S. 4754

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 4754 Introduced in Senate (IS)]

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119th CONGRESS
2d Session
S. 4754

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.

_______________________________________________________________________

IN THE SENATE OF THE UNITED STATES

June 11, 2026

Mr. King introduced the following bill; which was read twice and 
referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

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 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 2026''.

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 of Health and Human Services).
``(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--111 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 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 of Health and Human Services).
``(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 providing coverage 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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