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Bill
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H.R. 6317 — what changed

Primary Care Enhancement Act of 2018

From Introduced in House to Reported in House. 1 section amended and 1 added between Introduced in House and Reported in House.

Section 1 Short title

added This Act may be cited as the “Primary Care Enhancement Act of 2018”.

(a)
removed In general— Section 223(c)(1) of the Internal Revenue Code of 1986 is amended by adding at the end the following new subparagraph:

removed “(D) Treatment of direct primary care service arrangements

removed “(i) In general—A direct primary care service arrangement shall not be treated as a health plan for purposes of subparagraph (A)(ii).

removed “(ii) Direct primary care service arrangement—For purposes of this paragraph—

removed “(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 (as defined in section 1833(x)(2)(B) of the Social Security Act) 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.

removed “(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).

removed “(iii) Certain services specifically excluded from treatment as primary care services—For purposes of this paragraph, the term “primary care services” shall not include—

removed “(I) procedures that require the use of general anesthesia,

removed “(II) prescription drugs (other than vaccines), and

removed “(III) laboratory services not typically administered in an ambulatory primary care setting.”

(b)
removed Direct primary care service arrangement fees treated as medical expenses— Section 223(d)(2)(C) 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:

removed “(v) any direct primary care service arrangement.”

(c)
removed Inflation adjustment— Section 223(g)(1) of such Code is amended—
(1)
removed by striking “and (c)(2)(A)” and inserting “, (c)(1)(D)(ii)(II), and (c)(2)(A)”, and
(2)
removed in subparagraph (B), by striking “clause (ii)” and inserting “clauses (ii) and (iii)” 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:

removed “(iii) in the case of the dollar amount in subsection (c)(1)(D)(ii)(II) for taxable years beginning in calendar years after 2019, “calendar year 2018”.”

(d)
removed 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: .

removed “(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)
removed Effective date— The amendments made by this subsection shall apply to months beginning after December 31, 2018, in taxable years ending after such date.

Sec. 2 Treatment of direct primary care service arrangements

added
(a)
added In general— Section 223(c)(1) of the Internal Revenue Code of 1986 is amended by adding at the end the following new subparagraph:

added “(D) Treatment of direct primary care service arrangements

added “(i) In general—A direct primary care service arrangement shall not be treated as a health plan for purposes of subparagraph (A)(ii).

added “(ii) Direct primary care service arrangement—For purposes of this paragraph—

added “(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 (as defined in section 1833(x)(2)(B) of the Social Security Act) 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.

added “(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).

added “(iii) Certain services specifically excluded from treatment as primary care services—For purposes of this paragraph, the term “primary care services” shall not include—

added “(I) procedures that require the use of general anesthesia,

added “(II) prescription drugs (other than vaccines), and

added “(III) laboratory services not typically administered in an ambulatory primary care setting.”

(b)
added Direct primary care service arrangement fees treated as medical expenses— Section 223(d)(2)(C) 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:

added “(v) any direct primary care service arrangement.”

(c)
added Inflation adjustment— Section 223(g)(1) of such Code is amended—
(1)
added by striking “and (c)(2)(A)” each place it appears and inserting “, (c)(1)(D)(ii)(II), and (c)(2)(A)”, and
(2)
added in subparagraph (B), by striking “clause (ii)” and inserting “clauses (ii) and (iii)” 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:

added “(iii) in the case of the dollar amount in subsection (c)(1)(D)(ii)(II) for taxable years beginning in calendar years after 2019, “calendar year 2018”.”

(d)
added 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: .

added “(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)
added Effective date— The amendments made by this section shall apply to months beginning after December 31, 2018, in taxable years ending after such date.