,i  #aafth ,,congress  #b;d ,session    
,h4 ,r4 #hdag  ,,in ,,the ,,house ,,of  
,,representatives  ,september #bi1      
#bjbj,mr4 ,crenshaw introduced the      
following bill2 which was referred to   
the ,committee on ,ways and ,means1 and 
in addition to the ,committees on       
,energy and ,commerce1 and ,education   
and ,labor1 for a period to be          
subsequently determined by the ,speaker1
 in each case for consideration of such 
provisions as fall within the           
jurisdiction of the committee concerned 
,a ,,bill  ,to facilitate direct primary
 care arrangements4  #a4 ,short title   
,this ,act may be cited as the ,direct  
,primary ,care for ,america ,act4  #b4  
,findings ,congress finds as follows3   
7#a7 ,primary care services are able to 
reduce healthcare costs1 emergency room 
visits1 and hospitalizations4  7#b7     
,health systems that invest in primary  
care services are able to realign       
incentives in order to focus on         
proactive interventions to achieve      

results and population health4  7#c7    
,primary care creates increased patient 
satisfaction1 physician engagement1 and 
better patient outcomes4  7#d7 ,direct  
primary care is able to achieve         
physician compliance4  7#e7 ,the model  
of direct primary care can change       
patient usage patterns1 with more       
personalized1 home-based preventative   
care versus high-acuity episodic care4  
7#f7 ,direct primary care medical homes 
are able to incorporate community health
 via a collaborative model approach4    
7#g7 ,direct primary care can be used   
with population health platforms to     
develop a plan of care and proposed     
wellness outcomes4  #c4 ,treatment of   
direct primary care service arrangements
 for purposes of health savings account 
7a7 ,in general ,section #bbc7;c77#a7 of
 the ,internal ,revenue ,code of #aihf  
is amended by adding at the end the     
following new subparagraph3  7,d7       
,treatment of direct primary care       
service arrangements  7i7 ,in general ,a

 direct primary care service arrangement
 shall not be treated as a health plan  
for purposes of subparagraph 7,a77ii74  
7ii7 ,direct primary care service       
arrangement ,for purposes of this       
subparagraph-- 7,i7 ,in general ,the    
term direct primary care service        
arrangement means1 with respect to any  
individual1 an arrangement under which  
such individual is provided medical care
 7as defined in section #bac7;d77       
consisting solely of primary care       
services provided by primary care       
practitioners 7as defined in section    
#ahcc7x77#b77;,a7 of the ,social        
,security ,act1 determined without      
regard to clause 7ii7 thereof71 if the  
sole compensation for such care is a    
fixed periodic fee4  7,,ii7 ,limitation 
,with respect to any individual for any 
month1 such term shall not include any  
arrangement if the aggregate fees for   
all direct primary care service         
arrangements 7determined without regard 
to this subclause7 with respect to such 

individual for such month exceed #aej   
7twice such dollar amount in the case of
 an individual with any direct primary  
care service arrangement 7as so         
determined7 that covers more than one   
individual74  7iii7 ,certain services   
specifically excluded from treatment as 
primary care services ,for purposes of  
this subparagraph1 the term primary care
 services shall not include-- 7,i7      
procedures that require the use of      
general anesthesia1 and  7,,ii7         
laboratory services not typically       
administered in an ambulatory primary   
care setting4  ,the ,secretary1 after   
consultation with the ,secretary of     
,health and ,human ,services1 shall     
issue regulations or other guidance     
regarding the application of this       
clause4  4  7b7 ,direct primary care    
service arrangement fees treated as     
medical expenses ,section               
#bbc7;d77#b77;,c7 of such ,code is      
amended by striking or at the end of    
clause 7iii71 by striking the period at 

the end of clause 7iv7 and inserting 1  
or1 and by adding at the end the        
following new clause3  7v7 any direct   
primary care service arrangement4  4    
7c7 ,inflation adjustment ,section      
#bbc7;g77#a7 of such ,code is amended-- 
7#a7 by inserting 1                     
7c77#a77;,d77ii77,,ii71 after 7b77#b71  
each place such term appears2 and  7#b7 
in subparagraph 7,b71 by inserting and  
7iii7 after clause 7ii7 in clause 7i71  
by striking and at the end of clause    
7i71 by striking the period at the end  
of clause 7ii7 and inserting 1 and1 and 
by inserting after clause 7ii7 the      
following new clause3  7iii7 in the case
 of the dollar amount in subsection     
7c77#a77;,d77ii77,,ii7 for taxable years
 beginning in calendar years after      
#bjbj1 calendar year #bjai4  4  7d7     
,reporting of direct primary care       
service arrangement fees on ,w-#b       
,section #fjea7;a7 of such ,code is     
amended by striking and at the end of   
paragraph 7#af71 by striking the period 

