H. R. 1096

1. Short title

2. Requiring coverage of 3 primary care visits without cost sharing each year under Medicare

(a) Medicare

(1) In general

(2) Medicare Advantage

(VIII) the first 3 primary care visits (as defined in section 1861(nnn)) furnished to an enrollee during a year (beginning with 2026).

(3) Definition

(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.

(b) Medicaid

(1) In general

(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

(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

(xv) The first 3 primary care visits (as defined in section 1861(nnn)) furnished to an individual during a year (beginning with 2026).