COVID-19 Testing Site, Clinic Operator Seeks Tax Changes

December 22, 2020

Sunita Lough
Deputy Commissioner, Services and Enforcement
Internal Revenue Service
Attn: CC:PA: LPD:PR (IRS Review of Regulatory Relief), Room 5203
P.O. Box 7604
Ben Franklin Station
Washington, DC 20044

Dear Ms. Lough:

One Medical is pleased to submit comments to the IRS Review of Regulatory and Other Relief To Support Economic Recovery Request for Comments. One Medical is a membership-based primary care practice on a mission to make high quality care more affordable, accessible, and enjoyable for all through a blend of human-centered design, technology, and an exceptional team. Our members enjoy seamless access to comprehensive care at convenient offices near where they work, live, and “click” in twelve major U.S. markets (with more to come in 2021), as well as 24/7 access to virtual care.

Today, One Medical operates more than 100 clinics and walk-up/drive-through COVID-19 testing sites in 17 major metropolitan areas. We recently launched our workplace/campus reentry program, “Healthy Together,” designed to support employers and schools as they migrate workforces and students back into shared environments. One Medical's primary care providers are screening for potential SARS–CoV–2 infection and caring for patients who have contracted COVID–19. As we work to address this pandemic, One Medical is striving to ensure we protect our providers, order and administer testing consistent with clinical and CDC guidelines, prepare to effectively distribute and administer vaccines, and permit continued virtual care access that is convenient, timely, and cost-effective to help patients better manage their health.

This letter provides our policy recommendations given recent legislative and regulatory developments taken in response to the COVID-19 pandemic and economic downturn, including the May 19 Executive Order (E.O. 13924) on Regulatory Relief to Support Economic Recovery. In response to the Request for Comments, we address regulations and other requirements that can be rescinded, modified, or waived to assist business and individual taxpayers with the ongoing economic recovery from the Coronavirus Disease 2019 pandemic below.

Recommendation #1: Expand the preventive care safe harbor under Sec. 223(c)(2)(C) of the Internal Revenue Code to allow high-deductible health plans (HDHPs) to cover all primary care, whether virtual or in-person, on a pre-deductible basis and with no cost-sharing.

There is recent precedent for expanding the preventive care safe harbor. In 2019, IRS established in a Notice (Notice 2019-45) that the preventive care safe harbor extends to certain chronic care items and services which may be covered by Health Savings Account (HSA)-qualified HDHPs on a pre-deductible basis. Incentivizing primary care in this way would help reduce financial barriers for Americans seeking primary care for regular check-ups, maintenance care, and care that has been deferred due to the pandemic, particularly as many Americans are experiencing financial hardships. It will also aid primary care practitioners across the country experiencing steep losses in revenue. Primary care interventions help reduce downstream costs like emergency room or urgent care visits, which is especially important during the pandemic and as many Americans incur additional debt to continue to meet business and household expenses.

Recommendation #2: Exercise enforcement discretion to extend permanently, or at least through the economic recovery period, the bipartisan provisions under section 3701 of the CARES Act.

Section 3701 establishes a time-limited temporary telehealth-specific safe harbor, for purposes of Section 223 of the Code, to allow telehealth and other remote care services to be covered pre-deductible and allows plan sponsors to offer telehealth and remote care services as a standalone benefit offering to individuals enrolled in an HSA-qualified HDHP. Exercising enforcement discretion is appropriate given the positive role of telehealth and remote services during the pandemic to ensure access to care and to accommodate new norms and consumer expectations regarding remote health care service delivery.

Recommendation #3: Allow HSA-qualified HDHPs to continue to cover all received medical care services and purchased items associated with testing for and treatment of COVID-19 on a pre-deductible basis. Cost for testing and treatment of COVID-19 should not be a barrier regardless of coverage, and allowing for this flexibility will give plan sponsors additional options to better ensure that the entire workforce and their families can seek medically necessary appropriate care. We appreciate the IRS' recent guidance on this issue pursuant to Notice 2020-15 (made retroactive to January 1, 2020 through Notice 2020-29) and suggest confirmation that this flexibility is permanent (until further notice) for added clarity.

We request that IRS take these actions at least through the economic recovery period, to effectuate the stated goals of E.O. 13924, and to consider taking these actions on a permanent basis to aid taxpayers and businesses as they seek affordable choices to finance their health care needs for themselves and their families. One Medical hopes these recommendations will be helpful to IRS as you advance the President's vision of a swift and forceful economic recovery for the nation's critical health care sector and financial relief for Americans who choose consumer-driven health options like HSAs and direct primary care.

If you have any questions, please do not hesitate to reach out to me at lmango@onemedical.com.

Sincerely,

Lisa Mango
General Counsel
One Medical