What This Bill Does
This bill changes federal health insurance rules to say that direct primary care arrangements (a specific type of doctor-patient payment agreement) are not considered health insurance coverage. The bill creates an exception so these arrangements don't have to follow the same rules as regular health insurance.
Who It Affects
Health care providers who offer direct primary care arrangements and individuals who enter into these arrangements with those providers.
Key Provisions
• Direct primary care arrangements must be documented in writing and provided to the individual (or their legal representative) before the arrangement begins (Sec. 2)
• The written agreement must describe what items and services the provider will give in exchange for the direct fee (Sec. 2)
• The written agreement must state the exact direct fee amount and any additional fees that a third party will pay (Sec. 2)
• The written agreement must specify what the individual must pay (Sec. 2)
• Providers cannot charge or receive extra money for items and services that are already included in the direct fee (Sec. 2)
What Changes
Direct primary care arrangements, which include monthly retainers, membership fees, subscription fees, or per-visit fees, will no longer be regulated as health insurance coverage under federal law.
Important Definitions
Direct primary care arrangement: A deal where a health care provider gives items or services to a person in exchange for a direct fee, which can be a monthly retainer, membership fee, subscription fee, or per-service charge.
I
118TH CONGRESS
1ST SESSION
H. R. 633
To amend title XXVII of the Public Health Service Act to exempt certain
direct primary care arrangements from regulation as health insurance
coverage.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 30, 2023
Mr. ROSENDALE introduced the following bill; which was referred to the
Committee on Energy and Commerce
A BILL
To amend title XXVII of the Public Health Service Act
to exempt certain direct primary care arrangements from
regulation as health insurance coverage.
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
Accessibility Act of 2023’’.
5
VerDate Sep 11 2014
04:44 Feb 15, 2023
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H633.IH
H633
kjohnson on DSK79L0C42PROD with BILLS
2
•HR 633 IH
SEC. 2. EXEMPTING CERTAIN DIRECT PRIMARY CARE AR-
1
RANGEMENTS
FROM
REGULATION
AS
2
HEALTH INSURANCE COVERAGE.
3
Section 2791(b) of the Public Health Service Act (42
4
U.S.C. 300gg–91(b)) is amended—
5
(1) in paragraph (1), by inserting ‘‘, except that
6
such term shall not include a direct primary care ar-
7
rangement (as defined in paragraph (6))’’ before the
8
period; and
9
(2) by adding at the end the following new
10
paragraph:
11
‘‘(6) DIRECT PRIMARY CARE ARRANGEMENT.—
12
‘‘(A) IN GENERAL.—Except as provided in
13
subparagraph (B), the term ‘direct primary
14
care arrangement’ means an arrangement
15
under which an item or service is furnished by
16
a health care provider to an individual in return
17
for a direct fee. Such a fee may include—
18
‘‘(i) a monthly retainer;
19
‘‘(ii) a membership fee;
20
‘‘(iii) a subscription fee; or
21
‘‘(iv) a fee for a service, visit, or epi-
22
sode of care.
23
‘‘(B) EXCEPTION.—The term ‘direct pri-
24
mary care arrangement’ shall not include any
25
arrangement unless—
26
VerDate Sep 11 2014
04:44 Feb 15, 2023
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H633.IH
H633
kjohnson on DSK79L0C42PROD with BILLS
3
•HR 633 IH
‘‘(i) a copy of such arrangement is
1
provided to the individual entering into
2
such agreement (or the legal representative
3
of such individual); and
4
‘‘(ii) such agreement—
5
‘‘(I) is in writing;
6
‘‘(II) describes the items and
7
services to be provided in exchange for
8
payment of a direct fee (as described
9
in subparagraph (A));
10
‘‘(III) specifies the direct fee re-
11
quired and any additional fees to be
12
paid by a third party;
13
‘‘(IV) specifies the individual’s
14
payment obligation; and
15
‘‘(V) prohibits the provider from
16
charging or receiving additional com-
17
pensation for items and services in-
18
cluded in the direct fee.’’.
19
Æ
VerDate Sep 11 2014
04:44 Feb 15, 2023
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6301
E:\BILLS\H633.IH
H633
kjohnson on DSK79L0C42PROD with BILLS