,i  #aaf? ,,congress  #b;d ,session  ,h4
 ,r4 #hdag  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,septemb] #bi1        
#bjbj,mr4 ,cr5%aw introduc$ ! foll[+    
bill2 :i* 0 ref]r$ to ! ,committee on   
,ways & ,means1 & 9 addition to !       
,committees on ,en]gy & ,comm]ce1 &     
,education & ,labor1 = a p]iod to be    
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to facilitate      
direct prim>y c>e arrangem5ts4  #a4     
,%ort title ,?is ,act may be cit$ z !   
,direct ,prim>y ,c>e = ,am]ica ,act4    
#b4 ,f9d+s ,congress f9ds z foll[s3 7#a7
 ,prim>y c>e s]vices are able to r$uce  
heal?c>e co/s1 em]g5cy room visits1 &   
hospitalizations4  7#b7 ,heal? sy/ems t 
inve/ 9 prim>y c>e s]vices are able to  
realign inc5tives 9 ord] to focus on    
proactive int]v5tions to a*ieve results 
& population heal?4  7#c7 ,prim>y c>e   
creates increas$ pati5t satisfaction1   
physician engagem5t1 & bett] pati5t     

outcomes4  7#d7 ,direct prim>y c>e is   
able to a*ieve physician compliance4    
7#e7 ,! model ( direct prim>y c>e c     
*ange pati5t usage patt]ns1 ) m         
p]sonaliz$1 home-bas$ prev5tative c>e   
v]sus high-acuity episodic c>e4  7#f7   
,direct prim>y c>e m$ical homes are able
 to incorporate community heal? via a   
collaborative model approa*4  7#g7      
,direct prim>y c>e c be us$ ) population
 heal? plat=ms to develop a plan ( c>e &
 propos$ wellness outcomes4  #c4        
,treatm5t ( direct prim>y c>e s]vice    
arrangem5ts = purposes ( heal? sav+s    
acc\nt  7a7 ,9 g5]al ,section           
#bbc7;c77#a7 ( ! ,int]nal ,rev5ue ,code 
( #aihf is am5d$ by add+ at ! end !     
foll[+ new subp>agraph3  7,d7 ,treatm5t 
( direct prim>y c>e s]vice arrangem5ts  
7i7 ,9 g5]al ,a direct prim>y c>e s]vice
 arrangem5t %all n be treat$ z a heal?  
plan = purposes ( subp>agraph 7,a77ii74 
7ii7 ,direct prim>y c>e s]vice          
arrangem5t ,= purposes ( ?is            
subp>agraph-- 7,i7 ,9 g5]al ,! t]m      

direct prim>y c>e s]vice arrangem5t     
means1 ) respect to any individual1 an  
arrangem5t "u :i* su* individual is     
provid$ m$ical c>e 7z def9$ 9 section   
#bac7;d77 consi/+ solely ( prim>y c>e   
s]vices provid$ by prim>y c>e           
practition]s 7z def9$ 9 section         
#ahcc7x77#b77;,a7 ( ! ,social ,security 
,act1 det]m9$ )\t reg>d to clause 7ii7  
!re(71 if ! sole comp5sation = su* c>e  
is a fix$ p]iodic fee4  7,,ii7          
,limitation ,) respect to any individual
 = any mon?1 su* t]m %all n include any 
arrangem5t if ! aggregate fees = all    
direct prim>y c>e s]vice arrangem5ts    
7det]m9$ )\t reg>d to ?is subclause7 )  
respect to su* individual = su* mon?    
exce$ #aej 7twice su* doll> am\nt 9 !   
case ( an individual ) any direct prim>y
 c>e s]vice arrangem5t 7z s det]m9$7 t  
cov]s m ?an "o individual74  7iii7      
,c]ta9 s]vices specifically exclud$ f   
treatm5t z prim>y c>e s]vices ,=        
purposes ( ?is subp>agraph1 ! t]m prim>y
 c>e s]vices %all n include-- 7,i7      

proc$ures t require ! use ( g5]al       
ane/hesia1 &  7,,ii7 laboratory s]vices 
n typically adm9i/]$ 9 an ambulatory    
prim>y c>e sett+4  ,! ,secret>y1 aft]   
consultation ) ! ,secret>y ( ,heal? &   
,human ,s]vices1 %all issue regulations 
or o!r guidance reg>d+ ! application (  
?is clause4  4  7b7 ,direct prim>y c>e  
s]vice arrangem5t fees treat$ z m$ical  
exp5ses ,section #bbc7;d77#b77;,c7 ( su*
 ,code is am5d$ by /rik+ or at ! end (  
clause 7iii71 by /rik+ ! p]iod at ! end 
( clause 7iv7 & ins]t+ 1 or1 & by add+  
at ! end ! foll[+ new clause3  7v7 any  
direct prim>y c>e s]vice arrangem5t4  4 
7c7 ,inflation adju/m5t ,section        
#bbc7;g77#a7 ( su* ,code is am5d$-- 7#a7
 by ins]t+ 1 7c77#a77;,d77ii77,,ii71    
aft] 7b77#b71 ea* place su* t]m appe>s2 
&  7#b7 9 subp>agraph 7,b71 by ins]t+ & 
7iii7 aft] clause 7ii7 9 clause 7i71 by 
/rik+ & at ! end ( clause 7i71 by /rik+ 
! p]iod at ! end ( clause 7ii7 & ins]t+ 
1 &1 & by ins]t+ aft] clause 7ii7 !     
foll[+ new clause3  7iii7 9 ! case ( !  

