Primary and Behavioral Health Care Access Act of 2026
- Bill Number
- H.R. 9257
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-06-11: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-07-08T16:03:07Z
AI-Generated Summary
Summary of H.R. 9257: Primary and Behavioral Health Care Access Act of 2026
Purpose of the Legislation
This bill aims to improve access to essential health services by requiring certain health plans to cover a minimum number of primary care and behavioral health visits each year without any cost-sharing requirements, such as deductibles, copayments, or coinsurance.
Key Provisions Outlined
- Coverage Requirements: Group health plans and health insurance issuers offering group or individual coverage must provide, at a minimum, coverage for 3 primary care visits and 3 behavioral health care visits per plan year, with no cost-sharing applied.
- Treatment Limitations: Any limits on these visits must be no more restrictive than those for other similar visits under the plan, and no separate limits may apply only to these specific visits.
- Reimbursement Rates: Plans must apply the same reimbursement rates for these visits as for other primary care or behavioral health visits.
- Definitions:
- Primary care visit: An in-person visit to a designated primary care provider for services identified by specific HCPCS codes (99201–99215 as of January 1, 2009, with modifications).
- Behavioral health care visit: A visit to a qualified provider for diagnosis, treatment, screening, or prevention of a behavioral health condition.
- Qualified providers: Include physicians (e.g., general practitioners, psychiatrists), physician assistants, nurse practitioners, social workers, psychologists, and others acting under state law.
- Amendments: The bill adds new sections to the Employee Retirement Income Security Act of 1974 (ERISA Section 727), the Public Health Service Act (PHSA Section 2799A-12), and the Internal Revenue Code (IRC Section 9827). It also updates IRC provisions for high-deductible health plans to accommodate these visits.
- Effective Date: Applies to plan years beginning two years after the date of enactment.
Significant Changes to Existing Law Introduced
- Establishes new mandatory coverage rules for primary care and behavioral health visits beyond existing preventive services requirements under Section 2713 of the PHSA.
- Prohibits cost-sharing specifically for these visits while maintaining parity in treatment limitations and payments with other covered services.
- Modifies high-deductible health plan rules under the IRC to allow these visits without violating deductible requirements.
Potential Impacts
- On Government Agencies: Federal agencies, such as the Department of Health and Human Services, may face increased oversight and enforcement responsibilities for compliance across ERISA, PHSA, and IRC-regulated plans.
- On Citizens: Individuals with health coverage could experience reduced out-of-pocket costs for initial visits, potentially increasing utilization of primary and behavioral health services.
- On International Relations: No direct impacts are outlined in the legislation.
Main Stakeholders Affected
- Health insurance issuers and group health plans (including employer-sponsored plans).
- Patients and enrollees seeking primary care or behavioral health services.
- Healthcare providers, such as primary care physicians and behavioral health professionals.
- Employers sponsoring group health plans.
- Federal regulatory bodies responsible for health plan oversight.
Notable Legal, Constitutional, or Political Implications
- The legislation builds on existing federal insurance regulations, potentially raising questions about the scope of congressional authority under the Commerce Clause to mandate specific benefits in private health plans.
- It emphasizes parity between primary care and behavioral health services, aligning with prior mental health parity laws without introducing separate restrictions.
- No explicit constitutional challenges or political analyses are addressed in the bill text.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Underwood, Lauren [D-IL-14]
Cosponsors (1)
Recent Actions
- 2026-06-11: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-06-11: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-06-11: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-06-11: Introduced in House
- 2026-06-11: Introduced in House
Bill Versions
- Primary and Behavioral Health Care Access Act of 2026 — issued 2026-06-11 — PDF (12 pages)