New Florida Law Makes it Easier for Doctors to Offer Direct Primary Care Agreements

Direct primary care agreementLate last month, Florida Gov. Rick Scott signed a bill (HB 37) allowing physicians, chiropractors and group practices to sign direct primary care agreements (DPC) with patients without having to worry about violating insurance laws.

Such agreements are becoming increasingly popular. According to a survey from the American Academy of Family Physicians, nearly 3 percent of family physicians operated under DPC in 2017.

These agreements allow providers to offer primary care services to patients who pay a monthly membership fee (typically about $100) for the provision of primary care services at no additional charge to the patient/member. This agreement is an alternative to the traditional fee-for-service payment model and frees physicians from aggravations associated with pre-approvals and the mounds of paperwork required by insurers.

The legislation does not specify how much can be charged, or what services can be provided. It simply amends Florida’s insurance code to make it clear that direct primary care agreements do not violate insurance regulations. It does, however, require direct primary care contracts to be in writing and to describe the scope of services to be covered. It also prevents providers who accept payment via a direct care contract from billing insurance companies for those services.

The legislation was made necessary because some have argued that these direct primary care agreements should be considered insurance and therefore regulated as such.

Florida is the 24th state to pass “not insurance” legislation, according to DPC Frontier, which bills itself as “the ‘go to’ resource that will facilitate the growth of the DPC movement among physicians.”

In order to be compliant, a DPC agreement must:

  • Ensure that primary care services provided to DPC patients are within the competency and training of the provider who is rendering the service.
  • Be in writing and signed by the parties involved.
  • Include specified term and termination provisions.
  • Include a description of the scope of primary care services covered by the monthly fee. (Will you include any labs, medication or procedures, or will they be billed separately?)
  • Specify the duration of the agreement and any automatic renewal provisions.
  • Allow a party to terminate the agreement by giving the other party at least 30 days’ advance written notice. The agreement may provide for immediate termination due to a violation of the physician-patient relationship or a breach of the terms of the agreement.
  • Offer a refund to the patient, the patient’s legal representative, or the patient’s employer of monthly fees paid in advance, if the primary care provider ceases to offer primary care services for any reason.
  • The agreement must include explicit language stating that the DPC agreement does not constitute a policy of insurance.

DPC has its benefits in that it not only reduces costly administrative overhead, but also results in a reduction of external oversight by insurance carriers.

Physicians who want to explore this option may want to consider whether to run a pure or hybrid practice, and whether to opt out of Medicare. If you have any questions, the Health Law Offices of Anthony C. Vitale can assist you with these contractual matters. Contact us for additional information at 305-358-4500 or send an email to info@vitalehealthlaw.com and let’s discuss how we might be able to assist you.

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