I 

116TH CONGRESS 

1ST SESSION H. R. 3708 

To amend the Internal Revenue Code of 1986 to allow individuals with 

direct primary care service arrangements to remain eligible individuals 

for purposes of health savings accounts, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 11, 2019 

Mr. BLUMENAUER (for himself, Mr. NUNES, Mr. SCHNEIDER, and Mr. SMITH

of Missouri) introduced the following bill; which was referred to the Committee on Ways and Means 

A BILL 

To amend the Internal Revenue Code of 1986 to allow individuals with direct primary care service arrangements 

to remain eligible individuals for purposes of health savings accounts, 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 2019’’. 


pamtmann on DSKBFK8HB2PROD with BILLS
2 

•HR 3708 IH

1 SEC. 2. TREATMENT OF DIRECT PRIMARY CARE SERVICE 

2 ARRANGEMENTS. 

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

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

5 the following new subparagraph: 

6 ‘‘(D) TREATMENT OF DIRECT PRIMARY

7 CARE SERVICE ARRANGEMENTS.— 

8 ‘‘(i) IN GENERAL.—A direct primary 

9 care service arrangement shall not be 

10 treated as a health plan for purposes of 

11 subparagraph (A)(ii). 

12 ‘‘(ii) DIRECT PRIMARY CARE SERVICE

13 ARRANGEMENT.—For purposes of this 

14 paragraph— 

15 ‘‘(I) IN GENERAL.—The term ‘di16 rect primary care service arrange17 ment’ means, with respect to any indi18 vidual, an arrangement under which 

19 such individual is provided medical 

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

21 consisting solely of primary care serv22 ices provided by primary care practi23 tioners (as defined in section 

24 1833(x)(2)(A) of the Social Security 

25 Act, determined without regard to 

26 clause (ii) thereof), if the sole comVerDate Sep 11 2014 23:32 Jul 19, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3708.IH H3708

pamtmann on DSKBFK8HB2PROD with BILLS
3 

•HR 3708 IH

1 pensation for such care is a fixed peri2 odic fee. 

3 ‘‘(II) LIMITATION.—With respect 

4 to any individual for any month, such 

5 term shall not include any arrange6 ment if the aggregate fees for all di7 rect primary care service arrange8 ments (determined without regard to 

9 this subclause) with respect to such 

10 individual for such month exceed 

11 $150 (twice such dollar amount in the 

12 case of an individual with any direct 

13 primary care service arrangement (as 

14 so determined) that covers more than 

15 one individual). 

16 ‘‘(iii) CERTAIN SERVICES SPECIFI17 CALLY EXCLUDED FROM TREATMENT AS

18 PRIMARY CARE SERVICES.—For purposes 

19 of this paragraph, the term ‘primary care 

20 services’ shall not include— 

21 ‘‘(I) procedures that require the 

22 use of general anesthesia, 

23 ‘‘(II) prescription drugs (other 

24 than vaccines), and 


pamtmann on DSKBFK8HB2PROD with BILLS
4 

•HR 3708 IH

1 ‘‘(III) laboratory services not 

2 typically administered in an ambula3 tory primary care setting. 

4 The Secretary, after consultation with the 

5 Secretary of Health and Human Services, 

6 shall issue regulations or other guidance 

7 regarding the application of this clause.’’. 

8 (b) DIRECT PRIMARY CARE SERVICE ARRANGEMENT

9 FEES TREATED AS MEDICAL EXPENSES.—Section 

10 223(d)(2)(C) is amended by striking ‘‘or’’ at the end of 

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

12 and inserting ‘‘, or’’, and by adding at the end the fol13 lowing new clause: 

14 ‘‘(v) any direct primary care service arrangement.’’. 

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

16 such Code is amended— 

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

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

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

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

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

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

23 by inserting after clause (ii) the following new 

24 clause: 


pamtmann on DSKBFK8HB2PROD with BILLS
5 

•HR 3708 IH

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

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

3 years beginning in calendar years after 

4 2020, ‘calendar year 2019’.’’. 

5 (d) REPORTING OF DIRECT PRIMARY CARE SERVICE

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

7 Code is amended by striking ‘‘and’’ at the end of para8 graph (16), by striking the period at the end of paragraph 

9 (17) and inserting ‘‘, and’’, and by inserting after para10 graph (17) the following new paragraph: 

11 ‘‘(18) in the case of a direct primary care serv12 ice arrangement (as defined in section 

13 223(c)(1)(D)(ii)) which is provided in connection 

14 with employment, the aggregate fees for such ar15 rangement for such employee.’’. 

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

17 this section shall apply to months beginning after Decem18 ber 31, 2019, in taxable years ending after such date. 

Æ 


pamtmann on DSKBFK8HB2PROD with BILLS