Direct Primary Care for America Act

I 116TH CONGRESS 2D SESSION H. R. 8417 To facilitate direct primary care arrangements. IN THE HOUSE OF REPRESENTATIVES SEPTEMBER 29, 2020 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- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Direct Primary Care 4 for America Act’’. 5 SEC. 2. FINDINGS. 6 Congress finds as follows: 7 (1) Primary care services are able to reduce 8 healthcare costs, emergency room visits, and hos- 9 pitalizations. 10 VerDate Sep 11 2014 19:57 Oct 22, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H8417.IH H8417 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 8417 IH (2) Health systems that invest in primary care 1 services are able to realign incentives in order to 2 focus on proactive interventions to achieve results 3 and population health. 4 (3) Primary care creates increased patient sat- 5 isfaction, physician engagement, and better patient 6 outcomes. 7 (4) Direct primary care is able to achieve physi- 8 cian compliance. 9 (5) The model of direct primary care can 10 change patient usage patterns, with more personal- 11 ized, home-based preventative care versus high-acu- 12 ity episodic care. 13 (6) Direct primary care medical homes are able 14 to incorporate community health via a collaborative 15 model approach. 16 (7) Direct primary care can be used with popu- 17 lation health platforms to develop a plan of care and 18 proposed wellness outcomes. 19 SEC. 3. TREATMENT OF DIRECT PRIMARY CARE SERVICE 20 ARRANGEMENTS FOR PURPOSES OF HEALTH 21 SAVINGS ACCOUNT. 22 (a) IN GENERAL.—Section 223(c)(1) of the Internal 23 Revenue Code of 1986 is amended by adding at the end 24 the following new subparagraph: 25 VerDate Sep 11 2014 19:57 Oct 22, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H8417.IH H8417 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 8417 IH ‘‘(D) TREATMENT OF DIRECT PRIMARY 1 CARE SERVICE ARRANGEMENTS.— 2 ‘‘(i) IN GENERAL.—A direct primary 3 care service arrangement shall not be 4 treated as a health plan for purposes of 5 subparagraph (A)(ii). 6 ‘‘(ii) DIRECT PRIMARY CARE SERVICE 7 ARRANGEMENT.—For purposes of this sub- 8 paragraph— 9 ‘‘(I) IN GENERAL.—The term ‘di- 10 rect primary care service arrange- 11 ment’ means, with respect to any indi- 12 vidual, an arrangement under which 13 such individual is provided medical 14 care (as defined in section 213(d)) 15 consisting solely of primary care serv- 16 ices provided by primary care practi- 17 tioners (as defined in section 18 1833(x)(2)(A) of the Social Security 19 Act, determined without regard to 20 clause (ii) thereof), if the sole com- 21 pensation for such care is a fixed peri- 22 odic fee. 23 ‘‘(II) LIMITATION.—With respect 24 to any individual for any month, such 25 VerDate Sep 11 2014 19:57 Oct 22, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H8417.IH H8417 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 8417 IH term shall not include any arrange- 1 ment if the aggregate fees for all di- 2 rect primary care service arrange- 3 ments (determined without regard to 4 this subclause) with respect to such 5 individual for such month exceed 6 $150 (twice such dollar amount in the 7 case of an individual with any direct 8 primary care service arrangement (as 9 so determined) that covers more than 10 one individual). 11 ‘‘(iii) CERTAIN SERVICES SPECIFI- 12 CALLY EXCLUDED FROM TREATMENT AS 13 PRIMARY CARE SERVICES.—For purposes 14 of this subparagraph, the term ‘primary 15 care services’ shall not include— 16 ‘‘(I) procedures that require the 17 use of general anesthesia, and 18 ‘‘(II) laboratory services not typi- 19 cally administered in an ambulatory 20 primary care setting. 21 The Secretary, after consultation with the 22 Secretary of Health and Human Services, 23 shall issue regulations or other guidance 24 regarding the application of this clause.’’. 25 VerDate Sep 11 2014 19:57 Oct 22, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8417.IH H8417 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 8417 IH (b) DIRECT PRIMARY CARE SERVICE ARRANGEMENT 1 FEES TREATED AS MEDICAL EXPENSES.—Section 2 223(d)(2)(C) of such Code is amended by striking ‘‘or’’ 3 at the end of clause (iii), by striking the period at the 4 end of clause (iv) and inserting ‘‘, or’’, and by adding at 5 the end the following new clause: 6 ‘‘(v) any direct primary care service 7 arrangement.’’. 8 (c) INFLATION ADJUSTMENT.—Section 223(g)(1) of 9 such Code is amended— 10 (1) by inserting ‘‘, (c)(1)(D)(ii)(II),’’ after 11 ‘‘(b)(2),’’ each place such term appears; and 12 (2) in subparagraph (B), by inserting ‘‘and 13 (iii)’’ after ‘‘clause (ii)’’ in clause (i), by striking 14 ‘‘and’’ at the end of clause (i), by striking the period 15 at the end of clause (ii) and inserting ‘‘, and’’, and 16 by inserting after clause (ii) the following new 17 clause: 18 ‘‘(iii) in the case of the dollar amount 19 in subsection (c)(1)(D)(ii)(II) for taxable 20 years beginning in calendar years after 21 2020, ‘calendar year 2019’.’’