II 
115TH CONGRESS 
2D SESSION 
H. R. 6199 
IN THE SENATE OF THE UNITED STATES 
JULY 26, 2018 
Received 
AN ACT 
To amend the Internal Revenue Code of 1986 to include 
certain over-the-counter medical products as qualified 
medical expenses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Restoring Access to Medication and Modernizing Health 
Savings Accounts Act of 2018’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. First dollar coverage flexibility for high deductible health plans. 
Sec. 3. Treatment of direct primary care service arrangements. 
Sec. 4. Certain employment related services not treated as disqualifying cov-
erage for purposes of health savings accounts. 
Sec. 5. Contributions permitted if spouse has a health flexible spending ac-
count. 
Sec. 6. FSA and HRA terminations or conversions to fund HSAs. 
Sec. 7. Inclusion of certain over-the-counter medical products as qualified med-
ical expenses. 
Sec. 8. Certain amounts paid for physical activity, fitness, and exercise treated 
as amounts paid for medical care. 
SEC. 2. FIRST DOLLAR COVERAGE FLEXIBILITY FOR HIGH 
DEDUCTIBLE HEALTH PLANS. 
(a) IN GENERAL.—Section 223(c)(2) of the Internal 
Revenue Code of 1986 is amended by adding at the end 
the following new subparagraph: 
‘‘(E) FIRST
DOLLAR
COVERAGE
FLEXI-
BILITY.— 
‘‘(i) IN GENERAL.—A plan shall not 
fail to be treated as a high deductible 
health plan by reason of failing to have a 
deductible for not more than $250 of spec-
ified services for self-only coverage (twice 
such amount in the case of family cov-
erage) during a plan year. 
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‘‘(ii) SPECIFIED SERVICES.—For pur-
poses of this subparagraph, the term ‘spec-
ified services’ means, with respect to a 
plan, services other than preventive care 
(within the meaning of subparagraph (C)) 
identified under the terms of the plan as 
being services to which clause (i) applies.’’. 
(b) INFLATION ADJUSTMENT.—Section 223(g)(1) of 
such Code is amended— 
(1) by striking ‘‘and (c)(2)(A)’’ each place it 
appears and inserting ‘‘, (c)(2)(A), and (c)(2)(E)’’, 
and 
(2) in subparagraph (B)— 
(A) by striking ‘‘such taxable year’’ in the 
matter preceding clause (i) and inserting ‘‘the 
taxable year (plan year in the case of the dollar 
amount in subsection (c)(2)(E))’’, and 
(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 inserting ‘‘, 
and’’, and by inserting after clause (ii) the fol-
lowing new clause: 
‘‘(iii) in the case of the dollar amount 
in subsection (c)(2)(E) for plan years be-
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ginning in calendar years after 2019, ‘cal-
endar year 2018’.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to plan years begin-
ning after December 31, 2018. 
SEC. 3. 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 
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 ‘di-
rect primary care service arrange-
ment’ means, with respect to any indi-
vidual, an arrangement under which 
such individual is provided medical 
care (as defined in section 213(d)) 
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consisting solely of primary care serv-
ices provided by primary care practi-
tioners 
(as 
defined 
in 
section 
1833(x)(2)(A) of the Social Security 
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 di-
rect primary care service arrange-
ments (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
SPECIFI-
CALLY
EXCLUDED
FROM
TREATMENT
AS 
PRIMARY
CARE
SERVICES.—For purposes 
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of 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 
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’’ 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 fol-
lowing new clause: 
‘‘(v) any direct primary care service 
arrangement.’’. 
(c) INFLATION ADJUSTMENT.—Section 223(g)(1) of 
such Code, as amended by section 2(b), is amended— 
(1) 
by 
inserting 
‘‘(c)(1)(D)(ii)(II),’’ 
after 
‘‘(b)(2),’’ each place it appears, and 
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(2) in subparagraph (B), by striking ‘‘and (iii)’’ 
and inserting ‘‘, (iii) and (iv)’’ in clause (i), by strik-
ing ‘‘and’’ at the end of clause (ii), by striking the 
period at the end of clause (iii) and inserting ‘‘, 
and’’, and by inserting after clause (iii) the following 
new clause: 
‘‘(iv) 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 para-
graph (16), by striking the period at the end of paragraph 
(17) and inserting ‘‘, and’’, and by inserting after para-
graph (17) the following new paragraph: 
‘‘(18) in the case of a direct primary care serv-
ice 
arrangement 
(as 
defined 
in 
section 
223(c)(1)(D)(ii)) which is provided in connection 
with employment, the aggregate fees for such ar-
rangement for such employee.’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to months beginning after Decem-
ber 31, 2018, in taxable years ending after such date. 
