. COVERAGE OF CERTAIN PRIMARY CARE AND BE-
HAVIORAL HEALTH CARE VISITS. 
‘‘(a) IN GENERAL.—In addition to any item or serv-
ice described in section 2713(a) of the Public Health Serv-
ice Act, a group health plan, and a health insurance issuer 
offering group health insurance coverage, shall at a min-
imum provide coverage for and shall not impose any cost- 
sharing requirements for, with respect to a plan year— 
‘‘(1) 3 primary care visits; and 
‘‘(2) 3 behavioral health care visits. 
‘‘(b) LIMITATIONS.—A group health plan, and a 
health insurance issuer offering group health insurance 
coverage, shall ensure that— 
VerDate Sep 11 2014 
22:55 Jun 23, 2021
Jkt 019200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H3550.IH
H3550
kjohnson on DSK79L0C42PROD with BILLS
‘‘(1) the treatment limitations applicable to the 
3 primary care visits described in paragraph (1) of 
subsection (a) and the 3 behavioral health care visits 
described in paragraph (2) of such subsection are no 
more restrictive than the treatment limitations ap-
plied to any other primary care visit or behavioral 
health care visit covered by the plan or coverage and 
that there are no separate treatment limitations that 
are applicable only with respect to such 3 primary 
or such 3 behavioral health care visits; and 
‘‘(2) the reimbursement rates under such plan 
or such coverage for such 3 primary and such 3 be-
havioral health care visits are the same as such rates 
for any other primary care visit or behavioral health 
care visit covered by the plan or coverage. 
‘‘(c) DEFINITIONS.—For purposes of this section: 
‘‘(1) BEHAVIORAL HEALTH CARE VISIT.—The 
term ‘behavioral health care visit’ means a visit by 
an individual to a qualified provider during which 
services are provided with respect to the diagnosis, 
treatment, screening, or prevention of a behavioral 
health condition. 
‘‘(2) PRIMARY CARE SERVICE.—The term ‘pri-
mary care service’ means a service identified, as of 
January 1, 2009, by one of HCPCS codes 99201 
VerDate Sep 11 2014 
22:55 Jun 23, 2021
Jkt 019200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H3550.IH
H3550
kjohnson on DSK79L0C42PROD with BILLS
through 99215 (and as subsequently modified by the 
Secretary). 
‘‘(3) PRIMARY CARE VISIT.—The term ‘primary 
care visit’ means an in-person visit by an individual 
to a qualified provider who is designated by such in-
dividual as the primary care provider for such indi-
vidual, during which such individual receives pri-
mary care services. 
‘‘(4) QUALIFIED PROVIDER.—The term ‘quali-
fied provider’ means— 
‘‘(A) with respect to a primary care visit, 
a general practitioner, family physician, general 
internist, obstetrician-gynecologist, pediatrician, 
geriatric physician, or physician assistant or ad-
vanced practice registered nurse acting in ac-
cordance with State law (including a nurse 
practitioner, clinical nurse specialist, and cer-
tified nurse midwife); and 
‘‘(B) with respect to a behavioral health 
care visit, an individual employed in a full-time 
position (including a fellowship) where the pri-
mary intent and function of such position is the 
direct treatment or recovery support of individ-
uals with, or in recovery from, a behavioral 
health disorder, such as a physician, physician 
VerDate Sep 11 2014 
22:55 Jun 23, 2021
Jkt 019200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H3550.IH
H3550
kjohnson on DSK79L0C42PROD with BILLS
assistant or advanced practice registered nurse 
acting in accordance with State law (including 
a nurse practitioner, clinical nurse specialist, 
and certified nurse midwife), psychiatric nurse, 
social worker, marriage and family therapist, 
mental health counselor, occupational therapist, 
psychologist, psychiatrist, child and adolescent 
psychiatrist, or neurologist.’’. 
(2) CONFORMING AMENDMENT.—The table of 
contents in section 1 of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1001 et 
seq.) is amended by inserting after the item relating 
to section 720 the following new item: 
‘‘Sec. 721. Coverage of certain primary care and behavioral health care visits.’’. 
(b) PHSA.—Part D of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg et seq.) is amended 
by adding at the end the following new section: 
‘‘SEC. 2799A–6. COVERAGE OF CERTAIN PRIMARY CARE AND 
BEHAVIORAL HEALTH CARE VISITS. 
