II 

118TH CONGRESS 

1ST SESSION S. 628 

To amend the Internal Revenue Code of 1986 to provide for the treatment 

of direct primary care service arrangements as medical care, to provide 

that such arrangements do not disqualify deductible health savings account contributions, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 2, 2023 

Mr. CASSIDY (for himself, Mrs. SHAHEEN, Mr. SCOTT of South Carolina, and 

Mr. KELLY) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend the Internal Revenue Code of 1986 to provide 

for the treatment of direct primary care service arrangements as medical care, to provide that such arrangements do not disqualify deductible health savings account 

contributions, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Primary Care En5 hancement Act of 2023’’. 


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1 SEC. 2. TREATMENT OF DIRECT PRIMARY CARE SERVICE 

2 ARRANGEMENTS. 

3 (a) AMOUNT TREATED AS MEDICAL CARE.— 

4 (1) IN GENERAL.—Section 213(d)(1) of the In5 ternal Revenue Code of 1986 is amended by striking 

6 ‘‘or’’ at the end of subparagraph (C), by striking the 

7 period at the end of subparagraph (D) and inserting 

8 ‘‘, or’’, and by inserting after subparagraph (D) the 

9 following new subparagraph: 

10 ‘‘(E) for direct primary care service ar11 rangements.’’. 

12 (2) LIMITATION.—Section 213(d)(1) of such 

13 Code, as amended by paragraph (1), is further 

14 amended by adding at the end the following: ‘‘In the 

15 case of a direct care primary service arrangement, 

16 only eligible fee amounts (as defined in paragraph 

17 (13)) shall be taken into account under subpara18 graph (E).’’. 

19 (3) DEFINITIONS.—Section 213(d) of such 

20 Code is amended by inserting after paragraph (11) 

21 the following new paragraphs: 

22 ‘‘(12) DIRECT PRIMARY CARE SERVICE AR23 RANGEMENT.— 

24 ‘‘(A) IN GENERAL.—The term ‘direct pri25 mary care service arrangement’ means, with re26 spect to any individual, an arrangement under 


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1 which such individual is provided medical care 

2 (as defined in paragraph (1), determined with3 out regard to subparagraph (E) thereof) con4 sisting solely of primary care services provided 

5 by primary care practitioners (as defined in sec6 tion 1833(x)(2)(A) of the Social Security Act, 

7 determined without regard to clause (ii) there8 of), if the sole compensation for such care is a 

9 fixed periodic fee. 

10 ‘‘(B) CERTAIN SERVICES SPECIFICALLY

11 EXCLUDED FROM TREATMENT AS PRIMARY

12 CARE SERVICES.—For purposes of this para13 graph, the term ‘primary care services’ shall not 

14 include— 

15 ‘‘(i) procedures that require the use of 

16 general anesthesia, and 

17 ‘‘(ii) laboratory services not typically 

18 administered in an ambulatory primary 

19 care setting. 

20 The Secretary, after consultation with the Sec21 retary of Health and Human Services, shall 

22 issue regulations or other guidance regarding 

23 the application of this subparagraph. 

24 ‘‘(13) ELIGIBLE FEE AMOUNT.— 


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1 ‘‘(A) IN GENERAL.—The term ‘eligible fee 

2 amount’ means, with respect to any individual 

3 for any month, the amount of fixed periodic 

4 fees paid for a direct care primary service ar5 rangement, to the extent that the aggregate 

6 fees for all direct primary care service arrange7 ments with respect to such individual for such 

8 month do not exceed $150 (twice such dollar 

9 amount in the case of an individual with any di10 rect primary care service arrangement that cov11 ers more than one individual). 

12 ‘‘(B) INDEXING.—In the case of any tax13 able year beginning in a calendar year after 

14 2024, the $150 amount contained in subpara15 graph (A) shall be increased by an amount 

16 equal to— 

17 ‘‘(i) such dollar amount, multiplied by 

18 ‘‘(ii) the cost-of-living adjustment de19 termined under section 1(f)(3) for the cal20 endar year in which such taxable year be21 gins determined by substituting ‘calendar 

22 year 2023’ for ‘calendar year 2016’ in sub23 paragraph (A)(ii) thereof. 


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1 If any increase under the preceding sentence is 

2 not a multiple of $10, such increase shall be 

3 rounded to the nearest multiple of $10.’’. 

4 (b) HEALTH SAVINGS ACCOUNTS.—Section 223(c) of 

5 the Internal Revenue Code of 1986 is amended by adding 

6 at the end the following new paragraph: 

7 ‘‘(6) TREATMENT OF DIRECT PRIMARY CARE

8 SERVICE ARRANGEMENTS.—A direct care primary 

9 service arrangement (as defined in section 

10 213(d)(12))— 

11 ‘‘(A) shall not be treated as a health plan 

12 for purposes of paragraph (1)(A)(ii), and 

13 ‘‘(B) shall not be treated as insurance for 

14 purposes of subsection (d)(2)(B).’’. 

15 (c) REPORTING OF DIRECT PRIMARY CARE SERVICE

16 ARRANGEMENT FEES ON W–2.—Section 6051(a) of the 

17 Internal Revenue Code of 1986 is amended by striking 

18 ‘‘and’’ at the end of paragraph (16), by striking the period 

19 at the end of paragraph (17) and inserting ‘‘, and’’, and 

20 by inserting after paragraph (17) the following new para21 graph: 

22 ‘‘(18) in the case of a direct primary care serv23 ice arrangement (as defined in section 213(d)(12)) 

24 which is provided in connection with employment, 


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1 the aggregate fees for such arrangement for such 

2 employee.’’. 

3 (d) EFFECTIVE DATE.—The amendments made by 

4 this section shall apply to months beginning after Decem5 ber 31, 2023, in taxable years ending after such date. 

Æ 


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