Title: Primary Care Enhancement Act of 2018
Policy area: Taxation

Summary:
This bill amends the Internal Revenue Code to: (1) allow individuals who are eligible for a health savings account (HSA) to participate in a direct primary care service arrangement without losing their eligibility due to the arrangement, and (2) permit an HSA to be used to pay for a direct primary care service arrangement.
Under a direct primary care service arrangement, an individual receives medical care consisting solely of primary care services provided by primary care practitioners in exchange for a fixed periodic fee. The fees are subject to limits specified in the bill.
The primary care services covered by the arrangement may not include procedures that require the use of general anesthesia, prescription drugs (other than vaccines), and laboratory services not typically administered in an ambulatory primary care setting.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6317 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 6317

   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

_______________________________________________________________________

                                 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 contributions, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. 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 `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 (as 
                                defined in section 1833(x)(2)(B) of the 
                                Social Security Act) 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 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 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) 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 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 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 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 employee.''.
    (e) Effective Date.--The amendments made by this subsection shall 
apply to months beginning after December 31, 2018, in taxable years 
ending after such date.
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