Primary Care Enhancement Act of 2019

II 116TH CONGRESS 1ST SESSION S. 2999 To amend the Internal Revenue Code of 1986 to allow individuals with direct primary care service arrangements to remain eligible individuals for purposes of health savings accounts. IN THE SENATE OF THE UNITED STATES DECEMBER 9, 2019 Mr. CASSIDY (for himself, Mr. JONES, Mr. MORAN, and Mrs. SHAHEEN) in- troduced the following bill; which was read twice and referred to the Com- mittee on Finance A BILL To amend the Internal Revenue Code of 1986 to allow indi- viduals with direct primary care service arrangements to remain eligible individuals for purposes of health sav- ings accounts. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Primary Care En- 4 hancement Act of 2019’’. 5 VerDate Sep 11 2014 04:17 Dec 12, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2999.IS S2999 kjohnson on DSK79L0C42 with BILLS 2 •S 2999 IS SEC. 2. TREATMENT OF DIRECT PRIMARY CARE SERVICE 1 ARRANGEMENTS. 2 (a) IN GENERAL.—Section 223(c)(1) of the Internal 3 Revenue Code of 1986 is amended by adding at the end 4 the following new subparagraph: 5 ‘‘(D) TREATMENT OF DIRECT PRIMARY 6 CARE SERVICE ARRANGEMENTS.— 7 ‘‘(i) IN GENERAL.—A direct primary 8 care service arrangement shall not be 9 treated as a health plan for purposes of 10 subparagraph (A)(ii). 11 ‘‘(ii) DIRECT PRIMARY CARE SERVICE 12 ARRANGEMENT.—For purposes of this 13 paragraph— 14 ‘‘(I) IN GENERAL.—The term ‘di- 15 rect primary care service arrange- 16 ment’ means, with respect to any indi- 17 vidual, an arrangement under which 18 such individual is provided medical 19 care (as defined in section 213(d)) 20 consisting solely of primary care serv- 21 ices provided by primary care practi- 22 tioners (as defined in section 23 1833(x)(2)(A) of the Social Security 24 Act, determined without regard to 25 clause (ii) thereof), if the sole com- 26 VerDate Sep 11 2014 04:17 Dec 12, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2999.IS S2999 kjohnson on DSK79L0C42 with BILLS 3 •S 2999 IS pensation for such care is a fixed peri- 1 odic fee. 2 ‘‘(II) LIMITATION.—With respect 3 to any individual for any month, such 4 term shall not include any arrange- 5 ment if the aggregate fees for all di- 6 rect primary care service arrange- 7 ments (determined without regard to 8 this subclause) with respect to such 9 individual for such month exceed 10 $150 (twice such dollar amount in the 11 case of an individual with any direct 12 primary care service arrangement (as 13 so determined) that covers more than 14 one individual). 15 ‘‘(iii) CERTAIN SERVICES SPECIFI- 16 CALLY EXCLUDED FROM TREATMENT AS 17 PRIMARY CARE SERVICES.—For purposes 18 of this paragraph, the term ‘primary care 19 services’ shall not include— 20 ‘‘(I) procedures that require the 21 use of general anesthesia, and 22 ‘‘(II) laboratory services not typi- 23 cally administered in an ambulatory 24 primary care setting. 25 VerDate Sep 11 2014 04:17 Dec 12, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2999.IS S2999 kjohnson on DSK79L0C42 with BILLS 4 •S 2999 IS The Secretary, after consultation with the 1 Secretary of Health and Human Services, 2 shall issue regulations or other guidance 3 regarding the application of this clause.’’. 4 (b) DIRECT PRIMARY CARE SERVICE ARRANGEMENT 5 FEES TREATED AS MEDICAL EXPENSES.—Section 6 223(d)(2)(C) is amended by striking ‘‘or’’ at the end of 7 clause (iii), by striking the period at the end of clause (iv) 8 and inserting ‘‘, or’’, and by adding at the end the fol- 9 lowing new clause: 10 ‘‘(v) any direct primary care service arrangement.’’. 11 (c) INFLATION ADJUSTMENT.—Section 223(g)(1) of 12 such Code is amended— 13 (1) by inserting ‘‘, (c)(1)(D)(ii)(II),’’ after 14 ‘‘(b)(2),’’ each place such term appears, and 15 (2) in subparagraph (B), by inserting ‘‘and 16 (iii)’’ after ‘‘clause (ii)’’ in clause (i), by striking 17 ‘‘and’’ at the end of clause (i), by striking the period 18 at the end of clause (ii) and inserting ‘‘, and’’, and 19 by inserting after clause (ii) the following new 20 clause: 21 ‘‘(iii) in the case of the dollar amount 22 in subsection (c)(1)(D)(ii)(II) for taxable 23 years beginning in calendar years after 24 2020, ‘calendar year 2019’.’’. 25 VerDate Sep 11 2014 04:17 Dec 12, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2999.IS S2999 kjohnson on DSK79L0C42 with BILLS 5 •S 2999 IS (d) REPORTING OF DIRECT PRIMARY CARE SERVICE 1 ARRANGEMENT FEES ON W–2.—Section 6051(a) of such 2 Code is amended by striking ‘‘and’’ at the end of para- 3 graph (16), by striking the period at the end of paragraph 4 (17) and inserting ‘‘, and’’, and by inserting after para- 5 graph (17) the following new paragraph: 6 ‘‘(18) in the case of a direct primary care serv- 7 ice arrangement (as defined in section 8 223(c)(1)(D)(ii)) which is provided in connection 9 with employment, the aggregate fees for such ar- 10 rangement for such employee.’’. 11 (e) EFFECTIVE DATE.—The amendments made by 12 this section shall apply to months beginning after Decem- 13 ber 31, 2019, in taxable years ending after such date. 14 Æ VerDate Sep 11 2014 04:17 Dec 12, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\S2999.IS S2999 kjohnson on DSK79L0C42 with BILLS