H.R. 1096

119th CONGRESS 1st Session

To amend title XVIII of the Social Security Act to require coverage of 3 primary care visits without cost sharing each year under the Medicare program.

IN THE HOUSE OF REPRESENTATIVES · February 6, 2025 · Sponsor: Ms. Salinas

Table of contents

• H.R. 1096
  • SEC. 1. Short title
  • SEC. 2. Requiring coverage of 3 primary care visits without cost sharing each year under Medicare

SEC. 1. Short title

• This Act may be cited as the or the .

SEC. 2. Requiring coverage of 3 primary care visits without cost sharing each year under Medicare

• (a) Medicare
  • (1) In general
    • Section 1833 of the Social Security Act () is amended— 42 U.S.C. 1395l
      • in subsection (a)(1)—
        • (i) by striking before ; and
        • (ii) by inserting before the semicolon at the end the following: ; and
      • in subsection (b), in the first sentence—
        • (i) by striking before ;
        • (ii) in paragraph (13), by striking and inserting a period; and
        • (iii) by inserting before the period at the end the following: .
  • (2) Medicare Advantage
    • Section 1852(a)(1)(B) of the Social Security Act () is amended— 42 U.S.C. 1395w–22(a)(1)(B)
      • in clause (iv)—
        • (i) by redesignating subclause (VIII) as subclause (IX); and
        • (ii) by inserting after subclause (VII) the following new subclause:
          • the first 3 primary care visits (as defined in section 1861(nnn)) furnished to an enrollee during a year (beginning with 2026).
      • in clause (v), by striking and (VII)and inserting (VII), and (VIII).
  • (3) Definition
    • Section 1861 of the Social Security Act () is amended by adding at the end the following new subsection: 42 U.S.C. 1395x
      • (nnn) Primary care visit
        • The term means outpatient mental and behavioral health services, nonspecialty medical services, and care coordination services furnished for the prevention, diagnosis, treatment, or management of a physical, mental, or behavioral health condition. primary care visit
• (b) Medicaid
  • (1) In general
    • Section 1916 of the Social Security Act () is amended— 42 U.S.C. 1396o
      • in subsection (a)(2)—
        • (i) in subparagraph (I), by striking or at the end;
        • (ii) in subparagraph (J), by striking at the end and inserting , or; and
        • (iii) by adding at the end the following new subparagraph:
          • the first 3 primary care visits (as defined in section 1861(nnn)) furnished to an individual during a year (beginning with 2026) for which payment may be made under this title; and
      • in subsection (b)(2)—
        • (i) in subparagraph (I), by striking or at the end;
        • (ii) in subparagraph (J), by striking at the end and inserting , or; and
        • (iii) by adding at the end the following new subparagraph:
          • the first 3 primary care visits (as defined in section 1861(nnn)) furnished to an individual during a year (beginning with 2026); and
  • (2) Application to alternative cost sharing
    • Section 1916A(b)(3)(B) of the Social Security Act () is amended by adding at the end the following new clause: 42 U.S.C. 1396o–1(b)(3)(B)
      • (xv) The first 3 primary care visits (as defined in section 1861(nnn)) furnished to an individual during a year (beginning with 2026).