I
119THCONGRESS
1
STSESSION H. R. 1026
To amend the Internal Revenue Code of 1986 to allow individuals with
direct primary care service arrangements to remain eligible individuals
for purposes of health savings accounts, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY5, 2025
Mr. S
MUCKER(for himself, Ms. TENNEY, Mr. SCHNEIDER, Mr. PANETTA, Mr.
C
RENSHAW, and Ms. SCHRIER) introduced the following bill; which was
referred to the Committee on Ways and Means
A BILL
To amend the Internal Revenue Code of 1986 to allow indi-
viduals with direct primary care service arrangements
to remain eligible individuals for purposes of health sav-
ings accounts, and for other purposes.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Primary Care En-4
hancement Act of 2025’’. 5
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SEC. 2. TREATMENT OF DIRECT PRIMARY CARE SERVICE 1
ARRANGEMENTS. 2
(a) I
NGENERAL.—Section 223(c)(1) of the Internal 3
Revenue Code of 1986 is amended by adding at the end 4
the following new subparagraph: 5
‘‘(E) T
REATMENT OF DIRECT PRIMARY 6
CARE SERVICE ARRANGEMENTS .— 7
‘‘(i) I
N GENERAL.—A direct primary 8
care service arrangement shall not be 9
treated as a health plan for purposes of 10
subparagraph (A)(ii). 11
‘‘(ii) D
IRECT PRIMARY CARE SERVICE 12
ARRANGEMENT.—For purposes of this 13
paragraph— 14
‘‘(I) I
N GENERAL.—The term ‘di-15
rect primary care service arrange-16
ment’ means, with respect to any indi-17
vidual, an arrangement under which 18
such individual is provided medical 19
care (as defined in section 213(d)) 20
consisting solely of primary care serv-21
ices provided by primary care practi-22
tioners (as defined in section 23
1833(x)(2)(A) of the Social Security 24
Act, determined without regard to 25
clause (ii) thereof), if the sole com-26
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pensation for such care is a fixed peri-1
odic fee. 2
‘‘(II) L
IMITATION.—With respect 3
to any individual for any month, such 4
term shall not include any arrange-5
ment if the aggregate fees for all di-6
rect primary care service arrange-7
ments (determined without regard to 8
this subclause) with respect to such 9
individual for such month exceed 10
$150 (twice such dollar amount in the 11
case of an individual with any direct 12
primary care service arrangement (as 13
so determined) that covers more than 14
one individual). 15
‘‘(iii) C
ERTAIN SERVICES SPECIFI -16
CALLY EXCLUDED FROM TREATMENT AS 17
PRIMARY CARE SERVICES .—For purposes 18
of this paragraph, the term ‘primary care 19
services’ shall not include— 20
‘‘(I) procedures that require the 21
use of general anesthesia, 22
‘‘(II) prescription drugs (other 23
than vaccines), and 24
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‘‘(III) laboratory services not 1
typically administered in an ambula-2
tory primary care setting. 3
The Secretary, after consultation with the 4
Secretary of Health and Human Services, 5
shall issue regulations or other guidance 6
regarding the application of this clause.’’. 7
(b) D
IRECTPRIMARYCARESERVICEARRANGEMENT 8
F
EESTREATED AS MEDICALEXPENSES.—Section 9
223(d)(2)(C) of such Code is amended by striking ‘‘or’’ 10
at the end of clause (iii), by striking the period at the 11
end of clause (iv) and inserting ‘‘, or’’, and by adding at 12
the end the following new clause: 13
‘‘(v) any direct primary care service 14
arrangement.’’. 15
(c) I
NFLATIONADJUSTMENT.—Section 223(g)(1) of 16
such Code is amended— 17
(1) by inserting ‘‘, (c)(1)(D)(ii)(II),’’ after 18
‘‘(b)(2)’’ each place it appears, and 19
(2) in subparagraph (B), by inserting ‘‘and 20
(iii)’’ after ‘‘clause (ii)’’ in clause (i), by striking 21
‘‘and’’ at the end of clause (i), by striking the period 22
at the end of clause (ii) and inserting ‘‘, and’’, and 23
by inserting after clause (ii) the following new 24
clause: 25
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‘‘(iii) in the case of the dollar amount 1
in subsection (c)(1)(D)(ii)(II) for taxable 2
years beginning in calendar years after 3
2026, ‘calendar year 2025’.’’. 4
(d) R
EPORTING OFDIRECTPRIMARYCARESERVICE 5
A
RRANGEMENT FEES ONW–2.—Section 6051(a) of such 6
Code is amended by striking ‘‘and’’ at the end of para-7
graph (16), by striking the period at the end of paragraph 8
(17) and inserting ‘‘, and’’, and by inserting after para-9
graph (17) the following new paragraph: 10
‘‘(18) in the case of a direct primary care serv-11
ice arrangement (as defined in section 12
223(c)(1)(D)(ii)) which is provided in connection 13
with employment, the aggregate fees for such ar-14
rangement for such employee.’’. 15
(e) E
FFECTIVEDATE.—The amendments made by 16
this section shall apply to months beginning after Decem-17
ber 31, 2025, in taxable years ending after such date. 18
Æ
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