Sponsors (3)
The bill expands same-day integrated primary and behavioral/SUD care for Medicaid patients and helps sustain safety-net providers, but increases near-term Medicaid costs, implementation burdens, and the risk of overbilling that will need monitoring and safeguards.
Medicaid beneficiaries (including people in rural and low-income communities) can receive integrated primary care plus behavioral health/SUD services in a single visit (including via telehealth), improving access to coordinated care and reducing missed appointments and travel burdens.
Federally qualified health centers (FQHCs), rural health clinics (RHCs), and community clinics are more likely to be reimbursed for providing multiple same-day services, supporting the financial viability of safety-net providers and helping sustain local access.
State Medicaid programs and taxpayers may face higher costs from reimbursing multiple same-day services, increasing state Medicaid spending or requiring budget offsets or new revenue.
Paying for multiple visits the same day could create financial incentives for increased service volume or overbilling absent stronger safeguards, raising risk of misuse and waste that could harm taxpayers and program integrity.
Some states and providers will need to update billing systems and provider rules, creating administrative and implementation burdens for Medicaid agencies, clinics, and hospitals during rollout.
Based on analysis of 2 sections of legislative text.
Requires State Medicaid plans to permit payment when primary care, mental health, or SUD services are furnished to the same person on the same day (including via telehealth) at the same site.
Requires State Medicaid plans to permit payment when a primary care, mental health, or substance use disorder service is provided to the same individual on the same day by providers in the same clinic, center, or physician’s office (including via telehealth). It creates a new statutory definition of “same-day qualifying service” covering services delivered in-person or by telehealth by practitioners employed by or under contract with the same site. The change prevents states from denying payment solely because multiple qualifying services were furnished on the same day, expanding coverage and billing flexibility for coordinated care visits in Medicaid.
Official title: To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services or substance use disorder services and primary care services furnished on the same day.
Introduced July 22, 2026 by Neal Patrick Dunn · Last progress July 22, 2026