[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6271 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 6271
To amend the Internal Revenue Code of 1986 to improve access to health
care through expanded health savings accounts, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 14, 2021
Mr. LaTurner 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 the Judiciary, 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 amend the Internal Revenue Code of 1986 to improve access to health
care through expanded health savings accounts, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE, ETC.
(a) Short Title.--This Act may be cited as the ``Health Savings Act
of 2021''.
(b) Amendment of 1986 Code.--Except as otherwise expressly
provided, whenever in this Act an amendment or repeal is expressed in
terms of an amendment to, or repeal of, a section or other provision,
the reference shall be considered to be made to a section or other
provision of the Internal Revenue Code of 1986.
(c) Table of Contents.--The table of contents is as follows:
Sec. 1. Short title, etc.
TITLE I--RENAMING HIGH DEDUCTIBLE HEALTH PLANS
Sec. 101. High deductible health plans renamed HSA-qualified health
plans.
TITLE II--ENHANCING ACCESS TO TAX-PREFERRED HEALTH ACCOUNTS
Sec. 201. Allow both spouses to make catch-up contributions to the same
HSA account.
Sec. 202. Provisions relating to Medicare.
Sec. 203. Individuals eligible for Indian Health Service assistance.
Sec. 204. Members of health care sharing ministries eligible to
establish health savings accounts.
Sec. 205. Treatment of direct primary care service arrangements.
Sec. 206. Individuals eligible for on-site medical clinic coverage.
Sec. 207. Treatment of embedded deductibles.
TITLE III--IMPROVING COVERAGE UNDER TAX-PREFERRED HEALTH ACCOUNTS
Sec. 301. Purchase of health insurance from HSA account.
Sec. 302. Special rule for certain medical expenses incurred before
establishment of account.
Sec. 303. Preventive care prescription drug clarification.
TITLE IV--MISCELLANEOUS PROVISIONS RELATING TO TAX-PREFERRED HEALTH
ACCOUNTS
Sec. 401. FSA and HRA interaction with HSAs.
Sec. 402. Equivalent bankruptcy protections for health savings accounts
as retirement funds.
Sec. 403. Administrative error correction before due date of return.
Sec. 404. Reauthorization of Medicaid health opportunity accounts.
Sec. 405. Maximum contribution limit to health savings account
increased to amount of deductible and out-
of-pocket limitation.
TITLE V--OTHER PROVISIONS
Sec. 501. Certain exercise equipment and physical fitness programs
treated as medical care.
Sec. 502. Certain nutritional and dietary supplements to be treated as
medical care.
Sec. 503. Certain provider fees to be treated as medical care.
TITLE I--RENAMING HIGH DEDUCTIBLE HEALTH PLANS
SEC. 101. HIGH DEDUCTIBLE HEALTH PLANS RENAMED HSA-QUALIFIED HEALTH
PLANS.
(a) In General.--Section 223 is amended by striking ``high
deductible health plan'' each place it appears and inserting ``HSA-
qualified health plan''.
(b) Conforming Amendments.--
(1) The heading for paragraph (2) of section 223(c) is
amended by striking ``High deductible health plan'' and
inserting ``HSA-qualified health plan''.
(2) Section 408(d)(9) is amended--
(A) by striking ``high deductible health plan''
each place it appears in subparagraph (C) and inserting
``HSA-qualified health plan''; and
(B) by striking ``High deductible health plan'' in
the heading of subparagraph (D) and inserting ``HSA-
qualified health plan''.
(3) Section 106(e) is amended--
(A) by striking ``High deductible health plan'' in
the heading of paragraph (3) and inserting ``HSA-
qualified health plan''; and
(B) by striking ``high deductible health plan'' in
paragraph (5)(B)(iii) and inserting ``HSA-qualified
health plan''.
TITLE II--ENHANCING ACCESS TO TAX-PREFERRED HEALTH ACCOUNTS
SEC. 201. ALLOW BOTH SPOUSES TO MAKE CATCH-UP CONTRIBUTIONS TO THE SAME
HSA ACCOUNT.