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SEC. 4. CERTAIN EMPLOYMENT RELATED SERVICES NOT 
TREATED AS DISQUALIFYING COVERAGE FOR 
PURPOSES OF HEALTH SAVINGS ACCOUNTS. 
(a) IN GENERAL.—Section 223(c)(1) of the Internal 
Revenue Code of 1986, as amended by section 3(a), is 
amended by adding at the end the following new subpara-
graph: 
‘‘(E) SPECIAL
RULE
FOR
QUALIFIED 
ITEMS AND SERVICES.— 
‘‘(i) 
IN
GENERAL.—An 
individual 
shall not be treated as covered under a 
health plan for purposes of subparagraph 
(A)(ii) merely because the individual, in 
connection with the employment of the in-
dividual or the individual’s spouse, receives 
(or is eligible to receive) qualified items 
and services at— 
‘‘(I) a healthcare facility located 
at a facility owned or leased by the 
employer of the individual (or of the 
individual’s spouse), or operated pri-
marily for the benefit of such employ-
er’s employees, or 
‘‘(II) a healthcare facility located 
within a supermarket, pharmacy, or 
similar retail establishment. 
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‘‘(ii) QUALIFIED ITEMS AND SERVICES 
DEFINED.—For purposes of this subpara-
graph, the term ‘qualified items and serv-
ices’ means the following: 
‘‘(I) Physical examinations. 
‘‘(II) Immunizations, including 
injections of antigens provided by em-
ployees. 
‘‘(III) Drugs other than a pre-
scribed drug (as such term is defined 
in section 213(d)(3)). 
‘‘(IV) Treatment for injuries oc-
curring in the course of employment. 
‘‘(V) Drug testing, if required as 
a condition of employment. 
‘‘(VI) 
Hearing 
or 
vision 
screenings. 
‘‘(VII) Other similar items and 
services that do not provide signifi-
cant benefits in the nature of medical 
care. 
‘‘(iii) AGGREGATION.—For purposes 
of clause (i)(I), all persons treated as a 
single employer under subsection (b), (c), 
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(m), or (o) of section 414 shall be treated 
as a single employer.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to months beginning after Decem-
ber 31, 2018, in taxable years ending after such date. 
SEC. 5. CONTRIBUTIONS PERMITTED IF SPOUSE HAS A 
HEALTH FLEXIBLE SPENDING ACCOUNT. 
(a) CONTRIBUTIONS PERMITTED IF SPOUSE HAS A 
HEALTH
FLEXIBLE
SPENDING
ACCOUNT.—Section 
223(c)(1)(B) of the Internal Revenue Code of 1986 is 
amended by striking ‘‘and’’ at the end of clause (ii), by 
striking the period at the end of clause (iii) and inserting 
‘‘, and’’, and by inserting after clause (iii) the following 
new clause: 
‘‘(iv) coverage under a health flexible 
spending arrangement of the spouse of the 
individual for any plan year of such ar-
rangement if the aggregate reimburse-
ments under such arrangement for such 
year do not exceed the aggregate expenses 
which would be eligible for reimbursement 
under such arrangement if such expenses 
were determined without regard to any ex-
penses paid or incurred with respect to 
such individual.’’. 
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(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to plan years beginning after De-
cember 31, 2018. 
SEC. 6. FSA AND HRA TERMINATIONS OR CONVERSIONS TO 
FUND HSAS. 
(a) IN GENERAL.—Section 106(e)(2) of the Internal 
Revenue Code of 1986 is amended to read as follows: 
‘‘(2) QUALIFIED HSA DISTRIBUTION.—For pur-
poses of this subsection— 
‘‘(A) IN
GENERAL.—The term ‘qualified 
HSA distribution’ means, with respect to any 
employee, a distribution from a health flexible 
spending arrangement or health reimbursement 
arrangement of such employee directly to a 
health savings account of such employee if— 
‘‘(i) such distribution is made in con-
nection with such employee establishing 
coverage under a high deductible health 
plan (as defined in section 223(c)(2)) after 
a significant period of not having such cov-
erage, and 
‘‘(ii) such arrangement is described in 
section 223(c)(1)(B)(iii) with respect to 
the portion of the plan year after such dis-
tribution is made. 
