,,ib ,union ,cal5d> ,no4 #ccj #aah?     
,,congress  #b;d ,session  ,h4 ,r4 #efhh
 ,report ,no4 #aah-dja ,,9 ,,! ,,h\se   
,,( ,,repres5tatives  ,septemb] #bf1    
#bjbc,mr4 ,smuck] 7= himself & ,mr4     
,blum5au]7 introduc$ ! foll[+ bill2 :i* 
0 ref]r$ to ! ,committee on ,ways &     
,means  ,febru>y #bf1 #bjbd,report$ ) an
 am5dm5t1 committ$ to ! ,committee ( !  
,:ole ,h\se on ! ,/ate ( ! ,union1 &    
ord]$ to be printed,strike out all aft] 
! enact+ clause & ins]t ! "p pr9t$ 9    
italic,for text ( introduc$ bill1 see   
copy ( bill z introduc$ on ,septemb]    
#bf1 #bjbc  ,a ,,bill  ,to am5d !       
,int]nal ,rev5ue ,code ( #aihf to       
improve heal? sav+s acc\nts4  #a4 ,%ort 
title ,?is ,act may be cit$ z !         
,bip>tisan ,,hsa ,improvem5t ,act (     
#bjbc4  #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,e7
 ,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$ures t require ! use ( g5]al       
ane/hesia1  7,,ii7 prescription drugs   
7o!r ?an vacc9es71 &  7,,iii7 laboratory
 s]vices n typically adm9i/]$ 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;,e77ii77,,ii71 aft] 7b77#b7 ea*
 place x 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;,e77ii77,,ii7 =     
taxable ye>s beg9n+ 9 cal5d> ye>s aft]  
#bjbf1 cal5d> ye> #bjbe4  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;,e77ii77  
: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      

#bjbe1 9 taxable ye>s end+ aft] su*     
date4  #c4 ,on-site employee cl9ics  7a7
 ,9 g5]al ,section #bbc7;c77#a7 ( !     
,int]nal ,rev5ue ,code ( #aihf1 z am5d$ 
by ! prec$+ provisions ( ?is ,act1 is   
am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,f7 ,special rule =      
qualifi$ items & s]vices  7i7 ,9 g5]al  
,= purposes ( subp>agraph 7,a77ii71 an  
individual %all n be treat$ z cov]$ "u a
 heal? plan describ$ 9 subclauses 7,i7 &
 7,,ii7 ( su* subp>agraph m]ely because 
! individual is eligible to receive1 or 
receives1 qualifi$ items & s]vices--    
7,i7 at a heal?c>e facility locat$ at a 
facility own$ or leas$ by ! employ] ( ! 
individual 7or ( ! individual's sp\se71 
or  7,,ii7 at a heal?c>e facility op]at$
 prim>ily = ! b5efit ( employees ( !    
employ] ( ! individual 7or ( !          
individual's sp\se74  7ii7 ,qualifi$    
items & s]vices def9$ ,= purposes ( ?is 
subp>agraph1 ! t]m qualifi$ items &     
s]vices means ! foll[+3 7,i7 ,physical  
exam9ation4  7,,ii7 ,immunizations1     

includ+ injections ( antig5s provid$ by 
employees4  7,,iii7 ,drugs or           
biologicals o!r ?an a prescrib$ drug 7z 
su* t]m is def9$ 9 section              
#bac7;d77#c774  7,,iv7 ,treatm5t =      
injuries occurr+ 9 ! c\rse ( employm5t4 
7,v7 ,prev5tive c>e = *ronic conditions 
7z def9$ 9 clause 7iv774  7,,vi7 ,drug  
te/+4  7,,vii7 ,he>+ or vision scre5+s &
 relat$ s]vices4  7iii7 ,aggregation ,= 
purposes ( clause 7i71 all p]sons treat$
 z a s+le employ] "u subsection 7b71    
7c71 7m71 or 7o7 ( section #dad %all be 
treat$ z a s+le employ]4  7iv7          
,prev5tive c>e = *ronic conditions ,=   
purposes ( ?is subp>agraph1 ! t]m       
prev5tive c>e = *ronic conditions means 
any item or s]vice specifi$ 9 ! ,app5dix
 ( ,int]nal ,rev5ue ,s]vice ,notice     
#bjai-de :i* is prescrib$ to treat an   
individual diagnos$ ) ! associat$ *ronic
 condition specifi$ 9 su* ,app5dix = !  
purpose ( prev5t+ ! exac]bation ( su*   
*ronic condition or ! developm5t ( a    
second>y condition1 includ+ any am5dm5t1