(a) In General.--Paragraph (5) of section 223(b) is amended to read
as follows:
``(5) Special rule for married individuals with family
coverage.--
``(A) In general.--In the case of individuals who
are married to each other, if both spouses are eligible
individuals and either spouse has family coverage under
an HSA-qualified health plan as of the first day of any
month--
``(i) the limitation under paragraph (1)
shall be applied by not taking into account any
other HSA-qualified health plan coverage of
either spouse (and if such spouses both have
family coverage under separate HSA-qualified
health plans, only one such coverage shall be
taken into account),
``(ii) such limitation (after application
of clause (i)) shall be reduced by the
aggregate amount paid to Archer MSAs of such
spouses for the taxable year, and
``(iii) such limitation (after application
of clauses (i) and (ii)) shall be divided
equally between such spouses unless they agree
on a different division.
``(B) Treatment of additional contribution
amounts.--If both spouses referred to in subparagraph
(A) have attained age 55 before the close of the
taxable year, the limitation referred to in
subparagraph (A)(iii) which is subject to division
between the spouses shall include the additional
contribution amounts determined under paragraph (3) for
both spouses. In any other case, any additional
contribution amount determined under paragraph (3)
shall not be taken into account under subparagraph
(A)(iii) and shall not be subject to division between
the spouses.''.
(b) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after the date of the enactment of this Act.
SEC. 202. PROVISIONS RELATING TO MEDICARE.
(a) Individuals Over Age 65 Only Enrolled in Medicare Part A.--
Paragraph (7) of section 223(b) is amended by adding at the end the
following: ``This paragraph shall not apply to any individual during
any period for which the individual's only entitlement to such benefits
is an entitlement to hospital insurance benefits under part A of title
XVIII of such Act pursuant to an enrollment for such hospital insurance
benefits under section 226(a) of such Act.''.
(b) Medicare Beneficiaries Participating in Medicare Advantage MSA
May Contribute Their Own Money to Their MSA.--
(1) In general.--Subsection (b) of section 138 is amended
by striking paragraph (2) and by redesignating paragraphs (3)
and (4) as paragraphs (2) and (3), respectively.
(2) Conforming amendment.--Paragraph (4) of section 138(c)
is amended by striking ``and paragraph (2)''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after the date of the enactment of
this Act.
SEC. 203. INDIVIDUALS ELIGIBLE FOR INDIAN HEALTH SERVICE ASSISTANCE.
(a) In General.--Paragraph (1) of section 223(c), as amended by
section 102(c)(4) of the No Surprises Act, is amended by adding at the
end the following new subparagraph:
``(E) Special rule for individuals eligible for
assistance under indian health service programs.--For
purposes of subparagraph (A)(ii), an individual shall
not be treated as covered under a health plan described
in such subparagraph merely because the individual
receives hospital care or medical services under a
medical care program of the Indian Health Service or of
a tribal organization.''.
(b) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after the date of the enactment of this Act.
SEC. 204. MEMBERS OF HEALTH CARE SHARING MINISTRIES ELIGIBLE TO
ESTABLISH HEALTH SAVINGS ACCOUNTS.
(a) In General.--Section 223 is amended by adding at the end the
following new subsection:
``(i) Application to Health Care Sharing Ministries.--For purposes
of this section, membership in a health care sharing ministry (as
defined in section 5000A(d)(2)(B)(ii)) shall be treated as coverage
under an HSA-qualified health plan.''.
(b) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after the date of the enactment of this Act.
SEC. 205. TREATMENT OF DIRECT PRIMARY CARE SERVICE ARRANGEMENTS.
