IB 
Union Calendar No. 660 
115TH CONGRESS 
2D SESSION 
H. R. 6317 
[Report No. 115–852] 
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. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 10, 2018 
Mr. PAULSEN (for himself and Mr. BLUMENAUER) introduced the following 
bill; which was referred to the Committee on Ways and Means 
JULY 19, 2018 
Additional sponsor: Mr. SMUCKER 
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 
[Strike out all after the enacting clause and insert the part printed in italic] 
[For text of introduced bill, see copy of bill as introduced on July 10, 2018] 
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A BILL 
To amend the Internal Revenue Code of 1986 to provide 
that direct primary care service arrangements do not 
disqualify deductible health savings account contribu-
tions, and for other purposes. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Primary Care Enhance-
ment Act of 2018’’. 
SEC. 2. TREATMENT OF DIRECT PRIMARY CARE SERVICE 
ARRANGEMENTS. 
(a) IN GENERAL.—Section 223(c)(1) of the Internal 
Revenue Code of 1986 is amended by adding at the end 
the following new subparagraph: 
‘‘(D) TREATMENT
OF
DIRECT
PRIMARY 
CARE SERVICE ARRANGEMENTS.— 
‘‘(i) IN GENERAL.—A direct primary 
care service arrangement shall not be treat-
ed as a health plan for purposes of subpara-
graph (A)(ii). 
‘‘(ii) DIRECT PRIMARY CARE SERVICE 
ARRANGEMENT.—For purposes of this para-
graph— 
‘‘(I) IN GENERAL.—The term ‘di-
rect primary care service arrangement’ 
means, with respect to any individual, 
an arrangement under which such in-
dividual is provided medical care (as 
defined in section 213(d)) consisting 
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solely of primary care services (as de-
fined in section 1833(x)(2)(B) of the 
Social Security Act) provided by pri-
mary care practitioners (as defined in 
section 1833(x)(2)(A) of the Social Se-
curity Act, determined without regard 
to clause (ii) thereof), if the sole com-
pensation for such care is a fixed peri-
odic fee. 
‘‘(II) LIMITATION.—With respect 
to any individual for any month, such 
term shall not include any arrange-
ment if the aggregate fees for all direct 
primary care service arrangements (de-
termined without regard to this sub-
clause) with respect to such individual 
for such month exceed $150 (twice such 
dollar amount in the case of an indi-
vidual with any direct primary care 
service arrangement (as so determined) 
that covers more than one individual). 
‘‘(iii) CERTAIN
SERVICES
SPECIFI-
CALLY
EXCLUDED
FROM
TREATMENT
AS 
PRIMARY CARE SERVICES.—For purposes of 
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this paragraph, the term ‘primary care 
services’ shall not include— 
‘‘(I) procedures that require the 
use of general anesthesia, 
‘‘(II) prescription drugs (other 
than vaccines), and 
‘‘(III) 
laboratory 
services 
not 
typically administered in an ambula-
tory primary care setting. 
The Secretary, after consultation with the 
Secretary of Health and Human Services, 
shall issue regulations or other guidance re-
garding 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’’ at the end of 
clause (iii), by striking the period at the end of clause (iv) 
and inserting ‘‘, or’’, and by adding at the end the following 
new clause: 
‘‘(v) any direct primary care service 
arrangement.’’. 
(c) INFLATION ADJUSTMENT.—Section 223(g)(1) of 
such Code is amended— 
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(1) by striking ‘‘and (c)(2)(A)’’ each place it ap-
pears 
and 
inserting 
‘‘, 
(c)(1)(D)(ii)(II), 
and 
(c)(2)(A)’’, and 
(2) in subparagraph (B), by striking ‘‘clause 
(ii)’’ and inserting ‘‘clauses (ii) and (iii)’’ in clause 
(i), by striking ‘‘and’’ at the end of clause (i), by 
striking the period at the end of clause (ii) and in-
serting ‘‘, and’’, and by inserting after clause (ii) the 
following new clause: 
‘‘(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’’ at the end of paragraph 
(16), by striking the period at the end of paragraph (17) 
and inserting ‘‘, and’’, and by inserting after paragraph 
(17) the following new paragraph: . 
‘‘(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 em-
ployee.’’ 
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(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. 
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Union Calendar No. 660 
115TH CONGRESS 
2D SESSION 
H. R. 6317 
[Report No. 115–852] 
A BILL 
To amend the Internal Revenue Code of 1986 to 
provide that direct primary care service arrange-
ments do not disqualify deductible health savings 
account contributions, and for other purposes. 
JULY 19, 2018 
Reported with an amendment, committed to the Com-
mittee of the Whole House on the State of the Union, 
and ordered to be printed 
VerDate Sep 11 2014 
21:47 Jul 19, 2018
Jkt 079200
PO 00000
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