at the end of paragraph 7#ag7 and       
inserting 1 and1 and by inserting after 
paragraph 7#ag7 the following new       
paragraph3  7#ah7 in the case of a      
direct primary care service arrangement 
7as defined in section                  
#bbc7;c77#a77;,d77ii77 which is provided
 in connection with employment1 the     
aggregate fees for such arrangement for 
such employee4  4  7e7 ,effective date  
,the amendments made by this section    
shall apply to months beginning after   
,december #ca1 #bjai1 in taxable years  
ending after such date4  #d4 ,providing 
for ,state approval and implementation  
of specified waivers under the ,medicaid
 program ,section #aaae of the ,social  
,security ,act 7#db ,u4,s4,c4 #acae7 is 
amended-- 7#a7 in subsection 7d7-- 7,a7 
in paragraph 7#a71 by striking ,an      
application and inserting ,subject to   
paragraph 7#d71 an application2 and     
7,b7 by adding at the end the following 
new paragraph3  7#d7 7,a7 ,an           
experimental1 pilot1 or demonstration   

project undertaken under subsection 7a7 
may be approved or renewed by a ,state  
if such project is described in         
subparagraph 7,b74  7,b7 ,an            
experimental1 pilot1 or demonstration   
project is described in this            
subparagraph if such project provides   
for a waiver of requirements with       
respect to a ,state plan 7or a waiver of
 such plan7 under title ,,xix such      
that-- 7i7 individuals enrolled under   
such plan 7or such waiver7 may elect to 
participate in such project with respect
 to a year2 and  7ii7 such individuals  
who elect to so participate are         
furnished with primary care services 7as
 described in section                   
#bbc7;c77#a77;,d77ii77,i7 of the        
,internal ,revenue ,code of #aihf7      
through a direct primary care service   
arrangement 7as defined in such         
section74  7,c7 ,for purposes of a      
,state's approval or renewal of an      
experimental1 pilot1 or demonstration   
project under subparagraph 7,a71 each   

reference to the ,secretary in          
subsection 7a7 shall be deemed to be a  
reference to the ,state4  2 and  7#b7 in
 subsection 7e71 by inserting 7other    
than such a project that is described in
 paragraph 7#d77;,b77 before the period 
at the end4  #e4 ,health reimbursement  
arrangements and other account-based    
group health plans ,the final rule of   
the ,secretary of the ,treasury1 the    
,secretary of ,labor1 and the ,secretary
 of ,health and ,human ,services1 titled
 ,health ,reimbursement ,arrangements   
and ,other ,account-,based ,group       
,health ,plans and published in the     
,federal ,register on ,june #bj1 #bjai  
7#hd ,fed4 ,reg4 #bhhhh71 shall have the
 same force and effect of law as if such
 rule had been enacted by an ,act of    
,congress4  #f4 ,sense of ,congress ,it 
is the sense of ,congress that          
organizations offering ,medicare        
,advantage plans under part ,c of title 
,,xviii of the ,social ,security ,act   
7#db ,u4,s4,c4 #aciew-#ba et seq47      

should expand the offering of ,,msa     
plans 7as defined in section            
#ahei7;b77#c7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #aciew-#bh7;b77#c777
 under such part4  #g4 ,eligibility of  
entities that offer direct primary care 
service arrangements in certain         
,national ,health ,service ,corps       
programs ,notwithstanding subpart ,,ii  
or ,,iii of part ,d of title ,,iii of   
the ,public ,health ,service ,act 7#db  
,u4,s4,c4 #bed;d et seq471 an entity    
shall be eligible for assignment of one 
or more individuals performing a period 
of obligated service pursuant to the    
,national ,health ,service ,corps       
,scholarship ,program or ,national      
,health ,service ,corps ,loan ,repayment
 ,program if such entity-- 7#a7 offers  
direct primary care service arrangements
 7as defined in section                 
#bbc7;c77#a77;,d7 of the ,internal      
,revenue ,code of #aihf72 and  7#b7 is  
in a health professional shortage area  
7as defined in section #cca7;a7 of the  

,public ,health ,service ,act 7#db      
,u4,s4,c4 #bed;d7a7774