 addition1 removal1 or o!r modification 
made by ! ,secret>y 7pursuant to !      
au?ority grant$ to ! ,secret>y "u       
p>agraph 7#b77;,c77 to ! items or       
s]vices specifi$ 9 su* ,app5dix         
subsequ5t to ! date ( enactm5t ( ?is    
subp>agraph4  4  7b7 ,effective date ,! 
am5dm5ts made by ?is section %all apply 
to mon?s 9 taxable ye>s beg9n+ aft]     
,decemb] #ca1 #bjbe4  #d4 ,contributions
 p]mitt$ if sp\se has heal? flexible    
sp5d+ arrangem5t  7a7 ,contributions    
p]mitt$ if sp\se has a heal? flexible   
sp5d+ arrangem5t ,section               
#bbc7;c77#a77;,b7 ( ! ,int]nal ,rev5ue  
,code ( #aihf is am5d$ by /rik+ & at !  
end ( clause 7ii71 by /rik+ ! p]iod at !
 end ( clause 7iii7 & ins]t+ 1 &1 & by  
add+ at ! end ! foll[+ new clause3  7iv7
 cov]age "u a heal? flexible sp5d+      
arrangem5t ( ! sp\se ( ! individual =   
any plan ye> ( su* arrangem5t if !      
aggregate reimbursem5ts "u su*          
arrangem5t = su* ye> d n exce$ !        
aggregate exp5ses :i* w\ld be eligible =

 reimbursem5t "u su* arrangem5t if su*  
exp5ses 7 det]m9$ )\t reg>d to any      
exp5ses paid or incurr$ ) respect to su*
 individual4  4  7b7 ,effective date ,! 
am5dm5t made by ?is section %all apply  
to plan ye>s beg9n+ aft] ,decemb] #ca1  
#bjbe4  #e4 ,,fsa & ,,hra t]m9ations or 
conv]sions to fund ,h,s,as  7a7 ,9 g5]al
 ,section #ajf7;e77#b7 ( ! ,int]nal     
,rev5ue ,code ( #aihf is am5d$ to read z
 foll[s3  7#b7 ,qualifi$ ,,hsa          
di/ribution ,= purposes ( ?is           
subsection-- 7,a7 ,9 g5]al ,! t]m       
qualifi$ ,,hsa di/ribution means1 )     
respect to any employee1 a di/ribution f
 a heal? flexible sp5d+ arrangem5t or   
heal? reimbursem5t arrangem5t ( su*     
employee contribut$ directly to a heal? 
sav+s acc\nt ( su* employee if-- 7i7 su*
 di/ribution is made 9 connection ) su* 
employee e/abli%+ cov]age "u a high     
d$uctible heal? plan 7z def9$ 9 section 
#bbc7;c77#b77 if dur+ ! #d-ye> p]iod    
prec$+ ! date ! employee s e/abli%es    
cov]age ! employee 0 n cov]$ "u su* a   