‘‘(a) IN GENERAL.—In addition to any item or serv-
ice described in section 2713(a), a group health plan, and 
a health insurance issuer offering group or individual 
health insurance coverage, shall at a minimum provide 
coverage for and shall not impose any cost-sharing re-
quirements for, with respect to a plan year— 
‘‘(1) 3 primary care visits; and 
VerDate Sep 11 2014 
22:55 Jun 23, 2021
Jkt 019200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H3550.IH
H3550
kjohnson on DSK79L0C42PROD with BILLS
‘‘(2) 3 behavioral health care visits. 
‘‘(b) LIMITATIONS.—A group health plan, and a 
health insurance issuer offering group or individual health 
insurance coverage, shall ensure that— 
‘‘(1) the treatment limitations applicable to the 
3 primary care visits described in paragraph (1) of 
subsection (a) and the 3 behavioral health care visits 
described in paragraph (2) of such subsection are no 
more restrictive than the treatment limitations ap-
plied to any other primary care visit or behavioral 
health care visit covered by the plan or coverage and 
that there are no separate treatment limitations that 
are applicable only with respect to such 3 primary 
or such 3 behavioral health care visits; and 
‘‘(2) the reimbursement rates under such plan 
or such coverage for such 3 primary and such 3 be-
havioral health care visits are the same as such rates 
for any other primary care visit or behavioral health 
care visit covered by the plan or coverage. 
‘‘(c) DEFINITIONS.—For purposes of this section: 
‘‘(1) BEHAVIORAL HEALTH CARE VISIT.—The 
term ‘behavioral health care visit’ means a visit by 
an individual to a qualified provider during which 
services are provided with respect to the diagnosis, 
VerDate Sep 11 2014 
22:55 Jun 23, 2021
Jkt 019200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H3550.IH
H3550
kjohnson on DSK79L0C42PROD with BILLS
treatment, screening, or prevention of a behavioral 
health condition. 
‘‘(2) PRIMARY CARE SERVICE.—The term ‘pri-
mary care service’ means a service identified, as of 
January 1, 2009, by one of HCPCS codes 99201 
through 99215 (and as subsequently modified by the 
Secretary). 
‘‘(3) PRIMARY CARE VISIT.—The term ‘primary 
care visit’ means an in-person visit by an individual 
to a qualified provider who is designated by such in-
dividual as the primary care provider for such indi-
vidual, during which such individual receives pri-
mary care services. 
‘‘(4) QUALIFIED PROVIDER.—The term ‘quali-
fied provider’ means— 
‘‘(A) with respect to a primary care visit, 
a general practitioner, family physician, general 
internist, obstetrician-gynecologist, pediatrician, 
geriatric physician, or physician assistant or ad-
vanced practice registered nurse acting in ac-
cordance with State law (including a nurse 
practitioner, clinical nurse specialist, and cer-
tified nurse midwife); and 
‘‘(B) with respect to a behavioral health 
care visit, an individual employed in a full-time 
VerDate Sep 11 2014 
22:55 Jun 23, 2021
Jkt 019200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H3550.IH
H3550
kjohnson on DSK79L0C42PROD with BILLS
position (including a fellowship) where the pri-
mary intent and function of such position is the 
direct treatment or recovery support of individ-
uals with, or in recovery from, a behavioral 
health disorder, such as a physician, physician 
assistant or advanced practice registered nurse 
acting in accordance with State law (including 
a nurse practitioner, clinical nurse specialist, 
and certified nurse midwife), psychiatric nurse, 
social worker, marriage and family therapist, 
mental health counselor, occupational therapist, 
psychologist, psychiatrist, child and adolescent 
psychiatrist, or neurologist.’’. 
(c) IRC.— 
(1) IN
GENERAL.—Subchapter B of chapter 
100 of subtitle K of the Internal Revenue Code of 
1986 is amended by adding at the end the following 
new section: 
‘‘SEC. 9821. COVERAGE OF CERTAIN PRIMARY CARE AND 
BEHAVIORAL HEALTH CARE VISITS. 
‘‘(a) IN GENERAL.—In addition to any item or serv-
ice described in section 2713(a) of the Public Health Serv-
ice Act, a group health plan shall at a minimum provide 
coverage for and shall not impose any cost-sharing re-
quirements for, with respect to a plan year— 
VerDate Sep 11 2014 
22:55 Jun 23, 2021
Jkt 019200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H3550.IH
H3550
kjohnson on DSK79L0C42PROD with BILLS
‘‘(1) 3 primary care visits; and 
‘‘(2) 3 behavioral health care visits. 
