Treatment of direct primary care service arrangements

(a) In general Section 223(c)(1) is amended by adding at the end the following new subparagraph: (E) 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, (II) prescription drugs (other than vaccines), and (III) 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) 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) is amended— (1) by striking in subsections (b)(2) and (c)(2)(A) and inserting in subsections (b)(2), (c)(2)(A), and in the case of taxable years beginning after 2026, (c)(1)(E)(ii)(II), (2) in subparagraph (B), by striking clause (ii) in clause (i) and inserting clauses (ii) and (iii), 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)(E)(ii)(II), calendar year 2025., and (3) by inserting, (c)(1)(E)(ii)(II), after (b)(2) in the last sentence. (d) Effective date The amendments made by this section shall apply to months beginning after December 31, 2025.

(a) In general Section 223(c)(1) is amended by adding at the end the following new subparagraph: (E) 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, (II) prescription drugs (other than vaccines), and (III) 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) 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) is amended— (1) by striking in subsections (b)(2) and (c)(2)(A) and inserting in subsections (b)(2), (c)(2)(A), and in the case of taxable years beginning after 2026, (c)(1)(E)(ii)(II), (2) in subparagraph (B), by striking clause (ii) in clause (i) and inserting clauses (ii) and (iii), 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)(E)(ii)(II), calendar year 2025., and (3) by inserting, (c)(1)(E)(ii)(II), after (b)(2) in the last sentence. (d) Effective date The amendments made by this section shall apply to months beginning after December 31, 2025.