Primary and Behavioral Health Care Access Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 3550 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 MAY 25, 2021 Ms. UNDERWOOD (for herself, Ms. SCHRIER, and Ms. PORTER) introduced the following bill; which was referred to the Committee on Energy and Com- merce, 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 jurisdiction 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- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 22:55 Jun 23, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3550.IH H3550 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 3550 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Primary and Behav- 2 ioral Health Care Access Act of 2021’’. 3 SEC. 2. PROHIBITION ON APPLICATION OF COST SHARING 4 FOR CERTAIN PRIMARY CARE AND BEHAV- 5 IORAL HEALTH CARE VISITS. 6 (a) ERISA.— 7 (1) IN GENERAL.—Subpart B of part 7 of sub- 8 title B of title I of the Employee Retirement Income 9 Security Act of 1974 (29 U.S.C. 1185 et seq.) is 10 amended by adding at the end the following new sec- 11 tion: 12 ‘‘SEC. 721. COVERAGE OF CERTAIN PRIMARY CARE AND BE- 13 HAVIORAL HEALTH CARE VISITS. 14 ‘‘(a) IN GENERAL.—In addition to any item or serv- 15 ice described in section 2713(a) of the Public Health Serv- 16 ice Act, a group health plan, and a health insurance issuer 17 offering group health insurance coverage, shall at a min- 18 imum provide coverage for and shall not impose any cost- 19 sharing requirements for, with respect to a plan year— 20 ‘‘(1) 3 primary care visits; and 21 ‘‘(2) 3 behavioral health care visits. 22 ‘‘(b) LIMITATIONS.—A group health plan, and a 23 health insurance issuer offering group health insurance 24 coverage, shall ensure that— 25 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 3 •HR 3550 IH ‘‘(1) the treatment limitations applicable to the 1 3 primary care visits described in paragraph (1) of 2 subsection (a) and the 3 behavioral health care visits 3 described in paragraph (2) of such subsection are no 4 more restrictive than the treatment limitations ap- 5 plied to any other primary care visit or behavioral 6 health care visit covered by the plan or coverage and 7 that there are no separate treatment limitations that 8 are applicable only with respect to such 3 primary 9 or such 3 behavioral health care visits; and 10 ‘‘(2) the reimbursement rates under such plan 11 or such coverage for such 3 primary and such 3 be- 12 havioral health care visits are the same as such rates 13 for any other primary care visit or behavioral health 14 care visit covered by the plan or coverage. 15 ‘‘(c) DEFINITIONS.—For purposes of this section: 16 ‘‘(1) BEHAVIORAL HEALTH CARE VISIT.—The 17 term ‘behavioral health care visit’ means a visit by 18 an individual to a qualified provider during which 19 services are provided with respect to the diagnosis, 20 treatment, screening, or prevention of a behavioral 21 health condition. 22 ‘‘(2) PRIMARY CARE SERVICE.—The term ‘pri- 23 mary care service’ means a service identified, as of 24 January 1, 2009, by one of HCPCS codes 99201 25 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 4 •HR 3550 IH through 99215 (and as subsequently modified by the 1 Secretary). 2 ‘‘(3) PRIMARY CARE VISIT.—The term ‘primary 3 care visit’ means an in-person visit by an individual 4 to a qualified provider who is designated by such in- 5 dividual as the primary care provider for such indi- 6 vidual, during which such individual receives pri- 7 mary care services. 8 ‘‘(4) QUALIFIED PROVIDER.—The term ‘quali- 9 fied provider’ means— 10 ‘‘(A) with respect to a primary care visit, 11 a general practitioner, family physician, general 12 internist, obstetrician-gynecologist, pediatrician, 13 geriatric physician, or physician assistant or ad- 14 vanced practice registered nurse acting in ac- 15 cordance with State law (including a nurse 16 practitioner, clinical nurse specialist, and cer- 17 tified nurse midwife); and 18 ‘‘(B) with respect to a behavioral health 19 care visit, an individual employed in a full-time 20 position (including a fellowship) where the pri- 21 mary intent and function of such position is the 22 direct treatment or recovery support of individ- 23 uals with, or in recovery from, a behavioral 24 health disorder, such as a physician, physician 25 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 5 •HR 3550 IH assistant or advanced practice registered nurse 1 acting in accordance with State law (including 2 a nurse practitioner, clinical nurse specialist, 3 and certified nurse midwife), psychiatric nurse, 4 social worker, marriage and family therapist, 5 mental health counselor, occupational therapist, 6 psychologist, psychiatrist, child and adolescent 7 psychiatrist, or neurologist.’’