I 
117TH CONGRESS 
1ST SESSION H. R. 5157 
To facilitate direct primary care arrangements. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 3, 2021 
Mr. CRENSHAW introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committees on Energy 
and Commerce, and Education and Labor, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To facilitate direct primary care arrangements. 
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 ‘‘Direct Primary Care 
for America Act’’. 
SEC. 2. FINDINGS. 
Congress finds as follows: 
(1) Primary care services are able to reduce 
healthcare costs, emergency room visits, and hos-
pitalizations. 
VerDate Sep 11 2014 
21:38 Sep 08, 2021
Jkt 019200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H5157.IH
H5157
pamtmann on DSKBC07HB2PROD with BILLS
(2) Health systems that invest in primary care 
services are able to realign incentives in order to 
focus on proactive interventions to achieve results 
and population health. 
(3) Primary care creates increased patient sat-
isfaction, physician engagement, and better patient 
outcomes. 
(4) Direct primary care is able to achieve physi-
cian compliance. 
(5) The model of direct primary care can 
change patient usage patterns, with more personal-
ized, home-based preventative care versus high-acu-
ity episodic care. 
(6) Direct primary care medical homes are able 
to incorporate community health via a collaborative 
model approach. 
(7) Direct primary care can be used with popu-
lation health platforms to develop a plan of care and 
proposed wellness outcomes. 
SEC. 3. TREATMENT OF DIRECT PRIMARY CARE SERVICE 
ARRANGEMENTS FOR PURPOSES OF HEALTH 
SAVINGS ACCOUNT. 
(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: 
VerDate Sep 11 2014 
21:38 Sep 08, 2021
Jkt 019200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5157.IH
H5157
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(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 sub-
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 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 
VerDate Sep 11 2014 
21:38 Sep 08, 2021
Jkt 019200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5157.IH
H5157
pamtmann on DSKBC07HB2PROD with BILLS
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 subparagraph, the term ‘primary 
care services’ shall not include— 
‘‘(I) procedures that require the 
use of general anesthesia, and 
‘‘(II) laboratory services not typi-
cally 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.’’. 
VerDate Sep 11 2014 
21:38 Sep 08, 2021
Jkt 019200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5157.IH
H5157
pamtmann on DSKBC07HB2PROD with BILLS
(b) DIRECT PRIMARY CARE SERVICE ARRANGEMENT 
FEES
TREATED
AS
MEDICAL
EXPENSES.—Section 
223(d)(2)(C) of such Code 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— 
(1) by inserting ‘‘, (c)(1)(D)(ii)(II),’’ after 
‘‘(b)(2),’’ each place such term appears; and 
(2) in subparagraph (B), by inserting ‘‘and 
(iii)’’ after ‘‘clause (ii)’’ 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 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 
2021, ‘calendar year 2020’.’’. 
(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-
VerDate Sep 11 2014 
21:38 Sep 08, 2021
Jkt 019200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H5157.IH
H5157
pamtmann on DSKBC07HB2PROD with BILLS
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, 2020, in taxable years ending after such date. 
SEC. 4. PROVIDING FOR STATE APPROVAL AND IMPLEMEN-
TATION OF SPECIFIED WAIVERS UNDER THE 
MEDICAID PROGRAM. 
Section 1115 of the Social Security Act (42 U.S.C. 
1315) is amended— 
(1) in subsection (d)— 
(A) in paragraph (1), by striking ‘‘An ap-
plication’’ and inserting ‘‘Subject to paragraph 
(4), an application’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(4)(A) An experimental, pilot, or demonstra-
tion project undertaken under subsection (a) may be 
VerDate Sep 11 2014 
21:38 Sep 08, 2021
Jkt 019200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H5157.IH
H5157
pamtmann on DSKBC07HB2PROD with BILLS
approved or renewed by a State if such project is de-
scribed in subparagraph (B). 
‘‘(B) An experimental, pilot, or demonstration 
project is described in this subparagraph if such 
project provides for a waiver of requirements with 
respect to a State plan (or a waiver of such plan) 
under title XIX such that— 
‘‘(i) individuals enrolled under such plan 
(or such waiver) may elect to participate in 
such project with respect to a year; and 
‘‘(ii) such individuals who elect to so par-
ticipate are furnished with primary care serv-
ices (as described in section 223(c)(1)(D)(ii)(I) 
of the Internal Revenue Code of 1986) through 
a direct primary care service arrangement (as 
defined in such section). 
‘‘(C) For purposes of a State’s approval or re-
newal of an experimental, pilot, or demonstration 
project under subparagraph (A), each reference to 
‘the Secretary’ in subsection (a) shall be deemed to 
be a reference to ‘the State’.’’; and 
(2) in subsection (e), by inserting ‘‘(other than 
such a project that is described in paragraph 
(4)(B))’’ before the period at the end. 
VerDate Sep 11 2014 
21:38 Sep 08, 2021
Jkt 019200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H5157.IH
H5157
pamtmann on DSKBC07HB2PROD with BILLS
SEC. 5. HEALTH REIMBURSEMENT ARRANGEMENTS AND 
OTHER 
ACCOUNT-BASED 
GROUP 
HEALTH 
PLANS. 
The final rule of the Secretary of the Treasury, the 
Secretary of Labor, and the Secretary of Health and 
Human Services, titled ‘‘Health Reimbursement Arrange-
ments and Other Account-Based Group Health Plans’’ 
and published in the Federal Register on June 20, 2019 
(84 Fed. Reg. 28888), shall have the same force and effect 
of law as if such rule had been enacted by an Act of Con-
gress. 
SEC. 6. SENSE OF CONGRESS. 
It is the sense of Congress that organizations offering 
Medicare Advantage plans under part C of title XVIII of 
the Social Security Act (42 U.S.C. 1395w–21 et seq.) 
should expand the offering of MSA plans (as defined in 
section 1859(b)(3) of the Social Security Act (42 U.S.C. 
1395w–28(b)(3))) under such part. 
SEC. 7. ELIGIBILITY OF ENTITIES THAT OFFER DIRECT PRI-
MARY CARE SERVICE ARRANGEMENTS IN 
CERTAIN NATIONAL HEALTH SERVICE CORPS 
PROGRAMS. 
Notwithstanding subpart II or III of part D of title 
III of the Public Health Service Act (42 U.S.C. 254d et 
seq.), an entity shall be eligible for assignment of one or 
more individuals performing a period of obligated service 
VerDate Sep 11 2014 
21:38 Sep 08, 2021
Jkt 019200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H5157.IH
H5157
pamtmann on DSKBC07HB2PROD with BILLS
pursuant to the National Health Service Corps Scholar-
ship Program or National Health Service Corps Loan Re-
payment Program if such entity— 
(1) offers direct primary care service arrange-
ments (as defined in section 223(c)(1)(D) of the In-
ternal Revenue Code of 1986); and 
(2) is in a health professional shortage area (as 
defined in section 331(a) of the Public Health Serv-
ice Act (42 U.S.C. 254d(a))). 
Æ 
VerDate Sep 11 2014 
21:38 Sep 08, 2021
Jkt 019200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6301
E:\BILLS\H5157.IH
H5157
pamtmann on DSKBC07HB2PROD with BILLS