,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #biii  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,decemb] #i1 #bjai,mr4 
,cassidy 7= himself1 ,mr4 ,jones1 ,mr4  
,moran1 & ,mrs4 ,%ahe57 introduc$ !     
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,f9ance  ,a ,,bill   
,to am5d ! ,int]nal ,rev5ue ,code (     
#aihf to all[ individuals ) direct      
prim>y c>e s]vice arrangem5ts to rema9  
eligible individuals = purposes ( heal? 
sav+s acc\nts4  #a4 ,%ort title ,?is    
,act may be cit$ z ! ,prim>y ,c>e       
,enhancem5t ,act ( #bjai4  #b4 ,treatm5t
 ( direct prim>y c>e s]vice arrangem5ts 
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 p>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 p>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$ical  
exp5ses ,section #bbc7;d77#b77;,c7 is   
am5d$ 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>s1
 &  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