HF 2356 — A bill for an act relating to agreements between individuals and health care professionals for the provision of certain primary care health services for a service charge that covers an agreed upon period of time. (Formerly HF 2275.) Effective 7-1-18.

House File 2356 - IntroducedEnrolled HOUSEHouse FILEFile 2356 BYAN COMMITTEEACT ONRELATING HUMANTO RESOURCESAGREEMENTS (SUCCESSORBETWEEN TOINDIVIDUALS HFAND 2275)HEALTH ACARE BILLPROFESSIONALS FOR AnTHE ActPROVISION relatingOF toCERTAIN agreementsPRIMARY betweenCARE individualsHEALTH andSERVICES healthFOR careA professionalsSERVICE forCHARGE theTHAT provisionCOVERS ofAN certainAGREED primaryUPON carePERIOD healthOF servicesTIME. for a service charge that covers an agreed upon period of time.

TLSBSection 5639HV1. (1) 87 ko/rj H.F.

2356 Section 1.

“Direct provider” means a health care professional licensed,House accredited,File registered,2356, orp. certified to perform specified primary care health services consistent with the law of this state.

2 licensed, accredited, registered, or certified to perform specified primary care health services consistent with the law of this state.

Primary“Primary care health servicesservices” include LSBall 5639HVof (1)the 87following: -1- ko/rj 1/8 H.F.

2356 all of the following:

(4)House StateFile each2356, ofp. the direct provider’s locations where a direct patient may obtain primary care health services and specify any out-of-office primary care health services that are covered under the direct primary care agreement.

3 (4) State each of the direct provider’s locations where a direct patient may obtain primary care health services and specify any out-of-office primary care health services that are covered under the direct primary care agreement.

(8) Specify the terms and conditions under which the direct primary care agreement may be terminated by the LSBdirect 5639HVprovider. (1) 87 -2- ko/rj 2/8 H.F.

2356 direct provider.

This direct primary care agreement only covers the primary care health services describedHouse inFile this2356, agreement.p.

4 described in this agreement.

If a direct provider requires a prospective direct patient to complete an application for a direct primary care agreement, LSBthe 5639HVdirect (1)provider 87shall -3-provide ko/rja 3/8written H.F.disclaimer on each application that informs the prospective direct patient of the direct patient’s financial rights and responsibilities and that states that the direct provider will not bill a health insurance carrier for primary care health services covered under the direct primary care agreement.

2356 the direct provider shall provide a written disclaimer on each application that informs the prospective direct patient of the direct patient’s financial rights and responsibilities and that states that the direct provider will not bill a health insurance carrier for primary care health services covered under the direct primary care agreement.

A direct provider shall provide the notice by mailing a letter to the address of the direct patient that the direct providerHouse hasFile on2356, file.p.

5 provider has on file.

LSBa. 5639HV (1) 87 -4- ko/rj 4/8 H.F.

2356 a.

A direct patient shall not sell or transfer a directHouse primaryFile care2356, agreementp. to which the direct patient is a party.

EXPLANATION6 Thedirect inclusionprimary ofcare this explanation does not constitute agreement withto LSBwhich 5639HVthe (1)direct 87patient -5-is ko/rja 5/8party. H.F.

2356______________________________ the______________________________ explanation’sLINDA substanceUPMEYER byCHARLES SCHNEIDER Speaker of the membersHouse President of the generalSenate assembly.I hereby certify that this bill originated in the House and is known as House File 2356, Eighty-seventh General Assembly.

This______________________________ billCARMINE relatesBOAL toChief agreementsClerk betweenof individuals and health care professionals for the provisionHouse ofApproved certain_______________, primary2018 care______________________________ healthKIM servicesREYNOLDS forGovernor a service charge that covers an agreed upon period of time.

The bill defines a direct primary care agreement as an agreement between a direct provider and a direct patient, or the direct patient’s representative, in which the direct provider agrees to provide primary care health services to the direct patient for a direct service charge for the period of time designated in the agreement.

A direct patient is an individual, or an individual and the individual’s immediate family.

A direct provider is defined in the bill.

A direct service charge is a charge for primary care health services, as defined in the bill, provided by a direct provider to a direct patient and may include a periodic retainer, a membership fee, a subscription fee, or other charge paid by a direct patient to a direct provider.

The bill requires that a direct primary care agreement must be in writing, must be signed by the direct provider and the direct patient, must describe the scope of the primary care health services included under the agreement, must state each direct provider location where primary care health services may be obtained by a direct patient, must specify any out-of-office services that are included under the agreement, must specify the direct service charge and how often it must be paid, must specify any additional costs that may be assessed to the direct patient for primary care health services not covered by the direct service charge, and it must specify the duration of the direct primary care agreement and how the agreement is renewed.

The bill requires that the terms and conditions for termination of the direct primary care agreement by the direct provider or the direct patient be included in the agreement.

The bill requires that a notice be included on the direct primary care agreement and application that advises that the LSB 5639HV (1) 87 -6- ko/rj 6/8 H.F.

2356 agreement is not health insurance and is not a plan that provides health coverage for purposes of any federal mandates.

The notice advises that the agreement only covers the primary care health services described in the agreement and recommends that the direct patient obtain health insurance to cover other health care services as the patient is responsible for all additional expenses incurred.

A direct provider shall give a copy of the executed direct primary care agreement to the direct patient.

The bill requires a direct provider to give at least a 60-calendar-day advance, written notice to an existing direct patient of changes, as outlined in the bill, to a direct primary care service agreement.

A direct provider is prohibited from refusing to accept a new direct patient or discontinuing care for an existing direct patient based solely on the patient’s health status.

The bill provides that a direct primary care agreement is not insurance and is not subject to the authority of the commissioner of insurance.

A direct care provider is not required to be licensed by the commissioner to transact the business of insurance in this state, or to obtain a certificate issued by the commissioner to market or offer a direct primary care agreement.

The bill prohibits a direct provider from billing an insurer for services provided under a direct primary care agreement.

A direct patient may submit a request for reimbursement to an insurer if permitted under the direct patient’s policy of insurance.

A direct provider may bill a direct patient’s insurance for services provided by the direct provider that are not provided under a direct primary care agreement.