Primary and Behavioral Health Care Access Act of 2026

[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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