Primary Care Enhancement Act of 2018

To amend the Internal Revenue Code of 1986 to provide that direct primary care service arrangements do not disqualify deductible health savings account contributions, and for other purposes. 1. Short title This Act may be cited as the Primary Care Enhancement Act of 2018 2. Treatment of direct primary care service arrangements (a) In general Section 223(c)(1) (D) Treatment of direct primary care service arrangements (i) In general A direct primary care service arrangement shall not be treated as a health plan for purposes of subparagraph (A)(ii). (ii) Direct primary care service arrangement For purposes of this paragraph— (I) In general The term direct primary care service arrangement (II) Limitation With respect to any individual for any month, such term shall not include any arrangement if the aggregate fees for all direct primary care service arrangements (determined without regard to this subclause) with respect to such individual for such month exceed $150 (twice such dollar amount in the case of an individual with any direct primary care service arrangement (as so determined) that covers more than one individual). (iii) Certain services specifically excluded from treatment as primary care services For purposes of this paragraph, the term primary care services (I) procedures that require the use of general anesthesia, (II) prescription drugs (other than vaccines), and (III) laboratory services not typically administered in an ambulatory primary care setting. The Secretary, after consultation with the Secretary of Health and Human Services, shall issue regulations or other guidance regarding the application of this clause. . (b) Direct primary care service arrangement fees treated as medical expenses Section 223(d)(2)(C) is amended by striking or , or (v) any direct primary care service arrangement. . (c) Inflation adjustment Section 223(g)(1) of such Code is amended— (1) by striking and (c)(2)(A) , (c)(1)(D)(ii)(II), and (c)(2)(A) (2) in subparagraph (B), by striking clause (ii) clauses (ii) and (iii) and , and (iii) in the case of the dollar amount in subsection (c)(1)(D)(ii)(II) for taxable years beginning in calendar years after 2019, calendar year 2018 . (d) Reporting of direct primary care service arrangement fees on W–2 Section 6051(a) of such Code is amended by striking and , and (18) in the case of a direct primary care service arrangement (as defined in section 223(c)(1)(D)(ii)) which is provided in connection with employment, the aggregate fees for such arrangement for such employee. (e) Effective date The amendments made by this section shall apply to months beginning after December 31, 2018, in taxable years ending after such date. July 19, 2018 Reported with an amendment, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed

Summary: This bill amends the Internal Revenue Code to: (1) allow individuals who are eligible for a health savings account (HSA) to participate in a direct primary care service arrangement without losing their eligibility due to the arrangement, and (2) permit an HSA to be used to pay for a direct primary care service arrangement. Under a direct primary care service arrangement, an individual receives medical care consisting solely of primary care services provided by primary care practitioners in exchange for a fixed periodic fee. The fees are subject to limits specified in the bill. The primary care services covered by the arrangement may not include procedures that require the use of general anesthesia, prescription drugs (other than vaccines), and laboratory services not typically administered in an ambulatory primary care setting.