Primary and Behavioral Health Care Access Act of 2020

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- 1 tives of the United States of America in Congress assembled, 2 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 2 •HR 5575 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Primary and Behav- 2 ioral Health Care Access Act of 2020’’. 3 SEC. 2. PROHIBITION ON APPLICATION OF COST SHARING 4 FOR CERTAIN PRIMARY CARE AND BEHAV- 5 IORAL HEALTH CARE VISITS. 6 (a) ERISA.—Subpart B of part 7 of subtitle B of 7 title I of the Employee Retirement Income Security Act 8 of 1974 (29 U.S.C. 1185 et seq.) is amended by adding 9 at the end the following new section: 10 ‘‘SEC. 716. COVERAGE OF CERTAIN PRIMARY CARE AND BE- 11 HAVIORAL HEALTH CARE VISITS. 12 ‘‘(a) IN GENERAL.—In addition to any item or serv- 13 ice described in section 2713(a) of the Public Health Serv- 14 ice Act, a group health plan, and a health insurance issuer 15 offering group health insurance coverage, shall at a min- 16 imum provide coverage for and shall not impose any cost- 17 sharing requirements for, with respect to a plan year— 18 ‘‘(1) 3 primary care visits; and 19 ‘‘(2) 3 behavioral health care visits. 20 ‘‘(b) LIMITATIONS.—A group health plan, and a 21 health insurance issuer offering group health insurance 22 coverage, shall ensure that— 23 ‘‘(1) the treatment limitations applicable to the 24 3 primary care visits described in paragraph (1) of 25 subsection (a) and the 3 behavioral health care visits 26 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 3 •HR 5575 IH described in paragraph (2) of such subsection are no 1 more restrictive than the treatment limitations ap- 2 plied to any other primary care visit or behavioral 3 health care visit covered by the plan or coverage and 4 that there are no separate treatment limitations that 5 are applicable only with respect to such 3 primary 6 or such 3 behavioral health care visits; and 7 ‘‘(2) the reimbursement rates under such plan 8 or such coverage for such 3 primary and such 3 be- 9 havioral health care visits are the same as such rates 10 for any other primary care visit or behavioral health 11 care visit covered by the plan or coverage. 12 ‘‘(c) DEFINITIONS.—For purposes of this section: 13 ‘‘(1) BEHAVIORAL HEALTH CARE VISIT.—The 14 term ‘behavioral health care visit’ means a visit by 15 an individual to a qualified provider during which 16 services are provided with respect to the diagnosis, 17 treatment, screening, or prevention of a behavioral 18 health condition. 19 ‘‘(2) PRIMARY CARE SERVICE.—The term ‘pri- 20 mary care service’ means a service identified, as of 21 January 1, 2009, by one of HCPCS codes 99201 22 through 99215 (and as subsequently modified by the 23 Secretary). 24 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 4 •HR 5575 IH ‘‘(3) PRIMARY CARE VISIT.—The term ‘primary 1 care visit’ means an in-person visit by an individual 2 to a qualified provider who is designated by such in- 3 dividual as the primary care provider for such indi- 4 vidual, during which such individual receives pri- 5 mary care services. 6 ‘‘(4) QUALIFIED PROVIDER.—The term ‘quali- 7 fied provider’ means— 8 ‘‘(A) with respect to a primary care visit, 9 a general practitioner, family physician, general 10 internist, obstetrician-gynecologist, pediatrician, 11 geriatric physician, or advanced practice reg- 12 istered nurse acting in accordance with State 13 law (including a nurse practitioner, clinical 14 nurse specialist, and certified nurse midwife); 15 and 16 ‘‘(B) with respect to a behavioral health 17 care visit, an individual employed in a full-time 18 position (including a fellowship) where the pri- 19 mary intent and function of such position is the 20 direct treatment or recovery support of individ- 21 uals with, or in recovery from, a behavioral 22 health disorder, such as a physician, advanced 23 practice registered nurse acting in accordance 24 with State law (including a nurse practitioner, 25 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 5 •HR 5575 IH clinical nurse specialist, and certified nurse 1 midwife), psychiatric nurse, social worker, mar- 2 riage and family therapist, mental health coun- 3 selor, occupational therapist, psychologist, psy- 4 chiatrist, child and adolescent psychiatrist, or 5 neurologist.’’