Direct Primary Care: Legislative Example for States to Consider

REFERENCE TITLE: direct care plans; insurance; exemption

State of Arizona Senate Fifty-first Legislature Second Regular Session 2014

SB 1404

Introduced by Senator Ward

AN ACT

AMENDING TITLE 20, CHAPTER 1, ARTICLE 1, ARIZONA REVISED STATUTES, BY ADDING SECTION 20‑123; RELATING TO DIRECT PRIMARY CARE PROVIDER PLANS.

(TEXT OF BILL BEGINS ON NEXT PAGE)

Be it enacted by the Legislature of the State of Arizona:

Section 1.  Title 20, chapter 1, article 1, Arizona Revised Statutes, is amended by adding section 20-123, to read:

20-123.  Direct primary care provider; exemption from regulation; notice; definitions

A.  A DIRECT PRIMARY CARE PROVIDER PLAN DOES NOT CONSTITUTE THE TRANSACTION OF INSURANCE BUSINESS OR A HEALTH CARE SERVICES ORGANIZATION IN THIS STATE FOR THE PURPOSES OF REGULATION UNDER THIS TITLE.

B.  A DIRECT PRIMARY CARE PROVIDER PLAN MAY ARRANGE FOR PRIMARY HEALTH CARE FOR ENROLLEES IN THIS STATE.

C.  A DIRECT PRIMARY CARE PROVIDER PLAN MUST PROVIDE A WRITTEN DISCLAIMER ON OR ACCOMPANYING ALL APPLICATION AND GUIDELINE MATERIALS DISTRIBUTED BY OR ON BEHALF OF THE DIRECT PRIMARY CARE PROVIDER PLAN THAT READS, IN SUBSTANCE:

NOTICE:  THE ORGANIZATION FACILITATING THE DIRECT PRIMARY CARE PROVIDER PLAN IS NOT AN INSURANCE COMPANY AND THE DIRECT PRIMARY CARE COMPANY GUIDELINES AND PLAN OPERATION ARE NOT AN INSURANCE POLICY.  PARTICIPATION IN THE DIRECT PRIMARY CARE PROVIDER PLAN OR A SUBSCRIPTION TO ANY OF ITS DOCUMENTS SHOULD NOT BE CONSIDERED TO BE INSURANCE.  REGARDLESS OF WHETHER YOU RECEIVE TREATMENT FOR MEDICAL ISSUES THROUGH THE DIRECT PRIMARY CARE PROVIDER PLAN, YOU ARE ALWAYS PERSONALLY RESPONSIBLE FOR THE PAYMENT OF ANY ADDITIONAL MEDICAL EXPENSES YOU MAY INCUR.

D.  FOR THE PURPOSES OF THIS SECTION:

1.  "DIRECT PRIMARY CARE PROVIDER PLAN" MEANS A PRIMARY CARE PROVIDER THAT COLLECTS ON A PREPAID BASIS FEES TO CONDUCT PRIMARY HEALTH CARE FOR ENROLLEES.

2.  "ENROLLEE" MEANS AN INDIVIDUAL, FAMILY OR GROUP THAT HAS ENROLLED IN A DIRECT PRIMARY CARE PROVIDER PLAN.

3.  "PRIMARY CARE PROVIDER" MEANS A PHYSICIAN WHO IS LICENSED PURSUANT TO TITLE 32, CHAPTER 13 OR 17 AND WHO SPECIALIZES OR IS BOARD CERTIFIED IN GENERAL PRACTICE, FAMILY MEDICINE, INTERNAL MEDICINE OR PEDIATRICS.

4.  "PRIMARY HEALTH CARE" MEANS CONDUCTING ALL COMPONENTS OF PRIMARY CARE THAT IS ORDERED AND SUPERVISED BY A PRIMARY CARE PROVIDER, INCLUDING MEDICAL VISITS, LABORATORY TESTING, IMAGING, PATHOLOGY TESTING, PRESCRIBING AND ADMINISTERING MEDICATION AND OTHER MEDICAL PROCEDURES THAT MAY BE PERFORMED OR SUPERVISED BY A PRIMARY CARE PROVIDER WITH TRAINING AND EXPERIENCE IN THAT PROCEDURE.