DPC state laws: everything you need to know pt. 1

Direct primary care (DPC) is a medical practice model where providers contract directly with patients. DPC practices typically do not accept insurance but DPC physicians do encourage their patients to acquire a high-deductible wraparound policy to cover the services not provided under their DPC membership fee.

Currently, the Affordable Care Act “allows direct primary care providers to participate in the insurance exchanges with the requirement that providers must be coupled with an insurance policy covering non-primary care services,” although DPC practices have not yet taken off as part of the exchange. Given the continuing debate over ACA policies and the repeal of the individual mandate, the conversation about whether DPCs are eligible for the exchange may not be as big an issue going forward.

However, the debate over whether DPCs are considered insurance for regulation purposes continues. Many states have passed laws specific to regulatory concerns, in particular defining whether a DPC should be considered “as a medical service outside of state insurance regulation.”

The state of Washington passed legislation, “Direct Patient-Provider Primary Health Care,” stating that a DPC is not an insurer. In addition, the legislation reads:

Washington needs a multipronged approach to provide adequate health care to many citizens who lack adequate access to it. Direct patient-provider practices, in which patients enter into a direct relationship with medical practitioners and pay a fixed amount directly to the health care provider for primary care services, represent an innovative, affordable option which could improve access to medical care, reduce the number of people who now lack such access, and cut down on emergency room use for primary care purposes, thereby freeing up emergency room facilities to treat true emergencies.

On the opposite end of the debate, the state of Montana has attempted several times to pass legislation that would benefit DPC practices, but the bills have been vetoed at the governor level.

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