For many physicians, the direct primary care (DPC) model has become a more attractive option compared to today’s traditional medical practice. Why? Well, because many doctors feel that their ability to effectively treat patients is hindered by current payment and administrative requirements. David Usher, MD put it this way.
“I was experiencing the same thing a lot of Primare 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.1
For Usher, a direct primary care (DPC) practice turned out to be the right solution.
On April 16, 2015, this trend made headlines when the President signed H.R. 2, The Medicare Access and CHIP Reauthorization Act which opened Direct Primary Care (DPC) to Medicare patients.
If you are considering moving to a direct primary care (DPC) model there are many factors to evaluate. We covered some of these factors in Is Direct Primary Care Replacing Insurance?, but direct primary care state laws are also something to research during your evaluation. Did you know that 15 states have already enacted direct primary care (DPC) legislation and that other state laws are in currently in the works?2
The direct primary care state laws chart below shows current legislation that is relevant to direct primary care (DPC) as well as links so that you can review the information to determine how it applies to your business. Stay tuned to this blog for more information. As circumstances change legislatively, we will continue to follow this issue and report to you, here, on how direct primary care (DPC) is changing medicine.
Direct Primary Care State Laws
|Arizona||Arizona Rev Stat § 20-123 — This bill exempts direct primary care from regulation as an insurance entity as well as defines what constitutes direct primary care.|
|Florida||CS/CS/HB 7047: Bundled Health Care Services — Florida has pending legislation directed at establishing medical tourism in Florida using direct primary care. It would exempt direct primary care from regulation under the insurance code. This would also be the first bill with a focus on medical tourism.|
|Idaho||Idaho S1062/2015 (Passed: 04/15) — Idaho recently edited the policy of the state to promote personal responsibility for health care and the cost-effective delivery of medical services by encouraging innovative use of direct patient care practices for primary and specialty medical care. It also sets up rules and regulations for providers.|
|Kansas||Kansas House Bill HB2225 — This Kansas bill defines that a contract between a physician and a patient is not classified as insurance. It also provides a clear definition of direct primary care in and attempt to provided another layer of protection to providing physicians.|
|Louisiana||La. Act No. 867 — This bill regulates direct primary care and direct pay. Some of this regulation includes definitions on discrimination, cancellation of service, payment for services and that a direct pay provider is not an insurer.|
|Michigan||Michigan – PA-0522-14 — Michigan passed this bill to clarify that direct primary care services are not considered insurers. It also defines what must be considered in a medical retainer agreement, including the fee schedule and health care services that will be provided.|
|Mississippi||Mississippi Senate Bill No. 2687 — This recent bill allows for contracts between individuals and their direct primary care providers and exempts those contracts from being considered insurance.|
|Missouri||Missouri House Bill 769 — Passed in the spring of 2015, House Bill 769 defines the relationship between direct primary care providers and their patients, including defining that this relationship is not insurance. It allows for the payment of fees for the patient to be paid with pre-tax dollars from a health savings account.|
|New Hampshire||New Hampshire Senate Bill 176 — Senate Bill 176 was introduced in the 2015 session. It’s goal is to define the conditions that must be met for a primary care agreement to not be subjected to insurance laws as well as regulating the practice in general.|
|Oklahoma||Oklahoma Senate Bill 560 — The Health Empowerment Act, clarifies that contracts between a direct primary care provider and a patient is not subject to regulation by the Oklahoma Insurance Department and that they are not insurance. It also goes further, stating that there is no state law prohibiting a patient from obtaining medical care outside of an insurance plan.|
|Oregon||Oregon Statute § 735.500 — This statute defines rules for a certification as a retainer medical practice. Oregon requires that a direct care provider be certified by the state, and that they meet certain criteria. It includes provisions that define who can be a direct primary care provider, as well as defining the practice as not being medical insurance.|
|Texas||Texas House Bill 1945 (Passed 05/15) — The Texas legislature has passed a bill that allows for Texans to seek direct primary care. It goes on to define the provider, patient agreement as well as codifying that direct primary care is not insurance and is not regulated as such.|
|Utah||Utah Code, Title 31A, Chapter 4, Section 106.5 — Simply states that a direct primary care practice is exempt from state insurance regulations.|
|Washington||Washington Chapter 48.150 RCW — The Revised Code of Washington State (RCW) defines direct primary care and it’s rules. It also describes how it applies to the public policy of the state. It goes on to define that direct care providers are not insurers, as well as what they are allowed and not allowed to do.|
|West Virginia||West Virginia Code Chapter 16, Article 2 — West Virginia defines a direct primary care provider as a provider and not as an insurer. However direct care providers are overseen by the Insurance Commissioner for a variety of things, including certification and licensing.|
1. The direct primary care model is gaining traction. Is it right for you?