. 8 (2) CONFORMING AMENDMENT.—The table of 9 contents in section 1 of the Employee Retirement 10 Income Security Act of 1974 (29 U.S.C. 1001 et 11 seq.) is amended by inserting after the item relating 12 to section 720 the following new item: 13 ‘‘Sec. 721. Coverage of certain primary care and behavioral health care visits.’’. (b) PHSA.—Part D of title XXVII of the Public 14 Health Service Act (42 U.S.C. 300gg et seq.) is amended 15 by adding at the end the following new section: 16 ‘‘SEC. 2799A–6. COVERAGE OF CERTAIN PRIMARY CARE AND 17 BEHAVIORAL HEALTH CARE VISITS. 18 ‘‘(a) IN GENERAL.—In addition to any item or serv- 19 ice described in section 2713(a), a group health plan, and 20 a health insurance issuer offering group or individual 21 health insurance coverage, shall at a minimum provide 22 coverage for and shall not impose any cost-sharing re- 23 quirements for, with respect to a plan year— 24 ‘‘(1) 3 primary care visits; and 25 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 6 •HR 3550 IH ‘‘(2) 3 behavioral health care visits. 1 ‘‘(b) LIMITATIONS.—A group health plan, and a 2 health insurance issuer offering group or individual health 3 insurance coverage, shall ensure that— 4 ‘‘(1) the treatment limitations applicable to the 5 3 primary care visits described in paragraph (1) of 6 subsection (a) and the 3 behavioral health care visits 7 described in paragraph (2) of such subsection are no 8 more restrictive than the treatment limitations ap- 9 plied to any other primary care visit or behavioral 10 health care visit covered by the plan or coverage and 11 that there are no separate treatment limitations that 12 are applicable only with respect to such 3 primary 13 or such 3 behavioral health care visits; and 14 ‘‘(2) the reimbursement rates under such plan 15 or such coverage for such 3 primary and such 3 be- 16 havioral health care visits are the same as such rates 17 for any other primary care visit or behavioral health 18 care visit covered by the plan or coverage. 19 ‘‘(c) DEFINITIONS.—For purposes of this section: 20 ‘‘(1) BEHAVIORAL HEALTH CARE VISIT.—The 21 term ‘behavioral health care visit’ means a visit by 22 an individual to a qualified provider during which 23 services are provided with respect to the diagnosis, 24 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 7 •HR 3550 IH treatment, screening, or prevention of a behavioral 1 health condition. 2 ‘‘(2) PRIMARY CARE SERVICE.—The term ‘pri- 3 mary care service’ means a service identified, as of 4 January 1, 2009, by one of HCPCS codes 99201 5 through 99215 (and as subsequently modified by the 6 Secretary). 7 ‘‘(3) PRIMARY CARE VISIT.—The term ‘primary 8 care visit’ means an in-person visit by an individual 9 to a qualified provider who is designated by such in- 10 dividual as the primary care provider for such indi- 11 vidual, during which such individual receives pri- 12 mary care services. 13 ‘‘(4) QUALIFIED PROVIDER.—The term ‘quali- 14 fied provider’ means— 15 ‘‘(A) with respect to a primary care visit, 16 a general practitioner, family physician, general 17 internist, obstetrician-gynecologist, pediatrician, 18 geriatric physician, or physician assistant or ad- 19 vanced practice registered nurse acting in ac- 20 cordance with State law (including a nurse 21 practitioner, clinical nurse specialist, and cer- 22 tified nurse midwife); and 23 ‘‘(B) with respect to a behavioral health 24 care visit, an individual employed in a full-time 25 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 8 •HR 3550 IH position (including a fellowship) where the pri- 1 mary intent and function of such position is the 2 direct treatment or recovery support of individ- 3 uals with, or in recovery from, a behavioral 4 health disorder, such as a physician, physician 5 assistant or advanced practice registered nurse 6 acting in accordance with State law (including 7 a nurse practitioner, clinical nurse specialist, 8 and certified nurse midwife), psychiatric nurse, 9 social worker, marriage and family therapist, 10 mental health counselor, occupational therapist, 11 psychologist, psychiatrist, child and adolescent 12 psychiatrist, or neurologist.’’