(a) In General.--Section 223(c) is amended by adding at the end the
following new paragraph:
``(6) Treatment of direct primary care service
arrangements.--An arrangement under which an individual is
provided coverage restricted to primary care services in
exchange for a fixed periodic fee or payment for primary care
services--
``(A) shall not be treated as a health plan for
purposes of paragraph (1)(A)(ii), and
``(B) shall not be treated as insurance for
purposes of subsection (d)(2)(B).''.
(b) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after the date of the enactment of this Act.
SEC. 206. INDIVIDUALS ELIGIBLE FOR ON-SITE MEDICAL CLINIC COVERAGE.
(a) In General.--Paragraph (1) of section 223(c), as amended by
sections 203, is amended by adding at the end the following new
subparagraph:
``(F) Special rule for individuals eligible for on-
site medical clinic coverage.--
``(i) In general.--For purposes of
subparagraph (A)(ii), an individual shall not
be treated as covered under a health plan
described in such subparagraph merely because
the individual is eligible to receive health
care benefits from an on-site medical clinic of
the employer of the individual or the
individual's spouse if such health care
benefits are not significant benefits.
``(ii) Included benefits.--For purposes of
clause (i), the following health care benefits
shall be considered to be benefits which are
not significant benefits:
``(I) Physicals and immunizations.
``(II) Injecting antigens provided
by employees.
``(III) Medications available
without a prescription, such as pain
relievers and antihistamines.
``(IV) Treatment for injuries
occurring at the employer's place of
employment or otherwise in the course
of employment.
``(V) Tests for infectious diseases
and conditions, such as streptococcal
sore throat.
``(VI) Monitoring of chronic
conditions, such as diabetes.
``(VII) Drug testing.
``(VIII) Hearing or vision
screenings and related services.
``(IX) Other services and
treatments of a similar nature to the
services described in subclauses (I)
through (VIII).
``(iii) Aggregation rules.--For purposes of
clause (i), all persons treated as a single
employer under subsection (b), (c), (m), or (o)
of section 414 shall be treated as a single
employer.''.
(b) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after the date of the enactment of this Act.
SEC. 207. TREATMENT OF EMBEDDED DEDUCTIBLES.
(a) In General.--Paragraph (2) of section 223(c), as amended by
section 102(c)(4) of the No Surprises Act, is amended by adding at the
end the following new subparagraph:
``(G) Treatment of embedded deductible.--A health
plan providing family coverage that has an annual
deductible for all covered individuals under the plan
of at least the amount described in subparagraph
(A)(i)(II) shall not fail to be treated as an HSA-
qualified health plan solely because it covers expenses
with respect to an individual under that plan that
exceed an embedded deductible which is equal to or in
excess of the amount described in subparagraph
(A)(i)(I).''.
(b) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after the date of the enactment of this Act.
TITLE III--IMPROVING COVERAGE UNDER TAX-PREFERRED HEALTH ACCOUNTS
SEC. 301. PURCHASE OF HEALTH INSURANCE FROM HSA ACCOUNT.
(a) In General.--Paragraph (2) of section 223(d) is amended--
(1) by striking ``and any dependent (as defined in section
152, determined without regard to subsections (b)(1), (b)(2),
and (d)(1)(B) thereof) of such individual'' in subparagraph (A)
and inserting ``any dependent (as defined in section 152,
determined without regard to subsections (b)(1), (b)(2), and
(d)(1)(B) thereof) of such individual, and any child (as
defined in section 152(f)(1)) of such individual who has not
attained the age of 27 before the end of such individual's
taxable year'';
(2) by striking subparagraph (B) and inserting the
following:
``(B) Health insurance may not be purchased from
account.--Except as provided in subparagraph (C),
subparagraph (A) shall not apply to any payment for
insurance.''; and
(3) by striking ``or'' at the end of subparagraph (C)(iii)
and by striking subparagraph (C)(iv) and inserting the
following:
``(iv) an HSA-qualified health plan, or
``(v) any health insurance under title
XVIII of the Social Security Act, other than a
Medicare supplemental policy (as defined in
section 1882 of such Act).''.
