I 
116TH CONGRESS 
2D SESSION 
H. R. 5575 
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 applica-
tion of any cost-sharing requirement. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 10, 2020 
Ms. UNDERWOOD (for herself and Ms. SCHRIER) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committees on Education and Labor, and 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 jurisdic-
tion of the committee concerned 
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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
VerDate Sep 11 2014 
02:26 Jan 11, 2020
Jkt 099200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H5575.IH
H5575
kjohnson on DSK79L0C42PROD with BILLS
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Primary and Behav-
ioral Health Care Access Act of 2020’’. 
SEC. 2. PROHIBITION ON APPLICATION OF COST SHARING 
FOR CERTAIN PRIMARY CARE AND BEHAV-
IORAL HEALTH CARE VISITS. 
(a) ERISA.—Subpart B of part 7 of subtitle 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 section: 
‘‘SEC. 716. 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— 
‘‘(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 
VerDate Sep 11 2014 
02:26 Jan 11, 2020
Jkt 099200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5575.IH
H5575
kjohnson on DSK79L0C42PROD with BILLS
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 
through 99215 (and as subsequently modified by the 
Secretary). 
VerDate Sep 11 2014 
02:26 Jan 11, 2020
Jkt 099200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5575.IH
H5575
kjohnson on DSK79L0C42PROD with BILLS
‘‘(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 advanced practice reg-
istered nurse acting in accordance with State 
law (including a nurse practitioner, clinical 
nurse specialist, and certified 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, advanced 
practice registered nurse acting in accordance 
with State law (including a nurse practitioner, 
VerDate Sep 11 2014 
02:26 Jan 11, 2020
Jkt 099200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5575.IH
H5575
kjohnson on DSK79L0C42PROD with BILLS
clinical nurse specialist, and certified nurse 
midwife), psychiatric nurse, social worker, mar-
riage and family therapist, mental health coun-
selor, occupational therapist, psychologist, psy-
chiatrist, child and adolescent psychiatrist, or 
neurologist.’’. 
(b) PHSA.—Subpart II of part A of title XXVII of 
the Public Health Service Act (42 U.S.C. 300gg–11 et 
seq.) is amended by adding at the end the following new 
section: 
‘‘SEC. 2730. 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 
‘‘(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 
VerDate Sep 11 2014 
02:26 Jan 11, 2020
Jkt 099200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H5575.IH
H5575
kjohnson on DSK79L0C42PROD with BILLS
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 
through 99215 (and as subsequently modified by the 
Secretary). 
VerDate Sep 11 2014 
02:26 Jan 11, 2020
Jkt 099200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H5575.IH
H5575
kjohnson on DSK79L0C42PROD with BILLS
‘‘(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 advanced practice reg-
istered nurse acting in accordance with State 
law (including a nurse practitioner, clinical 
nurse specialist, and certified 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, advanced 
practice registered nurse acting in accordance 
with State law (including a nurse practitioner, 
VerDate Sep 11 2014 
02:26 Jan 11, 2020
Jkt 099200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H5575.IH
H5575
kjohnson on DSK79L0C42PROD with BILLS
clinical nurse specialist, and certified nurse 
midwife), psychiatric nurse, social worker, mar-
riage and family therapist, mental health coun-
selor, occupational therapist, psychologist, psy-
chiatrist, 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. 9816. 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— 
‘‘(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 
VerDate Sep 11 2014 
02:26 Jan 11, 2020
Jkt 099200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H5575.IH
H5575
kjohnson on DSK79L0C42PROD with BILLS