Primary and Behavioral Health Care Access Act of 2026
- Bill Number
- S. 4754
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-06-11: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
- Last Updated
- 2026-07-08T16:03:07Z
AI-Generated Summary
Purpose The legislation aims to expand access to essential health services by requiring certain health plans to cover three primary care visits and three behavioral health care visits each plan year with no cost-sharing (such as deductibles, copayments, or coinsurance).
Key Provisions
- Adds new sections to the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act (PHSA), and the Internal Revenue Code (IRC) mandating this coverage.
- Primary care visit is defined as an in-person visit to a designated primary care provider (such as a physician, physician assistant, or nurse practitioner) for services identified by specific HCPCS codes (99201–99215).
- Behavioral health care visit covers services for diagnosis, treatment, screening, or prevention of behavioral health conditions by qualified providers (including psychiatrists, psychologists, social workers, and others).
- Plans must apply the same treatment limitations and reimbursement rates to these visits as to other covered visits, with no separate restrictions.
- Updates IRC rules for high-deductible health plans to allow this coverage without affecting health savings account eligibility.
- Effective for plan years beginning two years after enactment.
Significant Changes to Existing Law
- Builds on the existing preventive services requirement in section 2713 of the PHSA by adding specific no-cost-sharing visits for primary and behavioral health care.
- Introduces new statutory mandates across ERISA, PHSA, and IRC, creating uniform federal requirements for group and individual health coverage.
- Modifies tax code provisions related to high-deductible plans to accommodate the new coverage.
Potential Impacts
- On citizens: Reduces financial barriers for up to six visits annually, potentially increasing utilization of primary and behavioral health services.
- On government agencies: Requires updates to regulations by the Departments of Labor, Health and Human Services, and Treasury; may increase administrative oversight for compliance.
- On health plans and providers: Affects reimbursement and plan design; no direct effects on international relations are specified.
Main Stakeholders Affected
- Group health plans and health insurance issuers (required to implement the coverage).
- Employers sponsoring plans and individuals enrolled in group or individual coverage.
- Primary care and behavioral health providers (who may see changes in visit volume and payment structures).
- Federal agencies responsible for enforcement and tax administration.
Notable Legal, Constitutional, or Political Implications
- Extends federal mandates on private health coverage, consistent with existing Affordable Care Act frameworks under the Commerce Clause.
- Raises potential issues around state-federal interaction in insurance regulation, though the bill applies uniformly to ERISA and non-ERISA plans.
- No explicit constitutional challenges or political provisions are detailed in the text.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Sen. King, Angus S., Jr. [I-ME]
Recent Actions
- 2026-06-11: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
- 2026-06-11: Introduced in Senate
Bill Versions
- Primary and Behavioral Health Care Access Act of 2026 — issued 2026-06-11 — PDF (12 pages)