. 6 (b) PHSA.—Subpart II of part A of title XXVII of 7 the Public Health Service Act (42 U.S.C. 300gg–11 et 8 seq.) is amended by adding at the end the following new 9 section: 10 ‘‘SEC. 2730. COVERAGE OF CERTAIN PRIMARY CARE AND 11 BEHAVIORAL HEALTH CARE VISITS. 12 ‘‘(a) IN GENERAL.—In addition to any item or serv- 13 ice described in section 2713(a), a group health plan, and 14 a health insurance issuer offering group or individual 15 health insurance coverage, shall at a minimum provide 16 coverage for and shall not impose any cost-sharing re- 17 quirements for, with respect to a plan year— 18 ‘‘(1) 3 primary care visits; and 19 ‘‘(2) 3 behavioral health care visits. 20 ‘‘(b) LIMITATIONS.—A group health plan, and a 21 health insurance issuer offering group or individual health 22 insurance coverage, shall ensure that— 23 ‘‘(1) the treatment limitations applicable to the 24 3 primary care visits described in paragraph (1) of 25 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 6 •HR 5575 IH subsection (a) and the 3 behavioral health care visits 1 described in paragraph (2) of such subsection are no 2 more restrictive than the treatment limitations ap- 3 plied to any other primary care visit or behavioral 4 health care visit covered by the plan or coverage and 5 that there are no separate treatment limitations that 6 are applicable only with respect to such 3 primary 7 or such 3 behavioral health care visits; and 8 ‘‘(2) the reimbursement rates under such plan 9 or such coverage for such 3 primary and such 3 be- 10 havioral health care visits are the same as such rates 11 for any other primary care visit or behavioral health 12 care visit covered by the plan or coverage. 13 ‘‘(c) DEFINITIONS.—For purposes of this section: 14 ‘‘(1) BEHAVIORAL HEALTH CARE VISIT.—The 15 term ‘behavioral health care visit’ means a visit by 16 an individual to a qualified provider during which 17 services are provided with respect to the diagnosis, 18 treatment, screening, or prevention of a behavioral 19 health condition. 20 ‘‘(2) PRIMARY CARE SERVICE.—The term ‘pri- 21 mary care service’ means a service identified, as of 22 January 1, 2009, by one of HCPCS codes 99201 23 through 99215 (and as subsequently modified by the 24 Secretary). 25 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 7 •HR 5575 IH ‘‘(3) PRIMARY CARE VISIT.—The term ‘primary 1 care visit’ means an in-person visit by an individual 2 to a qualified provider who is designated by such in- 3 dividual as the primary care provider for such indi- 4 vidual, during which such individual receives pri- 5 mary care services. 6 ‘‘(4) QUALIFIED PROVIDER.—The term ‘quali- 7 fied provider’ means— 8 ‘‘(A) with respect to a primary care visit, 9 a general practitioner, family physician, general 10 internist, obstetrician-gynecologist, pediatrician, 11 geriatric physician, or advanced practice reg- 12 istered nurse acting in accordance with State 13 law (including a nurse practitioner, clinical 14 nurse specialist, and certified nurse midwife); 15 and 16 ‘‘(B) with respect to a behavioral health 17 care visit, an individual employed in a full-time 18 position (including a fellowship) where the pri- 19 mary intent and function of such position is the 20 direct treatment or recovery support of individ- 21 uals with, or in recovery from, a behavioral 22 health disorder, such as a physician, advanced 23 practice registered nurse acting in accordance 24 with State law (including a nurse practitioner, 25 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 8 •HR 5575 IH clinical nurse specialist, and certified nurse 1 midwife), psychiatric nurse, social worker, mar- 2 riage and family therapist, mental health coun- 3 selor, occupational therapist, psychologist, psy- 4 chiatrist, child and adolescent psychiatrist, or 5 neurologist.’’. 6 (c) IRC.— 7 (1) IN GENERAL.—Subchapter B of chapter 8 100 of subtitle K of the Internal Revenue Code of 9 1986 is amended by adding at the end the following 10 new section: 11 ‘‘SEC. 9816. COVERAGE OF CERTAIN PRIMARY CARE AND 12 BEHAVIORAL HEALTH CARE VISITS. 