H.R. 1096: Helping Out Patients for Emotional and Mental Wellbeing Act

This bill, known as the Helping Out Patients for Emotional and Mental Wellbeing Act, proposes amendments to the Social Security Act to enhance coverage under Medicare and Medicaid for primary care visits related to mental and behavioral health. Here’s a summary of the key provisions of the bill:

1. Medicare Coverage Improvements

The bill requires Medicare to cover three primary care visits each year without any cost-sharing, starting in 2026. These visits specifically include:

• Outpatient mental and behavioral health services.
• Nonspecialty medical services.
• Care coordination services related to the prevention, diagnosis, treatment, or management of physical, mental, or behavioral health conditions.

2. Changes to Medicare Advantage Plans

Similar provisions are also added for Medicare Advantage plans, ensuring that the first three primary care visits for enrollees will be covered without cost-sharing, beginning in 2026.

3. Medicaid Coverage Enhancements

The bill extends similar coverage requirements to Medicaid, mandating that the first three primary care visits each year for eligible individuals will also be covered without cost-sharing, starting in 2026.

4. Definition of Primary Care Visits

The bill defines a "primary care visit" to include a range of services, primarily focusing on those related to mental and behavioral health, as well as general primary care needs.

5. Transition Timeline

All provisions relating to the coverage of primary care visits will begin in the year 2026, allowing for a transition period for implementation.

6. Legislative Process

The bill has been introduced in the House of Representatives and referred to the Committee on Energy and Commerce and the Committee on Ways and Means for consideration.

Relevant Companies

• UNH - UnitedHealth Group: A major player in the healthcare sector, particularly in managing Medicare Advantage plans, which could see changes in coverage requirements affecting service delivery and reimbursement.
• ANTM - Anthem, Inc.: As a significant provider of Medicaid and Medicare plans, changes in visit coverage could impact their operational costs and business model.
• CVS - CVS Health: Involved in managing healthcare services for Medicare and Medicaid patients, including potential adjustments to their pharmacy and care services based on the new coverage requirements.