(b) Effective Date.--The amendments made by this section shall
apply with respect to insurance purchased after the date of the
enactment of this Act in taxable years beginning after such date.
SEC. 302. SPECIAL RULE FOR CERTAIN MEDICAL EXPENSES INCURRED BEFORE
ESTABLISHMENT OF ACCOUNT.
(a) In General.--Paragraph (2) of section 223(d) is amended by
adding at the end the following new subparagraph:
``(E) Treatment of certain medical expenses
incurred before establishment of account.--If a health
savings account is established during the 60-day period
beginning on the date that coverage of the account
beneficiary under an HSA-qualified health plan begins,
then, solely for purposes of determining whether an
amount paid is used for a qualified medical expense,
such account shall be treated as having been
established on the date that such coverage begins.''.
(b) Effective Date.--The amendment made by this section shall apply
with respect to coverage beginning after the date of the enactment of
this Act.
SEC. 303. PREVENTIVE CARE PRESCRIPTION DRUG CLARIFICATION.
(a) Clarify Use of Drugs in Preventive Care.--Subparagraph (C) of
section 223(c)(2) is amended by adding at the end the following:
``Preventive care shall include prescription and over-the-counter drugs
and medicines which have the primary purpose of preventing the onset
of, further deterioration from, or complications associated with
chronic conditions, illnesses, or diseases.''.
(b) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after December 31, 2019.
TITLE IV--MISCELLANEOUS PROVISIONS RELATING TO TAX-PREFERRED HEALTH
ACCOUNTS
SEC. 401. FSA AND HRA INTERACTION WITH HSAS.
(a) Eligible Individuals Include FSA and HRA Participants.--
Subparagraph (B) of section 223(c)(1) is amended--
(1) by striking ``and'' at the end of clause (ii);
(2) by striking the period at the end of clause (iii) and
inserting ``, and''; and
(3) by inserting after clause (iii) the following new
clause:
``(iv) coverage under a health flexible
spending arrangement or a health reimbursement
arrangement in the plan year a qualified HSA
distribution as described in section 106(e) is
made on behalf of the individual if, after the
qualified HSA distribution is made and for the
remaining duration of the plan year, the
coverage provided under the arrangement is
converted solely to one or more of the
following:
``(I) Post-deductible fsa or hra.--
A health flexible spending arrangement
or a health reimbursement arrangement
that does not pay or reimburse any
medical expense incurred before the
minimum annual deductible under
paragraph (2)(A)(i) (prorated for the
period occurring after the qualified
HSA distribution is made) is satisfied.
``(II) Preventative care.--A health
flexible spending arrangement or a
health reimbursement arrangement that,
after the qualified HSA distribution is
made, does not pay or reimburse any
medical expense incurred after the
qualified HSA distribution is made
other than preventive care as defined
in paragraph (2)(C).
``(III) Limited purpose health
fsa.--A health flexible spending
arrangement that, after the qualified
HSA distribution is made, pays or
reimburses benefits for coverage
described in clause (ii) (but not
through insurance or for long-term care
services).
``(IV) Limited purpose hra.--A
health reimbursement arrangement that,
after the qualified HSA distribution is
made, pays or reimburses benefits for
permitted insurance or coverage
described in clause (ii) (but not for
long-term care services).
``(V) Retirement hra.--A health
reimbursement arrangement that, after
the qualified HSA distribution is made,
pays or reimburses only those medical
expenses incurred after an individual's
retirement (and no expenses incurred
before retirement).
``(VI) Suspended hra.--A health
reimbursement arrangement that, after
the qualified HSA distribution is made,
is suspended, pursuant to an election
made on or before the date the
individual elects a qualified HSA
distribution or, if later, on the date
of the individual enrolls in an HSA-
qualified health plan, that does not
pay or reimburse, at any time, any
medical expense incurred during the
suspension period except as described
in the preceding subclauses of this
clause.''.
