I 118TH CONGRESS 1ST SESSION H. R. 3029 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, and for other purposes. IN THE HOUSE OF REPRESENTATIVES APRIL 28, 2023 Mr. SMUCKER (for himself, Mr. BLUMENAUER, Ms. TENNEY, and Mr. SCHNEIDER) 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 allow indi- viduals with direct primary care service arrangements to remain eligible individuals for purposes of health sav- ings accounts, and for other purposes. 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 2023’’. 5 VerDate Sep 11 2014 03:20 May 12, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3029.IH H3029 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 3029 IH SEC. 2. TREATMENT OF DIRECT PRIMARY CARE SERVICE 1 ARRANGEMENTS. 2 (a) IN GENERAL.—Section 223(c)(1) of the Internal 3 Revenue Code of 1986 is amended by adding at the end 4 the following new subparagraph: 5 ‘‘(E) TREATMENT OF DIRECT PRIMARY 6 CARE SERVICE ARRANGEMENTS.— 7 ‘‘(i) IN GENERAL.—A direct primary 8 care service arrangement shall not be 9 treated as a health plan for purposes of 10 subparagraph (A)(ii). 11 ‘‘(ii) DIRECT PRIMARY CARE SERVICE 12 ARRANGEMENT.—For purposes of this 13 paragraph— 14 ‘‘(I) IN GENERAL.—The term ‘di- 15 rect primary care service arrange- 16 ment’ means, with respect to any indi- 17 vidual, an arrangement under which 18 such individual is provided medical 19 care (as defined in section 213(d)) 20 consisting solely of primary care serv- 21 ices provided by primary care practi- 22 tioners (as defined in section 23 1833(x)(2)(A) of the Social Security 24 Act, determined without regard to 25 clause (ii) thereof), if the sole com- 26 VerDate Sep 11 2014 03:20 May 12, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3029.IH H3029 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 3029 IH 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, 22 ‘‘(II) prescription drugs (other 23 than vaccines), and 24 VerDate Sep 11 2014 03:20 May 12, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3029.IH H3029 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 3029 IH ‘‘(III) laboratory services not 1 typically administered in an ambula- 2 tory primary care setting. 3 The Secretary, after consultation with the 4 Secretary of Health and Human Services, 5 shall issue regulations or other guidance 6 regarding the application of this clause.’’. 7 (b) DIRECT PRIMARY CARE SERVICE ARRANGEMENT 8 FEES TREATED AS MEDICAL EXPENSES.—Section 9 223(d)(2)(C) of such Code is amended by striking ‘‘or’’ 10 at the end of clause (iii), by striking the period at the 11 end of clause (iv) and inserting ‘‘, or’’, and by adding at 12 the end the following new clause: 13 ‘‘(v) any direct primary care service 14 arrangement.’’. 15 (c) INFLATION ADJUSTMENT.—Section 223(g)(1) of 16 such Code is amended— 17 (1) by inserting ‘‘, (c)(1)(D)(ii)(II),’’ after 18 ‘‘(b)(2)’’ each place it appears, and 19 (2) in subparagraph (B), by inserting ‘‘and 20 (iii)’’ after ‘‘clause (ii)’’ in clause (i), by striking 21 ‘‘and’’ at the end of clause (i), by striking the period 22 at the end of clause (ii) and inserting ‘‘, and’’, and 23 by inserting after clause (ii) the following new 24 clause: 25 VerDate Sep 11 2014 03:20 May 12, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3029.IH H3029 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 3029 IH ‘‘(iii) in the case of the dollar amount 1 in subsection (c)(1)(D)(ii)(II) for taxable 2 years beginning in calendar years after 3 2024, ‘calendar year 2023’.’’. 4 (d) REPORTING OF DIRECT PRIMARY CARE SERVICE 5 ARRANGEMENT FEES ON W–2.—Section 6051(a) of such 6 Code is amended by striking ‘‘and’’ at the end of para- 7 graph (16), by striking the period at the end of paragraph 8 (17) and inserting ‘‘, and’’, and by inserting after para- 9 graph (17) the following new paragraph: 10 ‘‘(18) in the case of a direct primary care serv- 11 ice arrangement (as defined in section 12 223(c)(1)(D)(ii)) which is provided in connection 13 with employment, the aggregate fees for such ar- 14 rangement for such employee.’’. 15 (e) EFFECTIVE DATE.—The amendments made by 16 this section shall apply to months beginning after Decem- 17 ber 31, 2023, in taxable years ending after such date. 18 Æ VerDate Sep 11 2014 03:20 May 12, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H3029.IH H3029 pbinns on DSKJLVW7X2PROD with $$_JOB