,,ii  #aag? ,,congress  #a/ ,session    
,s4 #abh  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,janu>y #bh1 #bjba,mr4 
,cassidy 7= himself1 ,mr4 ,kelly1 ,mr4  
,scott ( ,s\? ,c>ol9a1 & ,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 provide = !    
treatm5t ( direct prim>y c>e s]vice     
arrangem5ts z m$ical c>e1 to provide t  
su* arrangem5ts d n disqualify d$uctible
 heal? sav+s acc\nt contributions1 & =  
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,prim>y ,c>e           
,enhancem5t ,act ( #bjba4  #b4 ,treatm5t
 ( direct prim>y c>e s]vice arrangem5ts 
7a7 ,am\nt treat$ z m$ical c>e  7#a7 ,9 
g5]al ,section #bac7;d77#a7 ( ! ,int]nal
 ,rev5ue ,code ( #aihf is am5d$ by /rik+
 or at ! end ( subp>agraph 7,c71 by     
/rik+ ! p]iod at ! end ( subp>agraph    
7,d7 & ins]t+ 1 or1 & by add+ at ! end !
 foll[+ new subp>agraph3  7,e7 = direct 
prim>y c>e s]vice arrangem5ts4  4  7#b7 

,limitation ,section #bac7;d77#a7 ( su* 
,code1 z am5d$ by p>agraph 7#a71 is     
fur!r am5d$ by add+ at ! end ! foll[+3  
,9 ! case ( a direct c>e prim>y s]vice  
arrangem5t1 only eligible fee am\nts 7z 
def9$ 9 p>agraph 7#ac77 %all be tak5    
into acc\nt "u subp>agraph 7,e744  7#c7 
,def9itions ,section #bac7;d7 ( su*     
,code is am5d$ by add+ at ! end ! foll[+
 new p>agraphs3  7#ab7 ,direct prim>y   
c>e s]vice arrangem5t  7,a7 ,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 p>agraph  
7#a71 det]m9$ )\t reg>d to subp>agraph  
7,e7 !re(7 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,b7 ,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-- 7i7 proc$ures t require !   
use ( g5]al ane/hesia1 &  7ii7          
laboratory s]vices n typically adm9i/]$ 
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 subp>agraph4 
7#ac7 ,eligible fee am\nt  7,a7 ,9 g5]al
 ,! t]m eligible fee am\nt means1 )     
respect to any individual = any mon?1 ! 
am\nt ( fix$ p]iodic fees paid = a      
direct c>e prim>y s]vice arrangem5t1 to 
! ext5t t ! aggregate fees = all direct 
prim>y c>e s]vice arrangem5ts ) respect 
to su* individual = su* mon? d n exce$  
#aej 7twice su* doll> am\nt 9 ! case (  
an individual ) any direct prim>y c>e   
s]vice arrangem5t t cov]s m ?an "o      
individual74  7,b7 ,index+ ,9 ! case (  
any taxable ye> beg9n+ 9 a cal5d> ye>   
aft] #bjbb1 ! #aej am\nt conta9$ 9      
subp>agraph 7,a7 %all be increas$ by an 
am\nt equal to-- 7i7 su* doll> am\nt1   

multipli$ by  7ii7 ! co/-(-liv+ adju/m5t
 det]m9$ "u section #a7;f77#c7 = !      
cal5d> ye> 9 :i* su* taxable ye> beg9s  
det]m9$ by sub/itut+ cal5d> ye> #bjba = 
cal5d> ye> #bjaf 9 subp>agraph 7,a77ii7 
!re(4  ,if any increase "u ! prec$+     
s5t5ce is n a multiple ( #aj1 su*       
increase %all be r\nd$ to ! ne>e/       
multiple ( #aj4  4  7b7 ,heal? sav+s    
acc\nts ,section #bbc7;c7 ( ! ,int]nal  
,rev5ue ,code ( #aihf is am5d$ by add+  
at ! end ! foll[+ new p>agraph3  7#f7   
,treatm5t ( direct prim>y c>e s]vice    
arrangem5ts ,a direct c>e prim>y s]vice 
arrangem5t 7z def9$ 9 section           
#bac7;d77#ab77-- 7,a7 %all n be treat$ z
 a heal? plan = purposes ( p>agraph     
7#a77;,a77ii71 &  7,b7 %all n be treat$ 
z insurance = purposes ( subsection     
7d77#b77;,b74  4  7c7 ,report+ ( direct 
prim>y c>e s]vice arrangem5t fees on    
,w-#b ,section #fjea7;a7 ( ! ,int]nal   
,rev5ue ,code ( #aihf 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 #bac7;d77#ab77 :i* is   
provid$ 9 connection ) employm5t1 !     
aggregate fees = su* arrangem5t = su*   
employee4  4  7d7 ,effective date ,!    
am5dm5ts made by ?is section %all apply 
to mon?s beg9n+ aft] ,decemb] #ca1      
#bjba1 9 taxable ye>s end+ aft] su*     
date4