(b) Qualified HSA Distribution Shall Not Affect Flexible Spending
Arrangement.--Paragraph (1) of section 106(e) is amended to read as
follows:
``(1) In general.--A plan shall not fail to be treated as--
``(A) a health flexible spending arrangement under
this section, section 105, or section 125,
``(B) a health reimbursement arrangement under this
section or section 105, or
``(C) an accident or health plan,
merely because such plan provides for a qualified HSA
distribution.''.
(c) FSA Balances at Year End Shall Not Forfeit.--Paragraph (2) of
section 125(d) is amended by adding at the end the following new
subparagraph:
``(E) Exception for qualified hsa distributions.--
Subparagraph (A) shall not apply to the extent that
there is an amount remaining in a health flexible
spending account at the end of a plan year that an
individual elects to contribute to a health savings
account pursuant to a qualified HSA distribution (as
defined in section 106(e)(2)).''.
(d) Simplification of Limitations on FSA and HRA Rollovers.--
Paragraph (2) of section 106(e) is amended to read as follows:
``(2) Qualified hsa distribution.--
``(A) In general.--The term `qualified HSA
distribution' means a distribution from a health
flexible spending arrangement or health reimbursement
arrangement directly to a health savings account of the
employee to the extent that such distribution does not
exceed the lesser of--
``(i) the balance in such arrangement as of
the date of such distribution, or
``(ii) the amount determined under
subparagraph (B).
Such term shall not include more than 1 distribution
with respect to any arrangement.
``(B) Dollar limitations.--
``(i) Distributions from a health flexible
spending arrangement.--A qualified HSA
distribution from a health flexible spending
arrangement shall not exceed the applicable
amount.
``(ii) Distributions from a health
reimbursement arrangement.--A qualified HSA
distribution from a health reimbursement
arrangement shall not exceed--
``(I) the applicable amount divided
by 12, multiplied by
``(II) the number of months during
which the individual is a participant
in the health reimbursement
arrangement.
``(iii) Applicable amount.--For purposes of
this subparagraph, the applicable amount is--
``(I) $2,250 in the case of an
eligible individual who has self-only
coverage under an HSA-qualified health
plan at the time of such distribution,
and
``(II) $4,500 in the case of an
eligible individual who has family
coverage under an HSA-qualified health
plan at the time of such
distribution.''.
(e) Elimination of Additional Tax for Failure To Maintain HSA-
Qualified Health Plan Coverage.--Subsection (e) of section 106, as
amended by section 101, is amended--
(1) by striking paragraph (3) and redesignating paragraphs
(4) and (5) as paragraphs (3) and (4), respectively; and
(2) by striking subparagraph (A) of paragraph (3), as so
redesignated, and redesignating subparagraphs (B) and (C) of
such paragraph as subparagraphs (A) and (B) thereof,
respectively.
(f) Limited Purpose FSAs and HRAs.--Subsection (e) of section 106,
as amended by this section, is amended by adding at the end the
following new paragraph:
``(5) Limited purpose fsas and hras.--A plan shall not fail
to be a health flexible spending arrangement, a health
reimbursement arrangement, or an accident or health plan under
this section or section 105 merely because the plan converts
coverage for individuals who enroll in an HSA-qualified health
plan described in section 223(c)(2) to coverage described in
subclause (I), (II), (III), (IV), (V), or (VI) of section
223(c)(1)(B)(iv). Coverage for such individuals may be
converted as of the date of enrollment in the HSA-qualified
health plan, without regard to the period of coverage under the
health flexible spending arrangement or health reimbursement
arrangement, and without requiring any change in coverage to
individuals who do not enroll in an HSA-qualified health
plan.''.
(g) Distribution Amounts Adjusted for Cost-of-Living.--Subsection
(e) of section 106, as amended by this section, is amended by adding at
the end the following new paragraph:
``(6) Cost-of-living adjustment.--
``(A) In general.--In the case of any taxable year
beginning in a calendar year after 2019, each of the
dollar amounts in paragraph (2)(B)(iii) shall be
increased by an amount equal to such dollar amount,
multiplied by the cost-of-living adjustment determined
under section 1(f)(3) for the calendar year in which
such taxable year begins by substituting `calendar year
2018' for `calendar year 2016' in subparagraph (A)(ii)
thereof.
