MARYLAND:

Members of Congress have asked the Commissioner of Internal Revenue for clarification on how the Internal Revenue Service (IRS) treats Direct Primary Care Medical Homes with regard to Health Savings Accounts (HSAs).

Senator Maria Cantwell (D-WA), who authored ACA Sec. 1301 (a) (3), allowing DPC practices to participate in health exchanges with Qualified Health Plans, took the lead on the letter and was joined by Senate Budget Committee Chairman Patty Murray (D-WA) and Rep. Jim McDermott, MD (D-WA), ranking member of the Ways and Means Subcommittee on Health. The three WA state lawmakers point out that The ACA rules on exchanges and Qualified Health Plans (CMS-9989-F) promulgated by HHS, clearly state that DPC is not health insurance, and that the law has its roots in a provision in WA state law (48.150RCW) defining DPC as a health benefit outside insurance.

In subsequent meetings with officials at the IRS and the Department of the Treasury, as late as March of 2015, the administration continues to interpret DPC membership agreements as "health plans" under Sec. 223 (c) of the Internal Revenue Code (IRC)

This section says that HSA holders must be covered under a high deductible health plan while not covered under any health plan—which is not a high deductible health plan, and which provides coverage for any benefit which is covered under the high deductible health plan.

DPCC Continues to have dialogue with officials at Treasury to ask for a change in IRS guidance so that DPC fees are qualified medical expenses under Sec. 213 (d) of the IRC and can be offered as a benefit complimenting Health Savings Accounts (HSAs) paired with high deducible health plans. If the administration is unwilling to make such a change, legislation will be needed for practices to have clarity on the meaning of these regulations.

IRS Response:

Tell Congress:

All Americans Need Access to Affordable Primary Care

Please contact your Senators today

Ask Congress to support

HR 6199, Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018,

And

S.1358

The Primary Care Enhancement Act

Direct Primary Care is an innovative new way to deliver unlimited access to primary care for Americans of all ages and incomes outside of the entanglements of third party fee for service billing. With DPC, employers, individuals, or health plans pay the doctor a periodic fee directly for unlimited access to primary care and prevention services.

DPC is helping improve health care across America

by rebuilding the doctor patient relationship.

Unfortunately, the 21 million Americans with Health Savings Accounts cannot use a DPC physician because of outdated IRS regulations. The Primary Care Enhancement Act clarifies the tax code, defining DPC as a qualified health expense and not a health plan, allowing all Americans with HSAs better access to great affordable primary care.

Senators need to hear from their constituents about the importance of bringing high-quality affordable primary care to more Americans using DPC.

Download DPC Talking Points here:

Download HSA Growth Points here:

Download our letter to Chairman Brady here:

Connect

Please email your Senators' health staffers. Senators can be found on the list to the right. House members and House Ways and Means emails are at the top right.

Support & Explain

Send a short email explaining the importance of Section 3 of the Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018 and S. 1358 the Primary Care Enhancement Act. BRIEFLY, tell your story and explain why it is critical that Medicare beneficiaries and employees with HSAs have access to DPC Medical Homes. Attach the talking points and the 'Dear Colleague' letter from Senator Cassidy, both found below.

Thank you & Send!

If you are emailing Senators Cassidy or Cantwell, or any of the bills co-sponsors, be sure to thank them for their leadership in sponsoring the Primary Care Enhancement Act.

House Ways & Means Committee

Republican Members

Kevin Brady (TX-8)

Sam Johnson (TX-3)

Devin Nunes (CA-22)

Dave Reichert (WA-8)

Peter Roskam (IL-6)

Vern Buchanan (FL-16)

Adrian Smith (NE-3)

Lynn Jenkins (KS-2)

Erik Paulsen (MN-3)

Kenny Marchant (TX-24)

Diane Black (TN-6)

Tom Reed (NY-23)

Mike Kelly PA-3)

Jim Renacci (OH-16)

Vacant (PA-7)

Kristi Noem (SD-1)

George Holding (NC-2)

Jason Smith (MO-8)

Tom Rice (SC-7)

David Schweikert (AR-6)

Jackie Walorski (IN-2)

Carlos Curbelo (FL-26)

Mike Bishop (MI-8)

Darrin LaHood (IL-18)

Democrats

Richard Neal (MA-1)

Sander Levin (MI-9)

John Lewis (GA-5)

Llloyd Doggett (TX-35)

Mike Thompson (CA-5)

John Larson (CT-1)

Earl Blumenauer (OR-3)

Ron Kind (WI-3)

Bill Pascrell (NJ-9)

Joseph Crowley (NY-14)

Danny Davis (IL-7)

Linda Sanchez(CA-38)

Brian Higgins (NY-26)

Terri Sewell (AL-7)

Suzan DelBene (WA-1)

Judy Chu (CA-27)

On Thursday, April 16, 2015 the President signed H.R. 2, The Medicare Access and CHIP Reauthorization Act (MACRA) to permanently end the flawed “Sustainable Growth Rate” (“SGR”) physician payment formula and begin the process of transforming Medicare from fee-for-service into value based payment and delivery models, including direct primary care medical homes. H.R. 2 enables Medicare to move into value based models, but the new law replaces SGR with a whole new set of acronyms to learn and understand, like MIPS, APMs and the TAC. While much of the detail on how the changes will take shape is still unfolding, one thing is clear in Congressional intent: The days of the per visit fee are numbered. Payment reforms will be based on physicians' ability to demonstrate measured value by improving outcomes and reducing costs. Read more here.

Organized Medicine Rallies to Support the Primary Care Enhancement Act

The American Academy of Family Physicians and the American Osteopathic Association have announced support for S. 1989, the Primary Care Enhancement Act. “On behalf of the AOA and the more than 110,000 osteopathic physicians and osteopathic medical students we represent, thank you for introducing the “Primary Care Enhancement Act,” said AOA President John Becher, DO, adding; "the AOA commends your efforts to make access to coordinated health care less cost prohibitive." AAFP Board Chair Reid Blackwelder, MD, FAAFP praised Sen. Bill Cassidy, MD (R-LA) for his leadership, writing: “I am pleased to inform you that the AAFP supports the bill,” which would also allow patients “enrolled in Medicare, to more easily avail themselves of services through the DPC model.” Read full text at AAFP.org.

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Congress Asks IRS to Clarify Policy on Use of HSAs with DPC