13 ‘‘(a) IN GENERAL.—In addition to any item or serv- 14 ice described in section 2713(a) of the Public Health Serv- 15 ice Act, a group health plan shall at a minimum provide 16 coverage for and shall not impose any cost-sharing re- 17 quirements for, with respect to a plan year— 18 ‘‘(1) 3 primary care visits; and 19 ‘‘(2) 3 behavioral health care visits. 20 ‘‘(b) LIMITATIONS.—A group health plan shall ensure 21 that— 22 ‘‘(1) the treatment limitations applicable to the 23 3 primary care visits described in paragraph (1) of 24 subsection (a) and the 3 behavioral health care visits 25 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 9 •HR 5575 IH described in paragraph (2) of such subsection are no 1 more restrictive than the treatment limitations ap- 2 plied to any other primary care visit or behavioral 3 health care visit covered by the plan and that there 4 are no separate treatment limitations that are appli- 5 cable only with respect to such 3 primary or such 3 6 behavioral health care visits; and 7 ‘‘(2) the reimbursement rates under such plan 8 for such 3 primary and such 3 behavioral health 9 care visits are the same as such rates for any other 10 primary care visit or behavioral health care visit cov- 11 ered by the plan. 12 ‘‘(c) DEFINITIONS.—For purposes of this section: 13 ‘‘(1) BEHAVIORAL HEALTH CARE VISIT.—The 14 term ‘behavioral health care visit’ means a visit by 15 an individual to a qualified provider during which 16 services are provided with respect to the diagnosis, 17 treatment, screening, or prevention of a behavioral 18 health condition. 19 ‘‘(2) PRIMARY CARE SERVICE.—The term ‘pri- 20 mary care service’ means a service identified, as of 21 January 1, 2009, by one of HCPCS codes 99201 22 through 99215 (and as subsequently modified by the 23 Secretary). 24 VerDate Sep 11 2014 02:26 Jan 11, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H5575.IH H5575 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 5575 IH ‘‘(3) PRIMARY CARE VISIT.—The term ‘primary 1 care visit’ means an in-person visit by an individual 2 to a qualified provider who is designated by such in- 3 dividual as the primary care provider for such indi- 4 vidual, during which such individual receives pri- 5 mary care services. 6 ‘‘(4) QUALIFIED PROVIDER.—The term ‘quali- 7 fied provider’ means— 8 ‘‘(A) with respect to a primary care visit, 9 a general practitioner, family physician, general 10 internist, obstetrician-gynecologist, pediatrician, 11 geriatric physician, or advanced practice reg- 12 istered nurse acting in accordance with State 13 law (including a nurse practitioner, clinical 14 nurse specialist, and certified nurse midwife); 15 and 16 ‘‘(B) with respect to a behavioral health 17 care visit, an individual employed in a full-time 18 position (including a fellowship) where the pri- 19 mary intent and function of such position is the 20 direct treatment or recovery support of individ- 21 uals with, or in recovery from, a behavioral 22 health disorder, such as a physician, advanced 23 practice registered nurse acting in accordance 24 with State law (including a nurse practitioner, 25 VerDate Sep 11 2014 02:26 Jan 11, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H5575.IH H5575 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 5575 IH clinical nurse specialist, and certified nurse 1 midwife), psychiatric nurse, social worker, mar- 2 riage and family therapist, mental health coun- 3 selor, occupational therapist, psychologist, psy- 4 chiatrist, child and adolescent psychiatrist, or 5 neurologist.’’. 6 (2) HIGH DEDUCTIBLE HEALTH PLANS.—Sec- 7 tion 223(c)(2)(C) of the Internal Revenue Code of 8 1986 is amended by inserting ‘‘or for the visits de- 9 scribed in section 9816’’ before the period. 10 (d) EFFECTIVE DATE.—The amendments made by 11 this section shall apply with respect to plan years begin- 12 ning on or after the date that is 2 years after the date 13 of the enactment of this Act. 14 Æ VerDate Sep 11 2014 02:26 Jan 11, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\H5575.IH H5575 kjohnson on DSK79L0C42PROD with BILLS