``(B) Rounding.--If any increase under paragraph
(1) is not a multiple of $50, such increase shall be
rounded to the nearest multiple of $50.''.
(h) Disclaimer of Disqualifying Coverage.--Subparagraph (B) of
section 223(c)(1), as amended by this section, is amended--
(1) by striking ``and'' at the end of clause (iii);
(2) by striking the period at the end of clause (iv) and
inserting ``, and''; and
(3) by inserting after clause (iv) the following new
clause:
``(v) any coverage (including prospective
coverage) under a health plan that is not an
HSA-qualified health plan which is disclaimed
in writing, at the time of the creation or
organization of the health savings account,
including by execution of a trust described in
subsection (d)(1) through a governing
instrument that includes such a disclaimer, or
by acceptance of an amendment to such a trust
that includes such a disclaimer.''.
(i) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after the date of the enactment of
this Act.
SEC. 402. EQUIVALENT BANKRUPTCY PROTECTIONS FOR HEALTH SAVINGS ACCOUNTS
AS RETIREMENT FUNDS.
(a) In General.--Section 522 of title 11, United States Code, is
amended by adding at the end the following new subsection:
``(r) Treatment of Health Savings Accounts.--For purposes of this
section, any health savings account (as described in section 223 of the
Internal Revenue Code of 1986) shall be treated in the same manner as
an individual retirement account described in section 408 of such
Code.''.
(b) Effective Date.--The amendment made by this section shall apply
to cases commencing under title 11, United States Code, after the date
of the enactment of this Act.
SEC. 403. ADMINISTRATIVE ERROR CORRECTION BEFORE DUE DATE OF RETURN.
(a) In General.--Paragraph (4) of section 223(f) is amended by
adding at the end the following new subparagraph:
``(D) Exception for administrative errors corrected
before due date of return.--Subparagraph (A) shall not
apply if any payment or distribution is made to correct
an administrative, clerical, or payroll contribution
error and if--
``(i) such distribution is received by the
individual on or before the last day prescribed
by law (including extensions of time) for
filing such individual's return for such
taxable year, and
``(ii) such distribution is accompanied by
the amount of net income attributable to such
contribution.
Any net income described in clause (ii) shall be
included in the gross income of the individual for the
taxable year in which it is received.''.
(b) Effective Date.--The amendment made by this section shall take
effect on the date of the enactment of this Act.
SEC. 404. REAUTHORIZATION OF MEDICAID HEALTH OPPORTUNITY ACCOUNTS.
(a) In General.--Section 1938 of the Social Security Act (42 U.S.C.
