I 
119TH CONGRESS 
1ST SESSION H. R. 1096 
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 
FEBRUARY 6, 2025 
Ms. SALINAS (for herself, Mrs. WATSON COLEMAN, Ms. NORTON, Mr. DOG-
GETT, and Mr. GOLDMAN of New York) 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 subse-
quently 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Helping Out Patients 
for Emotional and Mental Wellbeing Act’’ or the ‘‘HOPE 
and Mental Wellbeing Act of 2025’’. 
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SEC. 2. REQUIRING COVERAGE OF 3 PRIMARY CARE VISITS 
WITHOUT COST SHARING EACH YEAR UNDER 
MEDICARE. 
(a) MEDICARE.— 
(1) IN GENERAL.—Section 1833 of the Social 
Security Act (42 U.S.C. 1395l) is amended— 
(A) in subsection (a)(1)— 
(i) by striking ‘‘and’’ before ‘‘(HH)’’; 
and 
(ii) by inserting before the semicolon 
at the end the following: ‘‘, and (II) with 
respect to the first 3 primary care visits 
(as defined in section 1861(nnn)) fur-
nished to an individual during a year (be-
ginning with 2026) for which payment may 
be made under a specified outpatient pay-
ment provision described in subsection 
(cc)(2), the amounts paid shall be 100 per-
cent of the lesser of the actual charge or 
the payment amount otherwise recognized 
under such respective specified outpatient 
payment provision for such visit’’; and 
(B) in subsection (b), in the first sen-
tence— 
(i) by striking ‘‘and’’ before ‘‘(13)’’; 
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(ii) in paragraph (13), by striking ‘‘..’’ 
and inserting a period; and 
(iii) by inserting before the period at 
the end the following: ‘‘, and (13) shall not 
apply with respect to the first 3 primary 
care 
visits 
(as 
defined 
in 
section 
1861(nnn)) furnished to an individual dur-
ing a year (beginning with 2026) for which 
payment may be made under a specified 
outpatient payment provision described in 
subsection (cc)(2)’’. 
(2) 
MEDICARE
ADVANTAGE.—Section 
1852(a)(1)(B) of the Social Security Act (42 U.S.C. 
1395w–22(a)(1)(B)) is amended— 
(A) in clause (iv)— 
(i) by redesignating subclause (VIII) 
as subclause (IX); and 
(ii) by inserting after subclause (VII) 
the following new subclause: 
‘‘(VIII) the first 3 primary care 
visits 
(as 
defined 
in 
section 
1861(nnn)) furnished to an enrollee 
during 
a 
year 
(beginning 
with 
2026).’’; and 
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(B) in clause (v), by striking ‘‘and (VII)’’ 
and inserting ‘‘(VII), and (VIII)’’. 
(3) DEFINITION.—Section 1861 of the Social 
Security Act (42 U.S.C. 1395x) is amended by add-
ing at the end the following new subsection: 
‘‘(nnn) PRIMARY CARE VISIT.—The term ‘primary 
care visit’ means outpatient mental and behavioral health 
services, nonspecialty medical services, and care coordina-
tion services furnished for the prevention, diagnosis, treat-
ment, or management of a physical, mental, or behavioral 
health condition.’’. 
(b) MEDICAID.— 
(1) IN GENERAL.—Section 1916 of the Social 
Security Act (42 U.S.C. 1396o) is amended— 
(A) in subsection (a)(2)— 
(i) in subparagraph (I), by striking 
‘‘or’’ at the end; 
(ii) in subparagraph (J), by striking 
‘‘; and’’ at the end and inserting ‘‘, or’’; 
and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(K) the first 3 primary care visits (as de-
fined in section 1861(nnn)) furnished to an in-
dividual during a year (beginning with 2026) 
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for which payment may be made under this 
title; and’’; and 
(B) in subsection (b)(2)— 
(i) in subparagraph (I), by striking 
‘‘or’’ at the end; 
(ii) in subparagraph (J), by striking 
‘‘; and’’ at the end and inserting ‘‘, or’’; 
and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(K) the first 3 primary care visits (as de-
fined in section 1861(nnn)) furnished to an in-
dividual during a year (beginning with 2026); 
and’’. 
(2) APPLICATION TO ALTERNATIVE COST SHAR-
ING.—Section 1916A(b)(3)(B) of the Social Security 
Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended by 
adding at the end the following new clause: 
‘‘(xv) The first 3 primary care visits 
(as defined in section 1861(nnn)) fur-
nished to an individual during a year (be-
ginning with 2026).’’. 
Æ 
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