doll> am\nt 9 subsection                
7c77#a77;,d77ii77,,ii7 = taxable ye>s   
beg9n+ 9 cal5d> ye>s aft] #bjbj1 cal5d> 
ye> #bjai4  4  7d7 ,report+ ( direct    
prim>y c>e s]vice arrangem5t fees on    
,w-#b ,section #fjea7;a7 ( su* ,code is 
am5d$ by /rik+ & at ! end ( p>agraph    
7#af71 by /rik+ ! p]iod at ! end (      
p>agraph 7#ag7 & ins]t+ 1 &1 & by ins]t+
 aft] p>agraph 7#ag7 ! foll[+ new       
p>agraph3  7#ah7 9 ! case ( a direct    
prim>y c>e s]vice arrangem5t 7z def9$ 9 
section #bbc7;c77#a77;,d77ii77 :i* is   
provid$ 9 connection ) employm5t1 !     
aggregate fees = su* arrangem5t = su*   
employee4  4  7e7 ,effective date ,!    
am5dm5ts made by ?is section %all apply 
to mon?s beg9n+ aft] ,decemb] #ca1      
#bjai1 9 taxable ye>s end+ aft] su*     
date4  #d4 ,provid+ = ,/ate approval &  
implem5tation ( specifi$ waiv]s "u !    
,m$icaid program ,section #aaae ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acae7 is am5d$-- 7#a7 9 subsection     
7d7-- 7,a7 9 p>agraph 7#a71 by /rik+ ,an

 application & ins]t+ ,subject to       
p>agraph 7#d71 an application2 &  7,b7  
by add+ at ! end ! foll[+ new p>agraph3 
7#d7 7,a7 ,an exp]im5tal1 pilot1 or     
demon/ration project und]tak5 "u        
subsection 7a7 may be approv$ or r5ew$  
by a ,/ate if su* project is describ$ 9 
subp>agraph 7,b74  7,b7 ,an exp]im5tal1 
pilot1 or demon/ration project is       
describ$ 9 ?is subp>agraph if su*       
project provides = a waiv] ( requirem5ts
 ) respect to a ,/ate plan 7or a waiv] (
 su* plan7 "u title ,,xix su* t-- 7i7   
individuals enroll$ "u su* plan 7or su* 
waiv]7 may elect to p>ticipate 9 su*    
project ) respect to a ye>2 &  7ii7 su* 
individuals :o elect to s p>ticipate are
 furni%$ ) prim>y c>e s]vices 7z        
describ$ 9 section                      
#bbc7;c77#a77;,d77ii77,i7 ( ! ,int]nal  
,rev5ue ,code ( #aihf7 ?r\gh a direct   
prim>y c>e s]vice arrangem5t 7z def9$ 9 
su* section74  7,c7 ,= purposes ( a     
,/ate's approval or r5ewal ( an         
exp]im5tal1 pilot1 or demon/ration      

project "u subp>agraph 7,a71 ea* ref]5ce
 to ! ,secret>y 9 subsection 7a7 %all be
 deem$ to be a ref]5ce to ! ,/ate4  2 & 
7#b7 9 subsection 7e71 by ins]t+ 7o!r   
?an su* a project t is describ$ 9       
p>agraph 7#d77;,b77 be=e ! p]iod at !   
end4  #e4 ,heal? reimbursem5t           
arrangem5ts & o!r acc\nt-bas$ gr\p heal?
 plans ,! f9al rule ( ! ,secret>y ( !   
,treasury1 ! ,secret>y ( ,labor1 & !    
,secret>y ( ,heal? & ,human ,s]vices1   
titl$ ,heal? ,reimbursem5t ,arrangem5ts 
& ,o!r ,acc\nt-,bas$ ,gr\p ,heal? ,plans
 & publi%$ 9 ! ,f$]al ,regi/] on ,june  
#bj1 #bjai 7#hd ,f$4 ,reg4 #bhhhh71 %all
 h ! same =ce & effect ( law z if su*   
rule _h be5 enact$ by an ,act (         
,congress4  #f4 ,s5se ( ,congress ,x is 
! s5se ( ,congress t organizations (f]+ 
,m$ic>e ,advantage plans "u "p ,c (     
title ,,xviii ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#ba et seq47 %\ld
 exp& ! (f]+ ( ,,msa plans 7z def9$ 9   
section #ahei7;b77#c7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           

#aciew-#bh7;b77#c777 "u su* "p4  #g4    
,eligibility ( entities t (f] direct    
prim>y c>e s]vice arrangem5ts 9 c]ta9   
,national ,heal? ,s]vice ,corps programs
 ,not)/&+ subp>t ,,ii or ,,iii ( "p ,d (
 title ,,iii ( ! ,public ,heal? ,s]vice 
,act 7#db ,u4,s4,c4 #bed;d et seq471 an 
entity %all be eligible = assignm5t ( "o
 or m individuals p]=m+ a p]iod (       
obligat$ s]vice pursuant to ! ,national 
,heal? ,s]vice ,corps ,s*ol>%ip ,program
 or ,national ,heal? ,s]vice ,corps     
,loan ,repaym5t ,program if su* entity--
 7#a7 (f]s direct prim>y c>e s]vice     
arrangem5ts 7z def9$ 9 section          
#bbc7;c77#a77;,d7 ( ! ,int]nal ,rev5ue  
,code ( #aihf72 &  7#b7 is 9 a heal?    
pr(essional %ortage area 7z def9$ 9     
section #cca7;a7 ( ! ,public ,heal?     
,s]vice ,act 7#db ,u4,s4,c4 #bed;d7a7774