Section 1 Short title
This Act may be cited as the “Helping Out Patients for Emotional and Mental Wellbeing Act” or the “HOPE and Mental Wellbeing Act of 2025”.
Helping Out Patients for Emotional and Mental Wellbeing Act
A BILL
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.
Sec. 2 Requiring coverage of 3 primary care visits without cost sharing each year under Medicare
Medicare—
in subsection (a)(1)—
by striking “and” before “(HH)”; and
by inserting before the semicolon at the end the following: “, and (II) with respect to 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 a specified outpatient payment provision described in subsection (cc)(2), the amounts paid shall be 100 percent of the lesser of the actual charge or the payment amount otherwise recognized under such respective specified outpatient payment provision for such visit”; and
in subsection (b), in the first sentence—
by striking “and” before “(13)”;
in paragraph (13), by striking “..” and inserting a period; and
by inserting before the period at the end the following: “, and (13) shall not apply with respect to 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 a specified outpatient payment provision described in subsection (cc)(2)”.
Medicare Advantage— Section 1852(a)(1)(B) of the Social Security Act (42 U.S.C. 1395w–22(a)(1)(B)) is amended—
in clause (iv)—
by redesignating subclause (VIII) as subclause (IX); and
by inserting after subclause (VII) the following new subclause:
“(VIII) 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)”.
Definition— Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:
“(nnn) Primary care visit—The term “primary care visit” 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.”
Medicaid—
in subsection (a)(2)—
in subparagraph (I), by striking “or” at the end;
in subparagraph (J), by striking “; and” at the end and inserting “, or”; and
by adding at the end the following new subparagraph:
“(K) 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)—
in subparagraph (I), by striking “or” at the end;
in subparagraph (J), by striking “; and” at the end and inserting “, or”; and
by adding at the end the following new subparagraph:
“(K) the first 3 primary care visits (as defined in section 1861(nnn)) furnished to an individual during a year (beginning with 2026); and”
Application to alternative cost sharing— Section 1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended by adding at the end the following new clause:
“(xv) The first 3 primary care visits (as defined in section 1861(nnn)) furnished to an individual during a year (beginning with 2026).”