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‘‘(B) DOLLAR
LIMITATION.—The aggre-
gate amount of distributions from health flexi-
ble spending arrangements and health reim-
bursement arrangements of any employee which 
may be treated as qualified HSA distributions 
in connection with an establishment of coverage 
described in subparagraph (A)(i) shall not ex-
ceed the dollar amount in effect under section 
125(i)(1) (twice such amount in the case of cov-
erage 
which 
is 
described 
in 
section 
223(b)(2)(B)).’’. 
(b) PARTIAL REDUCTION OF LIMITATION ON DE-
DUCTIBLE HSA CONTRIBUTIONS.—Section 223(b)(4) of 
such Code is amended by striking ‘‘and’’ at the end of 
subparagraph (B), by striking the period at the end of 
subparagraph (C) and inserting ‘‘, and’’, and by inserting 
after subparagraph (C) the following new subparagraph: 
‘‘(D) so much of any qualified HSA dis-
tribution (as defined in section 106(e)(2)) made 
to a health savings account of such individual 
during the taxable year as does not exceed the 
aggregate increases in the balance of the ar-
rangement from which such distribution is 
made which occur during the portion of the 
plan year which precedes such distribution 
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(other than any balance carried over to such 
plan year and determined without regard to any 
decrease in such balance during such portion of 
the plan year).’’. 
(c) CONVERSION
TO HSA-COMPATIBLE ARRANGE-
MENT
FOR
REMAINDER
OF
PLAN
YEAR.—Section 
223(c)(1)(B)(iii) of such Code, as amended by section 
5(a), is amended to read as follows: 
‘‘(iii) coverage under a health flexible 
spending arrangement or health reimburse-
ment arrangement for the portion of the 
plan year after a qualified HSA distribu-
tion (as defined in section 106(e)(2) deter-
mined without regard to subparagraph 
(A)(ii) thereof) is made, if the terms of 
such arrangement which apply for such 
portion of the plan year are such that, if 
such terms applied for the entire plan 
year, then such arrangement would not be 
taken into account under subparagraph 
(A)(ii) of this paragraph for such plan 
year, and’’. 
(d) INCLUSION OF QUALIFIED HSA DISTRIBUTIONS 
ON W–2.— 
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(1) IN
GENERAL.—Section 6051(a) of such 
Code, as amended by section 3(d), is amended by 
striking ‘‘and’’ at the end of paragraph (17), by 
striking the period at the end of paragraph (18) and 
inserting ‘‘, and’’, and by inserting after paragraph 
(18) the following new paragraph: 
‘‘(19) the amount of any qualified HSA dis-
tribution (as defined in section 106(e)(2)) with re-
spect to such employee.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
6051(a)(12) of such Code is amended by inserting 
‘‘(other than any qualified HSA distribution, as de-
fined in section 106(e)(2))’’ before the comma at the 
end. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to distributions made after Decem-
ber 31, 2018, in taxable years ending after such date. 
SEC. 7. INCLUSION OF CERTAIN OVER-THE-COUNTER MED-
ICAL PRODUCTS AS QUALIFIED MEDICAL EX-
PENSES. 
(a) HSAS.—Section 223(d)(2) of the Internal Rev-
enue Code of 1986 is amended— 
(1) by striking the last sentence of subpara-
graph (A) and inserting the following: ‘‘For pur-
poses of this subparagraph, amounts paid for men-
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strual care products shall be treated as paid for 
medical care.’’, and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(D) MENSTRUAL
CARE
PRODUCT.—For 
purposes of this paragraph, the term ‘menstrual 
care product’ means a tampon, pad, liner, cup, 
sponge, or similar product used by women with 
respect to menstruation or other genital-tract 
secretions.’’. 
(b) ARCHER MSAS.—Section 220(d)(2)(A) of such 
Code is amended by striking the last sentence and insert-
ing the following: ‘‘For purposes of this subparagraph, 
amounts paid for menstrual care products (as defined in 
section 223(d)(2)(D)) shall be treated as paid for medical 
care.’’. 
(c) HEALTH FLEXIBLE SPENDING ARRANGEMENTS 
AND HEALTH REIMBURSEMENT ARRANGEMENTS.—Sec-
tion 106 of such Code is amended by striking subsection 
(f) and inserting the following new subsection: 
‘‘(f) REIMBURSEMENTS
FOR
MENSTRUAL
CARE 
PRODUCTS.—For purposes of this section and section 
105, expenses incurred for menstrual care products (as 
defined in section 223(d)(2)(D)) shall be treated as in-
curred for medical care.’’. 
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(d) EFFECTIVE DATES.— 
(1) DISTRIBUTIONS FROM HEALTH SAVINGS AC-
COUNTS.—The amendments made by subsections (a) 
and (b) shall apply to amounts paid after December 
31, 2018. 
