Direct Primary Care for America Act
Bill: H.R.5157 | Sponsor: Rep. Crenshaw, Dan (R-TX)
Policy area: Taxation

Summary:
Direct Primary Care for America Act
This bill allows participants in health savings accounts to pay for direct primary care service arrangements from such accounts. A direct primary care service arrangement is primary medical care provided by primary care practitioners if the sole compensation for such care is a fixed periodic fee.
The bill allows waivers to states under Medicaid to provide direct primary care to low-income Medicaid recipients.
The bill also allows health care facilities to participate in the National Health Service Corps Scholarship or Loan Repayment Program if they offer direct primary care service arrangements and are in a health professional shortage area.

To facilitate direct primary care arrangements.

    Be it enacted by the Senate and House of Representatives 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 hospitalizations.
            (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 satisfaction, 
        physician engagement, and better patient outcomes.
            (4) Direct primary care is able to achieve physician 
        compliance.
            (5) The model of direct primary care can change patient 
        usage patterns, with more personalized, home-based preventative 
        care versus high-acuity 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 population 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:
                    ``(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 
                        subparagraph--
                                    ``(I) In general.--The term `direct 
                                primary care service arrangement' 
                                means, with respect to any individual, 
                                an arrangement under which such 
                                individual is provided medical care (as 
                                defined in section 213(d)) consisting 
                                solely of primary care services 
                                provided by primary care practitioners 
                                (as defined in section 1833(x)(2)(A) of 
                                the Social Security Act, determined 
                                without regard to clause (ii) thereof), 
                                if the sole compensation for such care 
                                is a fixed periodic fee.
                                    ``(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 subparagraph, 
                        the term `primary care services' shall not 
                        include--
                                    ``(I) procedures that require the 
                                use of general anesthesia, and
                                    ``(II) 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) 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 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 employee.''.
    (e) Effective Date.--The amendments made by this section shall 
apply to months beginning after December 31, 2020, in taxable years 
ending after such date.

SEC. 4. PROVIDING FOR STATE APPROVAL AND IMPLEMENTATION 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 
                application'' 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 demonstration project 
        undertaken under subsection (a) may be approved or renewed by a 
        State if such project is described 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 participate 
                are furnished with primary care services (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 renewal 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.

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 Arrangements 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 Congress.

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 PRIMARY 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 pursuant to the National Health Service Corps 
Scholarship Program or National Health Service Corps Loan Repayment 
Program if such entity--
            (1) offers direct primary care service arrangements (as 
        defined in section 223(c)(1)(D) of the Internal Revenue Code of 
        1986); and
            (2) is in a health professional shortage area (as defined 
        in section 331(a) of the Public Health Service Act (42 U.S.C. 
        254d(a))).
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