HR-9847-119
Referred to the House Committee on Energy and Commerce.
Sponsored by Neal Dunn (R-FL)
What it does
This bill would amend title XIX of the Social Security Act to prohibit state Medicaid programs from denying payment when a patient receives both a mental health or substance use disorder service and a primary care service on the same day at the same facility. It would apply to services delivered in person or via telehealth at physician's offices, Federally Qualified Health Centers, rural health clinics, and other outpatient facilities. States would be required to reimburse both services regardless of their same-day occurrence.
Who benefits
Medicaid enrollees — approximately 90 million people — who need both physical and behavioral health care, particularly those with co-occurring conditions such as depression and diabetes or opioid use disorder and chronic illness. Children and adolescents, who are the bill's named focus, would benefit from integrated care visits. Federally Qualified Health Centers and rural health clinics that already provide integrated care but face reimbursement barriers. Providers in rural and underserved areas where patients may have limited ability to make multiple separate appointments. Telehealth providers offering integrated services.
Who is hurt
State Medicaid programs and state budgets, which would face increased reimbursement obligations (though federal matching funds offset a share). Federal taxpayers, who fund the federal share of Medicaid costs. Insurers or managed care organizations operating Medicaid plans, which may face higher claims costs. Providers who currently benefit from administrative simplicity of single-service billing may face increased documentation requirements to justify same-day billing for multiple service types.
Supporters argue
Supporters argue that many state Medicaid programs currently deny payment when mental health and primary care services are billed on the same day — a policy that forces patients to choose between addressing physical and behavioral health needs in a single visit or scheduling multiple appointments they may never keep. They contend this billing barrier is a documented driver of unmet behavioral health needs among Medicaid enrollees, particularly youth, and that integrated care models have demonstrated improved outcomes and reduced long-term costs in peer-reviewed research. Removing the same-day billing prohibition, they argue, aligns payment policy with evidence-based, whole-person care.
Opponents argue
Opponents argue that eliminating same-day billing restrictions could increase Medicaid costs without sufficient safeguards against duplicative or unnecessary billing, since providers would face a reduced administrative check on claiming multiple services per visit. They contend that states, which co-administer and co-fund Medicaid, should retain flexibility to manage their own program integrity rules and reimbursement structures rather than having a federal mandate override locally tailored policies. Critics may also argue the bill does not address underlying provider shortages or the structural barriers — such as lack of co-located behavioral health staff — that prevent integrated care from being widely available in the first place.
Constitutional context
Congress enacted Medicaid under the Taxing and Spending Clause (Art. I, §8, cl. 1), conditioning federal funds on state compliance with federal requirements. NFIB v. Sebelius (2012) established that Spending Clause conditions are permissible so long as they do not become so coercive as to leave states no genuine choice; adding a new coverage requirement to an existing program is well within established precedent, as states retain the option to exit Medicaid.
Checks and balances
Congress gains authority by adding a new mandatory coverage condition to Medicaid; states retain the formal choice to opt out of Medicaid participation, and CMS retains administrative authority to implement and enforce the new requirement through the standard state plan amendment process.
Historical precedent
Several states have voluntarily eliminated same-day billing restrictions under Medicaid managed care contracts, and the Mental Health Parity and Addiction Equity Act of 2008 established a federal precedent for requiring parity between behavioral and physical health coverage conditions.