I 
115TH CONGRESS 
2D SESSION 
H. R. 6310 
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 6, 2018 
Mr. PAULSEN 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 provide 
that direct primary care service arrangements do not 
disqualify deductible health savings account contribu-
tions, and for other purposes. 
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 En-
hancement Act of 2018’’. 
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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 
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)) 
consisting solely of primary care serv-
ices 
(as 
defined 
in 
section 
1833(x)(2)(B) of the Social Security 
Act) provided by primary care practi-
tioners 
(as 
defined 
in 
section 
1833(x)(2)(A) of the Social Security 
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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 
of this paragraph, the term ‘primary care 
services’ shall not include— 
‘‘(I) procedures that require the 
use of general anesthesia, 
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‘‘(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 is amended— 
(1) by striking ‘‘and (c)(2)(A)’’ 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-
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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 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 subsection shall apply to months beginning after De-
cember 31, 2018, in taxable years ending after such date. 
Æ 
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