[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5157 Introduced in House (IH)]
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117th CONGRESS
1st Session
H. R. 5157
To facilitate direct primary care arrangements.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 3, 2021
Mr. Crenshaw introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committees on
Energy and Commerce, and Education and Labor, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To facilitate direct primary care arrangements.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Direct Primary Care for America
Act''.
SEC. 2. FINDINGS.
Congress finds as follows:
(1) Primary care services are able to reduce healthcare
costs, emergency room visits, and hospitalizations.
(2) Health systems that invest in primary care services are
able to realign incentives in order to focus on proactive
interventions to achieve results and population health.
(3) Primary care creates increased patient satisfaction,
physician engagement, and better patient outcomes.
(4) Direct primary care is able to achieve physician
compliance.
(5) The model of direct primary care can change patient
usage patterns, with more personalized, home-based preventative
care versus high-acuity episodic care.
(6) Direct primary care medical homes are able to
incorporate community health via a collaborative model
approach.
(7) Direct primary care can be used with population health
platforms to develop a plan of care and proposed wellness
outcomes.
SEC. 3. TREATMENT OF DIRECT PRIMARY CARE SERVICE ARRANGEMENTS FOR
PURPOSES OF HEALTH SAVINGS ACCOUNT.
(a) In General.--Section 223(c)(1) of the Internal Revenue Code of
1986 is amended by adding at the end the following new subparagraph:
``(D) Treatment of direct primary care service
arrangements.--
``(i) In general.--A direct primary care
service arrangement shall not be treated as a
health plan for purposes of subparagraph
(A)(ii).
``(ii) Direct primary care service
arrangement.--For purposes of this
subparagraph--
``(I) In general.--The term `direct
primary care service arrangement'
means, with respect to any individual,
an arrangement under which such
individual is provided medical care (as
defined in section 213(d)) consisting
solely of primary care services
provided by primary care practitioners
(as defined in section 1833(x)(2)(A) of
the Social Security Act, determined
without regard to clause (ii) thereof),
if the sole compensation for such care
is a fixed periodic fee.
``(II) Limitation.--With respect to
any individual for any month, such term
shall not include any arrangement if
the aggregate fees for all direct
primary care service arrangements
(determined without regard to this
subclause) with respect to such
individual for such month exceed $150
(twice such dollar amount in the case
of an individual with any direct
primary care service arrangement (as so
determined) that covers more than one
individual).
``(iii) Certain services specifically
excluded from treatment as primary care
services.--For purposes of this subparagraph,
the term `primary care services' shall not
include--
``(I) procedures that require the
use of general anesthesia, and
``(II) laboratory services not
typically administered in an ambulatory
primary care setting.
The Secretary, after consultation with the
Secretary of Health and Human Services, shall
issue regulations or other guidance regarding
the application of this clause.''.
(b) Direct Primary Care Service Arrangement Fees Treated as Medical
Expenses.--Section 223(d)(2)(C) of such Code is amended by striking
``or'' at the end of clause (iii), by striking the period at the end of
clause (iv) and inserting ``, or'', and by adding at the end the
following new clause:
``(v) any direct primary care service
arrangement.''.
(c) Inflation Adjustment.--Section 223(g)(1) of such Code is
amended--
(1) by inserting ``, (c)(1)(D)(ii)(II),'' after ``(b)(2),''
each place such term appears; and
(2) in subparagraph (B), by inserting ``and (iii)'' after
``clause (ii)'' in clause (i), by striking ``and'' at the end
of clause (i), by striking the period at the end of clause (ii)
and inserting ``, and'', and by inserting after clause (ii) the
following new clause:
``(iii) in the case of the dollar amount in
subsection (c)(1)(D)(ii)(II) for taxable years
beginning in calendar years after 2021,
`calendar year 2020'.''.
(d) Reporting of Direct Primary Care Service Arrangement Fees on W-
2.--Section 6051(a) of such Code is amended by striking ``and'' at the
end of paragraph (16), by striking the period at the end of paragraph
(17) and inserting ``, and'', and by inserting after paragraph (17) the
following new paragraph:
``(18) in the case of a direct primary care service
arrangement (as defined in section 223(c)(1)(D)(ii)) which is
provided in connection with employment, the aggregate fees for
such arrangement for such employee.''.
(e) Effective Date.--The amendments made by this section shall
apply to months beginning after December 31, 2020, in taxable years
ending after such date.
SEC. 4. PROVIDING FOR STATE APPROVAL AND IMPLEMENTATION OF SPECIFIED
WAIVERS UNDER THE MEDICAID PROGRAM.
Section 1115 of the Social Security Act (42 U.S.C. 1315) is
amended--
(1) in subsection (d)--
(A) in paragraph (1), by striking ``An
application'' and inserting ``Subject to paragraph (4),
an application''; and
(B) by adding at the end the following new
paragraph:
``(4)(A) An experimental, pilot, or demonstration project
undertaken under subsection (a) may be approved or renewed by a
State if such project is described in subparagraph (B).
``(B) An experimental, pilot, or demonstration project is
described in this subparagraph if such project provides for a
waiver of requirements with respect to a State plan (or a
waiver of such plan) under title XIX such that--
``(i) individuals enrolled under such plan (or such
waiver) may elect to participate in such project with
respect to a year; and
``(ii) such individuals who elect to so participate
are furnished with primary care services (as described
in section 223(c)(1)(D)(ii)(I) of the Internal Revenue
Code of 1986) through a direct primary care service
arrangement (as defined in such section).
``(C) For purposes of a State's approval or renewal of an
experimental, pilot, or demonstration project under
subparagraph (A), each reference to `the Secretary' in
subsection (a) shall be deemed to be a reference to `the
State'.''; and
(2) in subsection (e), by inserting ``(other than such a
project that is described in paragraph (4)(B))'' before the
period at the end.
SEC. 5. HEALTH REIMBURSEMENT ARRANGEMENTS AND OTHER ACCOUNT-BASED GROUP
HEALTH PLANS.
The final rule of the Secretary of the Treasury, the Secretary of
Labor, and the Secretary of Health and Human Services, titled ``Health
Reimbursement Arrangements and Other Account-Based Group Health Plans''
and published in the Federal Register on June 20, 2019 (84 Fed. Reg.
28888), shall have the same force and effect of law as if such rule had
been enacted by an Act of Congress.
SEC. 6. SENSE OF CONGRESS.
It is the sense of Congress that organizations offering Medicare
Advantage plans under part C of title XVIII of the Social Security Act
(42 U.S.C. 1395w-21 et seq.) should expand the offering of MSA plans
(as defined in section 1859(b)(3) of the Social Security Act (42 U.S.C.
1395w-28(b)(3))) under such part.
SEC. 7. ELIGIBILITY OF ENTITIES THAT OFFER DIRECT PRIMARY CARE SERVICE
ARRANGEMENTS IN CERTAIN NATIONAL HEALTH SERVICE CORPS
PROGRAMS.
Notwithstanding subpart II or III of part D of title III of the
Public Health Service Act (42 U.S.C. 254d et seq.), an entity shall be
eligible for assignment of one or more individuals performing a period
of obligated service pursuant to the National Health Service Corps
Scholarship Program or National Health Service Corps Loan Repayment
Program if such entity--
(1) offers direct primary care service arrangements (as
defined in section 223(c)(1)(D) of the Internal Revenue Code of
1986); and
(2) is in a health professional shortage area (as defined
in section 331(a) of the Public Health Service Act (42 U.S.C.
254d(a))).
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