(2) REIMBURSEMENTS.—The amendment made 
by subsection (c) shall apply to expenses incurred 
after December 31, 2018. 
SEC. 8. CERTAIN AMOUNTS PAID FOR PHYSICAL ACTIVITY, 
FITNESS, 
AND 
EXERCISE 
TREATED 
AS 
AMOUNTS PAID FOR MEDICAL CARE. 
(a) IN GENERAL.—Section 213(d)(1) of the Internal 
Revenue Code of 1986 is amended by striking ‘‘or’’ at the 
end of subparagraph (C), by striking the period at the end 
of subparagraph (D) and inserting ‘‘, or’’, and by adding 
at the end the following new subparagraph: 
‘‘(E) for qualified sports and fitness ex-
penses.’’. 
(b) QUALIFIED SPORTS AND FITNESS EXPENSES.— 
Section 213(d) of such Code is amended by adding at the 
end the following paragraph: 
‘‘(12) QUALIFIED
SPORTS
AND
FITNESS
EX-
PENSES.— 
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‘‘(A) IN
GENERAL.—The term ‘qualified 
sports and fitness expenses’ means amounts 
paid for— 
‘‘(i) membership at a fitness facility, 
‘‘(ii) participation or instruction in a 
program of qualified physical activity, or 
‘‘(iii) safety equipment for use in a 
program (including a self-directed pro-
gram) of qualified physical activity. 
‘‘(B) LIMITATIONS.— 
‘‘(i) OVERALL DOLLAR LIMITATION.— 
The aggregate amount treated as qualified 
sports and fitness expenses with respect to 
any taxpayer for any taxable year shall not 
exceed $500 (twice such amount in the 
case of a joint return or a head of house-
hold (as defined in section 2(b))). 
‘‘(ii) DOLLAR LIMITATION ON SAFETY 
EQUIPMENT.—The 
amount 
treated 
as 
qualified sports and fitness expenses with 
respect to any item of safety equipment de-
scribed in subparagraph (A)(iii) shall not 
exceed $250. 
‘‘(iii) EXCLUSION OF EXERCISE VID-
EOS, ETC.—Qualified sports and fitness ex-
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penses shall not include videos, books, or 
similar materials. 
‘‘(C) QUALIFIED
PHYSICAL
ACTIVITY.— 
For purposes of this paragraph— 
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), the term ‘qualified 
physical activity’ means any physical exer-
cise or physical activity. 
‘‘(ii) EXCLUSIONS.—The Secretary, 
after consultation with the Secretary of 
Health and Human Services, shall issue 
guidance to determine for purposes of this 
paragraph what does not constitute a 
qualified physical activity, including golf, 
hunting, sailing, horseback riding, and 
other similar activities. 
‘‘(D) FITNESS
FACILITY
DEFINED.—For 
purposes of subparagraph (A)(i), the term ‘fit-
ness facility’ means a facility— 
‘‘(i) providing instruction in a pro-
gram of qualified physical activity or facili-
ties for qualified physical activity, 
‘‘(ii) which is not a private club owned 
and operated by its members, 
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‘‘(iii) whose health or fitness facility is 
not incidental to its overall function and 
purpose, and 
‘‘(iv) which is fully compliant with ap-
plicable State and Federal anti-discrimina-
tion laws. 
‘‘(E) PROGRAMS WHICH INCLUDE COMPO-
NENTS
OTHER
QUALIFIED
PHYSICAL
ACTIV-
ITY.—Rules similar to the rules of paragraph 
(6) shall apply in the case of any program or 
facility that includes qualified physical activity 
(or facilities therefore) and also other compo-
nents. For purposes of the preceding sentence, 
travel and accommodations shall be treated as 
an other component. 
‘‘(F) INFLATION
ADJUSTMENT.—In the 
case of any taxable year beginning in a calendar 
year after 2019, the $500 amount in subpara-
graph (B)(i) and the $250 amount in subpara-
graph (B)(ii) shall each be increased by an 
amount equal to— 
‘‘(i) such dollar amount, multiplied by 
‘‘(ii) the cost-of-living adjustment de-
termined under section 1(f)(3) for the cal-
endar year in which such taxable year be-
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gins, determined by substituting ‘calendar 
year 2018’ for ‘calendar year 2016’ in sub-
paragraph (A)(ii) thereof. 
If any increase determined under the preceding 
sentence is not a multiple of $10, such increase 
shall be rounded to the next lowest multiple of 
$10.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2018. 
Passed the House of Representatives July 25, 2018. 
Attest: 
KAREN L. HAAS, 
Clerk. 
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