1396u-8) is amended--
(1) in subsection (a)--
(A) by striking paragraph (2) and inserting the
following:
``(2) Initial demonstration.--The Secretary shall approve
States to conduct demonstration programs under this section for
a 5-year period, with each State demonstration program covering
one or more geographic areas specified by the State. With
respect to a State, after the initial 5-year period of any
demonstration program conducted under this section by the
State, unless the Secretary finds, taking into account cost-
effectiveness and quality of care, that the State demonstration
program has been unsuccessful, the demonstration program may be
extended or made permanent in the State.''; and
(B) in paragraph (3), in the matter preceding
subparagraph (A)--
(i) by striking ``not''; and
(ii) by striking ``unless'' and inserting
``if'';
(2) in subsection (b)--
(A) in paragraph (3), by inserting ``clause (i)
through (vii), (viii) (without regard to the amendment
made by section 2004(c)(2) of Public Law 111-148), (x),
or (xi) of'' after ``described in''; and
(B) by striking paragraphs (4), (5), and (6);
(3) in subsection (c)--
(A) by striking paragraphs (3) and (4);
(B) by redesignating paragraphs (5) through (8) as
paragraphs (3) through (6), respectively; and
(C) in paragraph (4) (as redesignated by
subparagraph (B)), by striking ``Subject to
subparagraphs (D) and (E)'' and inserting ``Subject to
subparagraph (D)''; and
(4) in subsection (d)--
(A) in paragraph (2), by striking subparagraph (E);
and
(B) in paragraph (3)--
(i) in subparagraph (A)(ii), by striking
``Subject to subparagraph (B)(ii), in'' and
inserting ``In''; and
(ii) by striking subparagraph (B) and
inserting the following:
``(B) Maintenance of health opportunity account
after becoming ineligible for public benefit.--
Notwithstanding any other provision of law, if an
account holder of a health opportunity account becomes
ineligible for benefits under this title because of an
increase in income or assets--
``(i) no additional contribution shall be
made into the account under paragraph
(2)(A)(i); and
``(ii) the account shall remain available
to the account holder for 3 years after the
date on which the individual becomes ineligible
for such benefits for withdrawals under the
same terms and conditions as if the account
holder remained eligible for such benefits, and
such withdrawals shall be treated as medical
assistance in accordance with subsection
(c)(4).''.
(b) Conforming Amendment.--Section 613 of Public Law 111-3 is
repealed.
SEC. 405. MAXIMUM CONTRIBUTION LIMIT TO HEALTH SAVINGS ACCOUNT
INCREASED TO AMOUNT OF DEDUCTIBLE AND OUT-OF-POCKET
LIMITATION.
(a) Self-Only Coverage.--Section 223(b)(2)(A) is amended by
striking ``$2,250'' and inserting ``the amount in effect under
subsection (c)(2)(A)(ii)(I)''.
(b) Family Coverage.--Section 223(b)(2)(B) is amended by striking
``$4,500'' and inserting ``the amount in effect under subsection
(c)(2)(A)(ii)(II)''.
(c) Conforming Amendments.--Section 223(g)(1) is amended--
(1) by striking ``subsections (b)(2) and'' both places it
appears and inserting ``subsection''; and
(2) by striking ``determined by'' in subparagraph (B)
thereof and all that follows through ```calendar year 2003'.''
and inserting ``determined by substituting `calendar year 2003'
for `calendar year 2016' in subparagraph (A)(ii) thereof.''.
(d) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2021.
TITLE V--OTHER PROVISIONS
SEC. 501. CERTAIN EXERCISE EQUIPMENT AND PHYSICAL FITNESS PROGRAMS
TREATED AS MEDICAL CARE.
(a) In General.--Subsection (d) of section 213 is amended by adding
at the end the following new paragraph:
``(12) Exercise equipment and physical fitness activity.--
``(A) In general.--The term `medical care' shall
include amounts paid--
``(i) for equipment for use in a program
(including a self-directed program) of physical
exercise or physical activity,
``(ii) to participate, or receive
instruction, in a program of physical exercise,
nutrition, or health coaching (including a
self-directed program), and
``(iii) for membership at a fitness
facility.
``(B) Overall dollar limitation.--
``(i) In general.--Amounts treated as
medical care under subparagraph (A) shall not
exceed $1,000 with respect to any individual
for any taxable year.
``(ii) Exception.--Clause (i) shall not
apply for purposes of determining whether
expenses reimbursed through a health flexible
spending arrangement subject to section
125(i)(1) are incurred for medical care.
``(C) Limitations related to sports and fitness
equipment.--Amounts paid for equipment described in
subparagraph (A)(i) shall be treated as medical care
only--
``(i) if such equipment is utilized
exclusively for participation in fitness,
exercise, sport, or other physical activity
programs,
``(ii) if such equipment is not apparel or
footwear, and
``(iii) in the case of any item of sports
equipment (other than exercise equipment), with
respect to so much of the amount paid for such
item as does not exceed $250.
