Primary and Behavioral Health Care Access Act of 2022
Bill: S.4905 | Sponsor: Sen. King, Angus S., Jr. (I-ME)
Policy area: Health

Summary:
Primary and Behavioral Health Care Access Act of 2022
This bill requires private health insurance plans to cover, without cost sharing, three primary care visits and three behavioral health care visits during a plan year.

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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Primary and Behavioral Health Care 
Access Act of 2022''.

SEC. 2. PROHIBITION ON APPLICATION OF COST SHARING FOR CERTAIN PRIMARY 
              CARE AND BEHAVIORAL HEALTH CARE VISITS.

    (a) ERISA.--
            (1) In general.--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 inserting after section 720 
        the following new section:

``SEC. 721. COVERAGE OF CERTAIN PRIMARY CARE AND BEHAVIORAL HEALTH CARE 
              VISITS.

    ``(a) In General.--In addition to any item or service described in 
section 2713(a) of the Public Health Service Act, a group health plan, 
and a health insurance issuer offering group health insurance coverage, 
shall at a minimum 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 described in paragraph (2) 
        of such subsection are no more restrictive than the treatment 
        limitations applied 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 behavioral 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 `primary 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 individual as the primary 
        care provider for such individual, during which such individual 
        receives primary care services.
            ``(4) Qualified provider.--The term `qualified 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 advanced 
                practice registered 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 primary intent and 
                function of such position is the direct treatment or 
                recovery support of individuals 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) 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 inserting after section 2799A-5 
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 service 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 
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 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 applied 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 behavioral 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 `primary 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 individual as the primary 
        care provider for such individual, during which such individual 
        receives primary care services.
            ``(4) Qualified provider.--The term `qualified 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 advanced 
                practice registered 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 primary intent and 
                function of such position is the direct treatment or 
                recovery support of individuals 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 inserting 
        after section 9820 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 service described in 
section 2713(a) of the Public Health Service Act, a group health plan 
shall at a minimum 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 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 applied 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 applicable 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 covered 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, treatment, screening, or prevention 
        of a behavioral health condition.
            ``(2) Primary care service.--The term `primary 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 individual as the primary 
        care provider for such individual, during which such individual 
        receives primary care services.
            ``(4) Qualified provider.--The term `qualified 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 advanced 
                practice registered 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 primary intent and 
                function of such position is the direct treatment or 
                recovery support of individuals 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.--Section 223(c)(2)(C) of 
        the Internal Revenue Code of 1986 is amended by inserting ``or 
        for the visits described in section 9821'' before the period.
            (3) Conforming amendment.--The table of sections for 
        subchapter B of chapter 100 of the Internal Revenue Code of 
        1986 is amended by inserting after the item relating to section 
        9820 the following new item:

``Sec. 9821. Coverage of certain primary care and behavioral health 
                            care visits.''.
    (d) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after the date that is 
2 years after the date of the enactment of this Act.
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