Did you know that most states are currently passing direct primary care state laws? On April 16, 2015, President Obama signed H.R. 2, The Medicare Access and CHIP Reauthorization Act. This act opened direct primary care to Medicare patients. Since then, direct primary care state laws have quietly appeared in 25 states. Direct primary care (aka “concierge”) is a payment model that circumvents health insurance. In a nutshell, it allows patients to pay an annual fee to see their doctor as needed throughout the year.
David Usher, MD put it this way:
“I was experiencing the same thing a lot of Primary Care Physicians are. The system just over time ratcheting down what you get paid and forcing you to work harder and harder to get it,” Usher says, adding there was too much hassle to get paid and patients couldn’t afford the care he was recommending.
For Usher, a DPC practice turned out to be the right solution.
Before moving to a DPC model, there are many factors a physician should consider. The new direct primary care state laws are a good place to start. In some ways these laws all sound similar. They attempt to exclude direct care providers from insurance regulations. However, they can vary when it comes to added rules. Some direct primary care state laws regulate whether a clinic can dispense medication. Some set limits on using DPC with Medicare and other programs. A handful of states require doctors to register as Direct Primary Care providers before switching to DPC.
Direct Primary Care State Laws
|Alabama||SB94 — The Alabama Physicians and Dentists Direct Pay Act asserts that a DPC agreement is not subject to insurance laws.|
|Arizona||§ 20-123 — This bill defines DPC and excludes it from insurance regulation.|
|Arkansas||HB 1161 — The Arkansas “Concierge” Law excludes DPC agreements from the insurance laws of Arkansas. Note: it also states that in-office dispensing of medications requires a permit.|
|Colorado||HB17-1115 — This bill lists DPC agreement requirements. Note: Title 25.5. § 25.5-4-301 prohibits DPC agreements with Medicaid patients for services covered by Medicaid.|
|Florida||SB 80 and HB 37 — These bills defines DPC and excludes it from insurance regulation. Note: Florida needs physicians to register as “dispensing practitioners” before dispensing medications.|
|Idaho||SB 1062 — This senate bill excludes the direct patient care model from the insurance code. It also sets up rules and regulations for providers.|
|Indiana||SB 303 — This senate bill excludes DPC from insurance laws. Furthermore, DPC providers do not need to get an insurance certificate of authority.|
|Iowa||HF 2275 and HF 2356 — These 2 House Bills allow and set the requirements for DPC agreements.|
|Kansas||HB2225 — This House Bill includes a clear definition of DPC. It asserts that a DPC agreement is not classified as insurance.|
|Kentucky||KRS 331.6201 and 311.6202 — This Bill excludes DPC from insurance laws. Note: it prohibits billing Medicaid or an insurer for services included in the DPC agreement.|
|Louisiana||La. Act No. 867 — This bill states that a direct pay provider is not an insurer. It also sets parameters around discrimination, cancellation of service, and payment for services.|
|Maine||SP 472, Sec. 1. 22 MRSA c. 403 — The Health Care Empowerment Act allows patients to pay directly for care without loosing their current insurance. It also separates direct primary care from all insurance laws.|
|Michigan||500.129 — This Bill excludes DPC from insurance laws. Plus, it defines what to include in a DPC agreement.|
|Mississippi||SB 2687 — This Senate Bill allows This Senate Bill allows DPC agreements and excludes them from insurance laws.|
|Missouri||§ 376.1800 — The Medical Retainer Agreement paragraph defines DPC agreements and excludes them from insurance laws. Note: In addition, it allows patients to use pre-tax health savings accounts (HSA) to pay for DPC.|
|Nebraska||LB 817 — This Bill defines requirements for DPC agreements. Also, it states that these agreements do not constitute insurance. And, they do not qualify as health plans subject to any federal mandates.|
|New Hampshire||SB 176 — Senate Bill 176 defines what DPC agreements must include to stay exempt from insurance laws. Note: it includes important regulations for the practice in general.|
|Oklahoma||SB 560 — The Health Empowerment Act , allows patients to receive medical care outside of their insurance plan. And, it excludes DPC agreements from insurance regulation.|
|Oregon||§ 735.500 — This statute excludes DPC practices from insurance laws. But it also requires that a physician meet certain criteria to get certified as a DPC provider.|
|Tennessee||HB 2323 — House Bill 2323 defines DPC and sets forth what to include in a DPC agreement.|
|Texas||HB 1945 — This House Bill allows Texans to seek direct primary care. It defines what makes up a DPC agreement. It asserts that direct primary care is not insurance and is not regulated as such.|
|Utah||Title 31A, Chapter 4, Section 106.5 — This addition to the Utah Insurance Code states that DPC is exempt from state insurance regulations. It sets requirements for a DPC agreement to be valid.|
|Virginia||SB 800 — Senate Bill No. 800 provides that a DPC agreement is not subject to insurance or health maintenance organization laws.|
|Washington||48.150 RCW — The RCW defines DPC and it’s rules. It specifies that DPC is not subject to insurance laws. Plus, it restricts what kind of care a DPC agreement can offer.|
|Wyoming||§ 26-1-104(a)(vi) — This code defines DPC as excluded from insurance laws.|
last update: 05/21/2020