I 

116TH CONGRESS 

2D SESSION H. R. 8417 

To facilitate direct primary care arrangements. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 29, 2020 

Mr. CRENSHAW introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Energy 

and Commerce, and Education and Labor, 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 BILL 

To facilitate direct primary care arrangements. 

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 ‘‘Direct Primary Care 

5 for America Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds as follows: 

8 (1) Primary care services are able to reduce 

9 healthcare costs, emergency room visits, and hos10 pitalizations. 


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1 (2) Health systems that invest in primary care 

2 services are able to realign incentives in order to 

3 focus on proactive interventions to achieve results 

4 and population health. 

5 (3) Primary care creates increased patient sat6 isfaction, physician engagement, and better patient 

7 outcomes. 

8 (4) Direct primary care is able to achieve physi9 cian compliance. 

10 (5) The model of direct primary care can 

11 change patient usage patterns, with more personal12 ized, home-based preventative care versus high-acu13 ity episodic care. 

14 (6) Direct primary care medical homes are able 

15 to incorporate community health via a collaborative 

16 model approach. 

17 (7) Direct primary care can be used with popu18 lation health platforms to develop a plan of care and 

19 proposed wellness outcomes. 

20 SEC. 3. TREATMENT OF DIRECT PRIMARY CARE SERVICE 

21 ARRANGEMENTS FOR PURPOSES OF HEALTH 

22 SAVINGS ACCOUNT. 

23 (a) IN GENERAL.—Section 223(c)(1) of the Internal 

24 Revenue Code of 1986 is amended by adding at the end 

25 the following new subparagraph: 


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1 ‘‘(D) TREATMENT OF DIRECT PRIMARY

2 CARE SERVICE ARRANGEMENTS.— 

3 ‘‘(i) IN GENERAL.—A direct primary 

4 care service arrangement shall not be 

5 treated as a health plan for purposes of 

6 subparagraph (A)(ii). 

7 ‘‘(ii) DIRECT PRIMARY CARE SERVICE

8 ARRANGEMENT.—For purposes of this sub9 paragraph— 

10 ‘‘(I) IN GENERAL.—The term ‘di11 rect primary care service arrange12 ment’ means, with respect to any indi13 vidual, an arrangement under which 

14 such individual is provided medical 

15 care (as defined in section 213(d)) 

16 consisting solely of primary care serv17 ices provided by primary care practi18 tioners (as defined in section 

19 1833(x)(2)(A) of the Social Security 

20 Act, determined without regard to 

21 clause (ii) thereof), if the sole com22 pensation for such care is a fixed peri23 odic fee. 

24 ‘‘(II) LIMITATION.—With respect 

25 to any individual for any month, such 


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1 term shall not include any arrange2 ment if the aggregate fees for all di3 rect primary care service arrange4 ments (determined without regard to 

5 this subclause) with respect to such 

6 individual for such month exceed 

7 $150 (twice such dollar amount in the 

8 case of an individual with any direct 

9 primary care service arrangement (as 

10 so determined) that covers more than 

11 one individual). 

12 ‘‘(iii) CERTAIN SERVICES SPECIFI13 CALLY EXCLUDED FROM TREATMENT AS

14 PRIMARY CARE SERVICES.—For purposes 

15 of this subparagraph, the term ‘primary 

16 care services’ shall not include— 

17 ‘‘(I) procedures that require the 

18 use of general anesthesia, and 

19 ‘‘(II) laboratory services not typi20 cally administered in an ambulatory 

21 primary care setting. 

22 The Secretary, after consultation with the 

23 Secretary of Health and Human Services, 

24 shall issue regulations or other guidance 

25 regarding the application of this clause.’’. 


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1 (b) DIRECT PRIMARY CARE SERVICE ARRANGEMENT

2 FEES TREATED AS MEDICAL EXPENSES.—Section 

3 223(d)(2)(C) of such Code is amended by striking ‘‘or’’ 

4 at the end of clause (iii), by striking the period at the 

5 end of clause (iv) and inserting ‘‘, or’’, and by adding at 

6 the end the following new clause: 

7 ‘‘(v) any direct primary care service 

8 arrangement.’’. 

9 (c) INFLATION ADJUSTMENT.—Section 223(g)(1) of 

10 such Code is amended— 

11 (1) by inserting ‘‘, (c)(1)(D)(ii)(II),’’ after 

12 ‘‘(b)(2),’’ each place such term appears; and 

13 (2) in subparagraph (B), by inserting ‘‘and 

14 (iii)’’ after ‘‘clause (ii)’’ in clause (i), by striking 

15 ‘‘and’’ at the end of clause (i), by striking the period 

16 at the end of clause (ii) and inserting ‘‘, and’’, and 

17 by inserting after clause (ii) the following new 

18 clause: 

19 ‘‘(iii) in the case of the dollar amount 

20 in subsection (c)(1)(D)(ii)(II) for taxable 

21 years beginning in calendar years after 

22 2020, ‘calendar year 2019’.’’. 

