,,ii  #aahth ,,congress  #ast ,session  
,s4 #fbh  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,march #b1 #bjbc,mr4
 ,cassidy 7for himself1 ,mrs4 ,shaheen1 
,mr4 ,scott of ,south ,carolina1 and    
,mr4 ,kelly7 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 provide for the treatment  
of direct primary care service          
arrangements as medical care1 to provide
 that such arrangements do not          
disqualify deductible health savings    
account contributions1 and for other    
purposes4  #a4 ,short title ,this ,act  
may be cited as the ,primary ,care      
,enhancement ,act of #bjbc4  #b4        
,treatment of direct primary care       
service arrangements  7a7 ,amount       
treated as medical care  7#a7 ,in       
general ,section #bac7;d77#a7 of the    
,internal ,revenue ,code of #aihf is    
amended by striking or at the end of    
subparagraph 7,c71 by striking the      

period at the end of subparagraph 7,d7  
and inserting 1 or1 and by inserting    
after subparagraph 7,d7 the following   
new subparagraph3  7,e7 for direct      
primary care service arrangements4  4   
7#b7 ,limitation ,section #bac7;d77#a7  
of such ,code1 as amended by paragraph  
7#a71 is further amended by adding at   
the end the following3 ,in the case of a
 direct care primary service            
arrangement1 only eligible fee amounts  
7as defined in paragraph 7#ac77 shall be
 taken into account under subparagraph  
7,e744  7#c7 ,definitions ,section      
#bac7;d7 of such ,code is amended by    
inserting after paragraph 7#aa7 the     
following new paragraphs3  7#ab7 ,direct
 primary care service arrangement  7,a7 
,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 
paragraph 7#a71 determined without      
regard to subparagraph 7,e7 thereof7    

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,b7 ,certain      
services specifically excluded from     
treatment as primary care services ,for 
purposes of this paragraph1 the term    
primary care services shall not         
include-- 7i7 procedures that require   
the use of general anesthesia1 and  7ii7
 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       
subparagraph4  7#ac7 ,eligible fee      
amount  7,a7 ,in general ,the term      
eligible fee amount means1 with respect 
to any individual for any month1 the    

amount of fixed periodic fees paid for a
 direct care primary service            
arrangement1 to the extent that the     
aggregate fees for all direct primary   
care service arrangements with respect  
to such individual for such month do not
 exceed #aej 7twice such dollar amount  
in the case of an individual with any   
direct primary care service arrangement 
that covers more than one individual74  
7,b7 ,indexing ,in the case of any      
taxable year beginning in a calendar    
year after #bjbd1 the #aej amount       
contained in subparagraph 7,a7 shall be 
increased by an amount equal to-- 7i7   
such dollar amount1 multiplied by  7ii7 
the cost-of-living adjustment determined
 under section #a7;f77#c7 for the       
calendar year in which such taxable year
 begins determined by substituting      
calendar year #bjbc for calendar year   
#bjaf in subparagraph 7,a77ii7 thereof4 
,if any increase under the preceding    
sentence is not a multiple of #aj1 such 
increase shall be rounded to the nearest

 multiple of #aj4  4  7b7 ,health       
savings accounts ,section #bbc7;c7 of   
the ,internal ,revenue ,code of #aihf is
 amended by adding at the end the       
following new paragraph3  7#f7          
,treatment of direct primary care       
service arrangements ,a direct care     
primary service arrangement 7as defined 
in section #bac7;d77#ab77-- 7,a7 shall  
not be treated as a health plan for     
purposes of paragraph 7#a77;,a77ii71 and
  7,b7 shall not be treated as insurance
 for purposes of subsection             
7d77#b77;,b74  4  7c7 ,reporting of     
direct primary care service arrangement 
fees on ,w-#b ,section #fjea7;a7 of the 
,internal ,revenue ,code of #aihf 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 #bac7;d77#ab77   

which is provided in connection with    
employment1 the aggregate fees for such 
arrangement for such employee4  4  7d7  
,effective date ,the amendments made by 
this section shall apply to months      
beginning after ,december #ca1 #bjbc1 in
 taxable years ending after such date4