‘‘(b) LIMITATIONS.—A group health plan shall ensure 
that— 
‘‘(1) the treatment limitations applicable to the 
3 primary care visits described in paragraph (1) of 
subsection (a) and the 3 behavioral health care visits 
described in paragraph (2) of such subsection are no 
more restrictive than the treatment limitations ap-
plied to any other primary care visit or behavioral 
health care visit covered by the plan and that there 
are no separate treatment limitations that are appli-
cable only with respect to such 3 primary or such 3 
behavioral health care visits; and 
‘‘(2) the reimbursement rates under such plan 
for such 3 primary and such 3 behavioral health 
care visits are the same as such rates for any other 
primary care visit or behavioral health care visit cov-
ered by the plan. 
‘‘(c) DEFINITIONS.—For purposes of this section: 
‘‘(1) BEHAVIORAL HEALTH CARE VISIT.—The 
term ‘behavioral health care visit’ means a visit by 
an individual to a qualified provider during which 
services are provided with respect to the diagnosis, 
VerDate Sep 11 2014 
22:55 Jun 23, 2021
Jkt 019200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H3550.IH
H3550
kjohnson on DSK79L0C42PROD with BILLS
treatment, screening, or prevention of a behavioral 
health condition. 
‘‘(2) PRIMARY CARE SERVICE.—The term ‘pri-
mary care service’ means a service identified, as of 
January 1, 2009, by one of HCPCS codes 99201 
through 99215 (and as subsequently modified by the 
Secretary). 
‘‘(3) PRIMARY CARE VISIT.—The term ‘primary 
care visit’ means an in-person visit by an individual 
to a qualified provider who is designated by such in-
dividual as the primary care provider for such indi-
vidual, during which such individual receives pri-
mary care services. 
‘‘(4) QUALIFIED PROVIDER.—The term ‘quali-
fied provider’ means— 
‘‘(A) with respect to a primary care visit, 
a general practitioner, family physician, general 
internist, obstetrician-gynecologist, pediatrician, 
geriatric physician, or physician assistant or ad-
vanced practice registered nurse acting in ac-
cordance with State law (including a nurse 
practitioner, clinical nurse specialist, and cer-
tified nurse midwife); and 
‘‘(B) with respect to a behavioral health 
care visit, an individual employed in a full-time 
VerDate Sep 11 2014 
22:55 Jun 23, 2021
Jkt 019200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H3550.IH
H3550
kjohnson on DSK79L0C42PROD with BILLS
position (including a fellowship) where the pri-
mary intent and function of such position is the 
direct treatment or recovery support of individ-
uals with, or in recovery from, a behavioral 
health disorder, such as a physician, physician 
assistant or advanced practice registered nurse 
acting in accordance with State law (including 
a nurse practitioner, clinical nurse specialist, 
and certified nurse midwife), psychiatric nurse, 
social worker, marriage and family therapist, 
mental health counselor, occupational therapist, 
psychologist, psychiatrist, child and adolescent 
psychiatrist, or neurologist.’’. 
(2) HIGH DEDUCTIBLE HEALTH PLANS.—Sec-
tion 223(c)(2)(C) of the Internal Revenue Code of 
1986 is amended by inserting ‘‘or for the visits de-
scribed in section 9821’’ before the period. 
(3) CONFORMING AMENDMENT.—The table of 
sections for subchapter B of chapter 100 of the In-
ternal Revenue Code of 1986 is amended by insert-
ing after the item relating to section 9820 the fol-
lowing new item: 
‘‘Sec. 9821. Coverage of certain primary care and behavioral health care vis-
its.’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to plan years begin-
VerDate Sep 11 2014 
22:55 Jun 23, 2021
Jkt 019200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H3550.IH
H3550
kjohnson on DSK79L0C42PROD with BILLS
ning on or after the date that is 2 years after the date 
of the enactment of this Act. 
Æ 
VerDate Sep 11 2014 
22:55 Jun 23, 2021
Jkt 019200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6301
E:\BILLS\H3550.IH
H3550
kjohnson on DSK79L0C42PROD with BILLS