,,ii  #aafth ,,congress  #ast ,session  
,s4 #biii  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,december #i1  
#bjai,mr4 ,cassidy 7for himself1 ,mr4   
,jones1 ,mr4 ,moran1 and ,mrs4 ,shaheen7
 introduced the following bill2 which   
was read twice and referred to the      
,committee on ,finance  ,a ,,bill  ,to  
amend the ,internal ,revenue ,code of   
#aihf to allow individuals with direct  
primary care service arrangements to    
remain eligible individuals for purposes
 of health savings accounts4  #a4 ,short
 title ,this ,act may be cited as the   
,primary ,care ,enhancement ,act of     
#bjai4  #b4 ,treatment of direct primary
 care service arrangements  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       
paragraph-- 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 paragraph1 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 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 appears1 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