. 13 (c) IRC.— 14 (1) IN GENERAL.—Subchapter B of chapter 15 100 of subtitle K of the Internal Revenue Code of 16 1986 is amended by adding at the end the following 17 new section: 18 ‘‘SEC. 9821. COVERAGE OF CERTAIN PRIMARY CARE AND 19 BEHAVIORAL HEALTH CARE VISITS. 20 ‘‘(a) IN GENERAL.—In addition to any item or serv- 21 ice described in section 2713(a) of the Public Health Serv- 22 ice Act, a group health plan shall at a minimum provide 23 coverage for and shall not impose any cost-sharing re- 24 quirements for, with respect to a plan year— 25 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 9 •HR 3550 IH ‘‘(1) 3 primary care visits; and 1 ‘‘(2) 3 behavioral health care visits. 2 ‘‘(b) LIMITATIONS.—A group health plan shall ensure 3 that— 4 ‘‘(1) the treatment limitations applicable to the 5 3 primary care visits described in paragraph (1) of 6 subsection (a) and the 3 behavioral health care visits 7 described in paragraph (2) of such subsection are no 8 more restrictive than the treatment limitations ap- 9 plied to any other primary care visit or behavioral 10 health care visit covered by the plan and that there 11 are no separate treatment limitations that are appli- 12 cable only with respect to such 3 primary or such 3 13 behavioral health care visits; and 14 ‘‘(2) the reimbursement rates under such plan 15 for such 3 primary and such 3 behavioral health 16 care visits are the same as such rates for any other 17 primary care visit or behavioral health care visit cov- 18 ered by the plan. 19 ‘‘(c) DEFINITIONS.—For purposes of this section: 20 ‘‘(1) BEHAVIORAL HEALTH CARE VISIT.—The 21 term ‘behavioral health care visit’ means a visit by 22 an individual to a qualified provider during which 23 services are provided with respect to the diagnosis, 24 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 10 •HR 3550 IH treatment, screening, or prevention of a behavioral 1 health condition. 2 ‘‘(2) PRIMARY CARE SERVICE.—The term ‘pri- 3 mary care service’ means a service identified, as of 4 January 1, 2009, by one of HCPCS codes 99201 5 through 99215 (and as subsequently modified by the 6 Secretary). 7 ‘‘(3) PRIMARY CARE VISIT.—The term ‘primary 8 care visit’ means an in-person visit by an individual 9 to a qualified provider who is designated by such in- 10 dividual as the primary care provider for such indi- 11 vidual, during which such individual receives pri- 12 mary care services. 13 ‘‘(4) QUALIFIED PROVIDER.—The term ‘quali- 14 fied provider’ means— 15 ‘‘(A) with respect to a primary care visit, 16 a general practitioner, family physician, general 17 internist, obstetrician-gynecologist, pediatrician, 18 geriatric physician, or physician assistant or ad- 19 vanced practice registered nurse acting in ac- 20 cordance with State law (including a nurse 21 practitioner, clinical nurse specialist, and cer- 22 tified nurse midwife); and 23 ‘‘(B) with respect to a behavioral health 24 care visit, an individual employed in a full-time 25 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 11 •HR 3550 IH position (including a fellowship) where the pri- 1 mary intent and function of such position is the 2 direct treatment or recovery support of individ- 3 uals with, or in recovery from, a behavioral 4 health disorder, such as a physician, physician 5 assistant or advanced practice registered nurse 6 acting in accordance with State law (including 7 a nurse practitioner, clinical nurse specialist, 8 and certified nurse midwife), psychiatric nurse, 9 social worker, marriage and family therapist, 10 mental health counselor, occupational therapist, 11 psychologist, psychiatrist, child and adolescent 12 psychiatrist, or neurologist.’’. 13 (2) HIGH DEDUCTIBLE HEALTH PLANS.—Sec- 14 tion 223(c)(2)(C) of the Internal Revenue Code of 15 1986 is amended by inserting ‘‘or for the visits de- 16 scribed in section 9821’’ before the period. 17 (3) CONFORMING AMENDMENT.—The table of 18 sections for subchapter B of chapter 100 of the [Text truncated for display. 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