``(D) Fitness facility defined.--For purposes of
subparagraph (A)(iii), the term `fitness facility'
means a facility--
``(i) providing instruction in a program of
physical exercise, offering facilities for the
preservation, maintenance, encouragement, or
development of physical fitness, or serving as
the site of such a program of a State or local
government,
``(ii) which is not a private club owned
and operated by its members,
``(iii) which does not offer golf, hunting,
sailing, or riding facilities,
``(iv) whose health or fitness facility is
not incidental to its overall function and
purpose, and
``(v) which is fully compliant with the
State of jurisdiction and Federal anti-
discrimination laws.''.
(b) Limitation Not To Apply for Certain Purposes.--
(1) Health savings accounts.--Subparagraph (A) of section
223(d)(2) is amended by inserting ``, determined without regard
to paragraph (12)(B) thereof'' after ``medical care (as defined
in section 213(d)''.
(2) Archer msas.--Subparagraph (A) of section 220(d)(2) is
amended by inserting ``, determined without regard to paragraph
(12)(B) thereof'' after ``medical care (as defined in section
213(d)''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after the date of the enactment of
this Act.
SEC. 502. CERTAIN NUTRITIONAL AND DIETARY SUPPLEMENTS TO BE TREATED AS
MEDICAL CARE.
(a) In General.--Subsection (d) of section 213, as amended by
section 501, is amended by adding at the end the following new
paragraph:
``(13) Nutritional and dietary supplements.--
``(A) In general.--The term `medical care' shall
include amounts paid to purchase herbs, vitamins,
minerals, homeopathic remedies, meal replacement
products, and other dietary and nutritional
supplements.
``(B) Limitation.--Amounts treated as medical care
under subparagraph (A) shall not exceed $1,000 with
respect to any individual for any taxable year.
``(C) Meal replacement product.--For purposes of
this paragraph, the term `meal replacement product'
means any product that--
``(i) is permitted to bear labeling making
a claim described in section 403(r)(3) of the
Federal Food, Drug, and Cosmetic Act, and
``(ii) is permitted to claim under such
section that such product is low in fat and is
a good source of protein, fiber, and multiple
essential vitamins and minerals.
``(D) Exception.--Subparagraph (B) shall not apply
for purposes of determining whether expenses reimbursed
through a health flexible spending arrangement subject
to section 125(i)(1) are incurred for medical care.''.
(b) Limitation Not To Apply for Certain Purposes.--
(1) Health savings accounts.--Subparagraph (A) of section
223(d)(2), as amended by section 501, is amended by striking
``paragraph (12)(B)'' and inserting ``paragraphs (12)(B) and
(13)(B)''.
(2) Archer msas.--Subparagraph (A) of section 220(d)(2), as
amended by section 501, is amended by striking ``paragraph
(12)(B)'' and inserting ``paragraphs (12)(B) and (13)(B)''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after the date of the enactment of
this Act.
SEC. 503. CERTAIN PROVIDER FEES TO BE TREATED AS MEDICAL CARE.
(a) In General.--Subsection (d) of section 213, as amended by
sections 501 and 502, is amended by adding at the end the following new
paragraph:
``(14) Periodic provider fees.--The term `medical care'
shall include--
``(A) periodic fees paid to a primary care
physician for a defined set of medical services or the
right to receive medical services on an as-needed
basis, and
``(B) pre-paid primary care services designed to
screen for, diagnose, cure, mitigate, treat, or prevent
disease and promote wellness.''.
(b) Exception for Flexible Spending Accounts.--Section 125 is
amended by redesignating subsections (k) and (l) as subsections (l) and
(m), respectively, and by inserting after subsection (j) the following
new subsection:
``(k) Special Rule With Respect to Health Flexible Spending
Arrangements.--For purposes of applying this with respect to any health
flexible spending arrangement, amounts described in section 213(d)(14)
shall not be considered insurance.''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after the date of the enactment of
this Act.
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