23 (d) REPORTING OF DIRECT PRIMARY CARE SERVICE

24 ARRANGEMENT FEES ON W–2.—Section 6051(a) of such 

25 Code is amended by striking ‘‘and’’ at the end of paraVerDate Sep 11 2014 02:27 Oct 25, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8417.IH H8417

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1 graph (16), by striking the period at the end of paragraph 

2 (17) and inserting ‘‘, and’’, and by inserting after para3 graph (17) the following new paragraph: 

4 ‘‘(18) in the case of a direct primary care serv5 ice arrangement (as defined in section 

6 223(c)(1)(D)(ii)) which is provided in connection 

7 with employment, the aggregate fees for such ar8 rangement for such employee.’’. 

9 (e) EFFECTIVE DATE.—The amendments made by 

10 this section shall apply to months beginning after Decem11 ber 31, 2019, in taxable years ending after such date. 

12 SEC. 4. PROVIDING FOR STATE APPROVAL AND IMPLEMEN13 TATION OF SPECIFIED WAIVERS UNDER THE 

14 MEDICAID PROGRAM. 

15 Section 1115 of the Social Security Act (42 U.S.C. 

16 1315) is amended— 

17 (1) in subsection (d)— 

18 (A) in paragraph (1), by striking ‘‘An ap19 plication’’ and inserting ‘‘Subject to paragraph 

20 (4), an application’’; and 

21 (B) by adding at the end the following new 

22 paragraph: 

23 ‘‘(4)(A) An experimental, pilot, or demonstra24 tion project undertaken under subsection (a) may be 


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1 approved or renewed by a State if such project is de2 scribed in subparagraph (B). 

3 ‘‘(B) An experimental, pilot, or demonstration 

4 project is described in this subparagraph if such 

5 project provides for a waiver of requirements with 

6 respect to a State plan (or a waiver of such plan) 

7 under title XIX such that— 

8 ‘‘(i) individuals enrolled under such plan 

9 (or such waiver) may elect to participate in 

10 such project with respect to a year; and 

11 ‘‘(ii) such individuals who elect to so par12 ticipate are furnished with primary care serv13 ices (as described in section 223(c)(1)(D)(ii)(I) 

14 of the Internal Revenue Code of 1986) through 

15 a direct primary care service arrangement (as 

16 defined in such section). 

17 ‘‘(C) For purposes of a State’s approval or re18 newal of an experimental, pilot, or demonstration 

19 project under subparagraph (A), each reference to 

20 ‘the Secretary’ in subsection (a) shall be deemed to 

21 be a reference to ‘the State’.’’; and 

22 (2) in subsection (e), by inserting ‘‘(other than 

23 such a project that is described in paragraph 

24 (4)(B))’’ before the period at the end. 


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1 SEC. 5. HEALTH REIMBURSEMENT ARRANGEMENTS AND 

2 OTHER ACCOUNT-BASED GROUP HEALTH 

3 PLANS. 

4 The final rule of the Secretary of the Treasury, the 

5 Secretary of Labor, and the Secretary of Health and 

6 Human Services, titled ‘‘Health Reimbursement Arrange7 ments and Other Account-Based Group Health Plans’’ 

8 and published in the Federal Register on June 20, 2019 

9 (84 Fed. Reg. 28888), shall have the same force and effect 

10 of law as if such rule had been enacted by an Act of Con11 gress. 

12 SEC. 6. SENSE OF CONGRESS. 

13 It is the sense of Congress that organizations offering 

14 Medicare Advantage plans under part C of title XVIII of 

15 the Social Security Act (42 U.S.C. 1395w–21 et seq.) 

16 should expand the offering of MSA plans (as defined in 

17 section 1859(b)(3) of the Social Security Act (42 U.S.C. 

18 1395w–28(b)(3))) under such part. 

19 SEC. 7. ELIGIBILITY OF ENTITIES THAT OFFER DIRECT PRI20 MARY CARE SERVICE ARRANGEMENTS IN 

21 CERTAIN NATIONAL HEALTH SERVICE CORPS 

22 PROGRAMS. 

23 Notwithstanding subpart II or III of part D of title 

24 III of the Public Health Service Act (42 U.S.C. 254d et 

25 seq.), an entity shall be eligible for assignment of one or 

26 more individuals performing a period of obligated service 


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1 pursuant to the National Health Service Corps Scholar2 ship Program or National Health Service Corps Loan Re3 payment Program if such entity— 

4 (1) offers direct primary care service arrange5 ments (as defined in section 223(c)(1)(D) of the In6 ternal Revenue Code of 1986); and 

7 (2) is in a health professional shortage area (as 

8 defined in section 331(a) of the Public Health Serv9 ice Act (42 U.S.C. 254d(a))). 

Æ 


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