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). (C) Certain services specifically excluded from treatment as primary care services For purposes of this paragraph, 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 subparagraph. . (c) Inflation adjustment Section 223(g)(1) of such Code is amended— (1) by striking and (c)(2)(A) and inserting , (c)(2)(A), and (c)(4)(B) , and (2) 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: (iii) in the case of the dollar amount in subsection (c)(4)(B) for taxable years beginning in calendar years after 2019, calendar year 2018 . . (d) 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: (18) in the case of a direct primary care service arrangement (as defined in section 223(c)(4)) which is provided in connection with employment, the aggregate fees for such arrangement for such employee. . (e) Effective date The amendments made by this subsection shall apply to months beginning after December 31, 2018, in taxable years ending after such date. 5. Allowing certain individuals with alternative health coverage to choose to opt out of the Medicare part A benefit (a) In