. 22 (d) REPORTING OF DIRECT PRIMARY CARE SERVICE 23 ARRANGEMENT FEES ON W–2.—Section 6051(a) of such 24 Code is amended by striking ‘‘and’’ at the end of para- 25 VerDate Sep 11 2014 02:27 Oct 25, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8417.IH H8417 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 8417 IH graph (16), by striking the period at the end of paragraph 1 (17) and inserting ‘‘, and’’, and by inserting after para- 2 graph (17) the following new paragraph: 3 ‘‘(18) in the case of a direct primary care serv- 4 ice arrangement (as defined in section 5 223(c)(1)(D)(ii)) which is provided in connection 6 with employment, the aggregate fees for such ar- 7 rangement for such employee.’’. 8 (e) EFFECTIVE DATE.—The amendments made by 9 this section shall apply to months beginning after Decem- 10 ber 31, 2019, in taxable years ending after such date. 11 SEC. 4. PROVIDING FOR STATE APPROVAL AND IMPLEMEN- 12 TATION OF SPECIFIED WAIVERS UNDER THE 13 MEDICAID PROGRAM. 14 Section 1115 of the Social Security Act (42 U.S.C. 15 1315) is amended— 16 (1) in subsection (d)— 17 (A) in paragraph (1), by striking ‘‘An ap- 18 plication’’ and inserting ‘‘Subject to paragraph 19 (4), an application’’; and 20 (B) by adding at the end the following new 21 paragraph: 22 ‘‘(4)(A) An experimental, pilot, or demonstra- 23 tion project undertaken under subsection (a) may be 24 VerDate Sep 11 2014 19:57 Oct 22, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8417.IH H8417 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 8417 IH approved or renewed by a State if such project is de- 1 scribed in subparagraph (B). 2 ‘‘(B) An experimental, pilot, or demonstration 3 project is described in this subparagraph if such 4 project provides for a waiver of requirements with 5 respect to a State plan (or a waiver of such plan) 6 under title XIX such that— 7 ‘‘(i) individuals enrolled under such plan 8 (or such waiver) may elect to participate in 9 such project with respect to a year; and 10 ‘‘(ii) such individuals who elect to so par- 11 ticipate are furnished with primary care serv- 12 ices (as described in section 223(c)(1)(D)(ii)(I) 13 of the Internal Revenue Code of 1986) through 14 a direct primary care service arrangement (as 15 defined in such section). 16 ‘‘(C) For purposes of a State’s approval or re- 17 newal of an experimental, pilot, or demonstration 18 project under subparagraph (A), each reference to 19 ‘the Secretary’ in subsection (a) shall be deemed to 20 be a reference to ‘the State’.’’; and 21 (2) in subsection (e), by inserting ‘‘(other than 22 such a project that is described in paragraph 23 (4)(B))’’ before the period at the end. 24 VerDate Sep 11 2014 02:27 Oct 25, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H8417.IH H8417 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 8417 IH SEC. 5. HEALTH REIMBURSEMENT ARRANGEMENTS AND 1 OTHER ACCOUNT-BASED GROUP HEALTH 2 PLANS. 3 The final rule of the Secretary of the Treasury, the 4 Secretary of Labor, and the Secretary of Health and 5 Human Services, titled ‘‘Health Reimbursement Arrange- 6 ments and Other Account-Based Group Health Plans’’ 7 and published in the Federal Register on June 20, 2019 8 (84 Fed. Reg. 28888), shall have the same force and effect 9 of law as if such rule had been enacted by an Act of Con- 10 gress. 11 SEC. 6. SENSE OF CONGRESS. 12 It is the sense of Congress that organizations offering 13 Medicare Advantage plans under part C of title XVIII of 14 the Social Security Act (42 U.S.C. 1395w–21 et seq.) 15 should expand the offering of MSA plans (as defined in 16 section 1859(b)(3) of the Social Security Act (42 U.S.C. 17 1395w–28(b)(3))) under such part. 18 SEC. 7. ELIGIBILITY OF ENTITIES THAT OFFER DIRECT PRI- 19 MARY CARE SERVICE ARRANGEMENTS IN 20 CERTAIN NATIONAL HEALTH SERVICE CORPS 21 PROGRAMS. 22 Notwithstanding subpart II or III of part D of title 23 III of the Public Health Service Act (42 U.S.C. 254d et 24 seq.), an entity shall be eligible for assignment of one or 25 more individuals performing a period of obligated service 26 VerDate Sep 11 2014 19:57 Oct 22, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H8417.IH H8417 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 8417 IH pursuant to the National Health Service Corps Scholar- 1 ship Program or National Health Service Corps Loan Re- 2 payment Program if such entity— 3 (1) offers direct primary care service arrange- 4 ments (as defined in section 223(c)(1)(D) of the In- 5 ternal Revenue Code of 1986); and 6 (2) is in a health professional shortage area (as 7 defined in section 331(a) of the Public Health Serv- 8 ice Act (42 U.S.C. 254d(a))). 9 Æ VerDate Sep 11 2014 19:57 Oct 22, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\H8417.IH H8417 pamtmann on DSKBC07HB2PROD with BILLS