high d$uctible heal? plan1 &  7ii7 su*  
arrangem5t is describ$ 9 section        
#bbc7;c77#a77;,b77vi7 ) respect to any  
portion ( ! plan ye> rema9+ aft] su*    
di/ribution is made1 if su* employee    
rema9s enroll$ 9 su* arrangem5t4  7,b7  
,doll> limitation ,! aggregate am\nt (  
di/ributions f heal? flexible sp5d+     
arrangem5ts & heal? reimbursem5t        
arrangem5ts ( any employee :i* may be   
treat$ z qualifi$ ,,hsa di/ributions 9  
connection ) an e/abli%m5t ( cov]age    
describ$ 9 subp>agraph 7,a77i7 %all n   
exce$ ! doll> am\nt 9 effect "u section 
#abe7;i77#a7 7twice su* am\nt 9 ! case (
 cov]age :i* is describ$ 9 section      
#bbc7;b77#b77;,b774  4  7b7 ,p>tial     
r$uction ( limitation on d$uctible ,,hsa
 contributions ,section #bbc7;b77#d7 (  
su* ,code is am5d$ by /rik+ & at ! end (
 subp>agraph 7,b71 by /rik+ ! p]iod at !
 end ( subp>agraph 7,c7 & ins]t+ 1 &1 & 
by ins]t+ aft] subp>agraph 7,c7 ! foll[+
 new subp>agraph3  7,d7 s mu* ( any     
qualifi$ ,,hsa di/ribution 7z def9$ 9   

section #ajf7;e77#b77 made to a heal?   
sav+s acc\nt ( su* individual dur+ !    
taxable ye> z does n exce$ ! aggregate  
increases 9 ! balance ( ! arrangem5t f  
:i* su* di/ribution is made :i* occur   
dur+ ! portion ( ! plan ye> :i* prec$es 
su* di/ribution 7o!r ?an any balance    
c>ri$ ov] to su* plan ye> & det]m9$ )\t 
reg>d to any decrease 9 su* balance dur+
 su* portion ( ! plan ye>74  4  7c7     
,conv]sion to ,,hsa-,compatible         
arrangem5t = rema9d] ( plan ye> ,section
 #bbc7;c77#a77;,b7 ( su* ,code1 z am5d$ 
by ?is prec$+ provisions ( ?is ,act1 is 
am5d$ by /rik+ & at ! end ( clause      
7iii71 by /rik+ ! p]iod at ! end (      
clause 7iv7 & ins]t+ 1 &1 & by add+ at !
 end ! foll[+ new clause3  7v7 cov]age  
"u a heal? flexible sp5d+ arrangem5t or 
heal? reimbursem5t arrangem5t = !       
portion ( ! plan ye> aft] a qualifi$    
,,hsa di/ribution 7z def9$ 9 section    
#ajf7;e77#b7 det]m9$ )\t reg>d to       
subp>agraph 7,a77ii7 !re(7 is made1 if !
 t]ms ( su* arrangem5t :i* apply = su*  

portion ( ! plan ye> are su* t1 if su*  
t]ms appli$ = ! entire plan ye>1 !n su* 
arrangem5t w\ld n be tak5 into acc\nt "u
 subp>agraph 7,a77ii7 ( ?is p>agraph =  
su* plan ye>4  4  7d7 ,inclusion (      
qualifi$ ,,hsa di/ributions on ,w-#b    
7#a7 ,9 g5]al ,section #fjea7;a7 ( su*  
,code1 z am5d$ by ?is prec$+ provisions 
( ?is ,act1 is am5d$ by /rik+ & at ! end
 ( p>agraph 7#ag71 by /rik+ ! p]iod at !
 end ( p>agraph 7#ah7 & ins]t+ 1 &1 & by
 ins]t+ aft] p>agraph 7#ah7 ! foll[+ new
 p>agraph3  7#ai7 ! am\nt ( any qualifi$
 ,,hsa di/ribution 7z def9$ 9 section   
#ajf7;e77#b77 ) respect to su* employee4
  4  7#b7 ,con=m+ am5dm5t ,section      
#fjea7;a77#ab7 ( su* ,code is am5d$ by  
ins]t+ 7o!r ?an any qualifi$ ,,hsa      
di/ribution1 z def9$ 9 section          
#ajf7;e77#b77 be=e ! comma at ! end4    
7e7 ,effective date ,! am5dm5ts made by 
?is section %all apply to di/ributions  
made aft] ,decemb] #ca1 #bjbe1 9 taxable
 ye>s end+ aft] su* date4  ,febru>y #bf1
 #bjbd,report$ ) an am5dm5t1 committ$ to

 ! ,committee ( ! ,:ole ,h\se on ! ,/ate
 ( ! ,union1 & ord]$ to be pr9t$