Sponsors (4)
Requires State Medicaid plans to pay for same-day primary care, mental health, or SUD services at the same office/clinic (including telehealth).
The bill expands access to integrated primary and behavioral health care for Medicaid beneficiaries and strengthens reimbursement for safety‑net providers, while increasing Medicaid costs, imposing implementation burdens on states/providers, and creating some risk of overbilling without additional safeguards.
Medicaid beneficiaries (including many in rural and low‑income communities) can receive primary care and behavioral health/SUD services in a single visit (including via telehealth), improving access to integrated 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 integrated same‑day visits, supporting the financial viability of safety‑net providers.
State Medicaid programs and taxpayers may face higher costs because Medicaid would pay for multiple same‑day services, potentially increasing state Medicaid spending or requiring budget offsets.
State Medicaid agencies and providers (including hospitals and clinics) may incur administrative burden from changing billing systems and provider rules to implement same‑day payment policies.
Paying for multiple services on the same day could create incentives for overbilling or increased service volume without stronger safeguards, raising misuse and fraud risk that could harm taxpayers and program integrity.
Based on analysis of 2 sections of legislative text.
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
Requires State Medicaid plans to cover and pay for a mental health service, substance use disorder (SUD) service, or primary care service when any of those services are furnished to the same individual on the same day (a “same-day qualifying service”). It defines same-day qualifying services to include in-person and telehealth services provided by clinicians employed by or under contract with the same physician’s office, FQHC, RHC, or outpatient facility, whether furnished by the same or a different practitioner in that location on that day. The change amends federal Medicaid plan requirements to prohibit denial of payment for these same-day services and adds a new statutory definition to clarify the covered settings and telehealth inclusion. The provision expands coverage scope in state plans and may affect providers, patients, and state Medicaid program costs and billing practices.