PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the Committee on Energy and Commerce, and in addition to the Committee on 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.
Congressional Research Service
Version 00 · Introduced in House · Feb 6, 2025
Helping Out Patients for Emotional and Mental Wellbeing Act or the HOPE and Mental Wellbeing Act of 2025
This bill provides for coverage under Medicare and Medicaid of three primary care visits per year without cost-sharing.
People & committees
Rep. Salinas, Andrea [D-OR-6] · D–OR
Legislative record
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Referred to the Committee on Energy and Commerce, and in addition to the Committee on 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on 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.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
No related bills are listed in this snapshot. This does not establish whether the proposal has appeared in earlier Congresses.
Source last updated: Jul 14, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2025-02-06 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
This proposal seeks to remove patients’ share of costs for their first three primary care visits each year, beginning in 2026. It would change Medicare payment rules and add protections to Medicare Advantage and Medicaid provisions. Qualifying visits would include mental and behavioral health care, general medical care, and care coordination. The supplied amendments do not reproduce all existing rules needed to establish exactly how those protections would operate.
Requiring coverage of 3 primary care visits without cost sharing each year under Medicare
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)
(2) Medicare Advantage Section 1852(a)(1)(B) of the Social Security Act (42 U.S.C. 1395w–22(a)(1)(B)) is amended
(b) Medicaid (1) In general Section 1916 of the Social Security Act (42 U.S.C. 1396o) is amended
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.
Section 1 would name the bill the Helping Out Patients for Emotional and Mental Wellbeing Act, or the HOPE and Mental Wellbeing Act of 2025.
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.
Section 2 would define a primary care visit by the services provided: outpatient mental and behavioral health services, general rather than specialty medical services, and care coordination. Those services must address prevention, diagnosis, treatment, or management of a physical, mental, or behavioral health condition.
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.
For each person’s first three qualifying visits each year beginning in 2026, Medicare would pay 100 percent of the lower of the actual charge or the amount recognized under the applicable outpatient payment rule. This applies only to visits payable under the specified outpatient provisions referenced in the bill; it does not promise payment of every provider’s full charge.
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
The bill would also add an exception to section 1833(b) for the first three qualifying Medicare visits annually beginning in 2026. The supplied wording says “(13) shall not apply”; without the surrounding statute, the precise operation of this exception is unclear.
in subsection (b), in the first sentence
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).
For Medicare Advantage enrollees, the bill would add the first three primary care visits each year beginning in 2026 to section 1852(a)(1)(B)(iv), and update a related reference in clause (v). The existing clauses are not reproduced, limiting what the supplied text establishes about the resulting plan obligations.
(2) Medicare Advantage Section 1852(a)(1)(B) of the Social Security Act (42 U.S.C. 1395w–22(a)(1)(B)) is amended— (A) in clause (iv)— (i) by redesignating subclause (VIII) as subclause (IX); and (ii) 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). ; and (B) in clause (v), by striking and (VII) and inserting (VII), and (VIII).
For Medicaid, the bill would add the first three primary care visits each year beginning in 2026 to both section 1916(a)(2) and section 1916(b)(2), and to the alternative cost-sharing provisions in section 1916A(b)(3)(B). The addition to section 1916(a)(2) expressly requires that payment for the visits be available under Medicaid. The surrounding rules governing patients’ share of costs are not supplied.
(b) Medicaid (1) In general Section 1916 of the Social Security Act (42 U.S.C. 1396o) is amended— (A) in subsection (a)(2)
(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
(B) in subsection (b)(2)— (i) in subparagraph (I), by striking or at the end; (ii) in subparagraph (J), by striking ; and at the end and inserting , or; and (iii) 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 .
(2) 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).
The supplied official-actions snapshot, updated July 14, 2026, records introduction in the House and referral to the Energy and Commerce and Ways and Means committees on February 6, 2025. It does not establish the bill’s status after those recorded actions.
Source snapshot updated 2026-07-14T08:07:06Z.
2025-02-06: Introduced in House
2025-02-06: Referred to the Committee on Energy and Commerce, and in addition to the Committee on 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.
A closer look
Reviewed version: Introduced in House · 2025-02-06. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy change attached to appropriations was identified in the complete supplied introduced text. This conclusion does not extend to other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for particular recipients or places was identified in the complete supplied introduced text. This does not establish the absence of earmarks in other versions or accompanying materials.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
None identified in the reviewed text
No materially narrow carve-out, special exemption, or preferential treatment warranting a finding was identified in the complete supplied introduced text. Ordinary coverage of intended program beneficiaries is not treated as a targeted benefit. This conclusion is limited to this version.
Full text preserved for this analysis. Legislative record snapshot: Jul 14, 2026. How PlainBill uses AI