Arkansas

Unknown to many in the DPC community, Arkansas quietly passed a "Concierge" law (HB 1161) now enacted as Act 101 in Feb 19, 2015, making it the eighth state to pass DPC legislation.  This will be placed in Arkansas code Section 23-60-104 and 23-76-103(c).  This piece of legislation fails on multiple levels:

  • It never mentions the phrase "direct primary care" (DPC physicians benefit from avoiding "business of insurance" language much more than concierge - this has historically not been an issue in the concierge community)
  • It uses (and poorly defines) the term concierge - a group that is less likely to require protection from the insurance commissioner
  • It fails to narrowly define the group of physicians that fit within the "concierge" definition
  • It fails to provide any consumer protections
  • In the event it faced legal challenge, there is a high likelihood it will not survive judicial scrutiny
  • It fails to address the concern that DPC might be defined as a "Health Maintenance Organization"

The law states that "Concierge service arrangement means a contractual agreement between a licensed healthcare provider and an individual to provide select medical services as specified under a medical arrangement for an established fee." This is a vague and useless definition.  

DPC practices are known to be operating within the state.  When designing your contract be sure to review the Arkansas Insurance Code, and note that Arkansas makes it very difficult to conduct any in-office dispensing.  

The in-office dispensing of medications can be more difficult in Arkansas compared to other states.  A permit must be obtained from the state medical board.  

Here are some important provisions from the Arkansas Insurance Code

CHAPTER 60 GENERAL PROVISIONS  
23-60-102. Definitions.
 
As used in the Arkansas Insurance Code, unless the context otherwise requires:
            (1)(A)(i)  “Insurance” is any agreement, contract, or other transaction whereby one party, the “insurer”, is obligated to confer benefit of pecuniary value upon another party, the “insured” or “beneficiary”, dependent upon the happening of a fortuitous event in which the insured or beneficiary has, or is expected to have at the time of such happening, a material interest that will be adversely affected by the happening of such an event.
                                    (ii)  A “fortuitous event” means any occurrence or failure to occur that is, or is assumed by the parties to be, to a substantial extent beyond the control of either party.
                        (B)  “Insurance” shall, for purposes of subtitle 3 of this title, be deemed to include “annuities”, which are agreements by insurers to make periodic payments that continue during the survival of the measuring life or lives under the agreements or for a specified period.
                        (C)  “Reinsurance” is a contract under which an originating insurer, called the “ceding” insurer, procures insurance for itself in another insurer, called the “assuming” insurer or reinsurer, with respect to part or all of an insurance risk of the originating insurer.
                        (D)(i)  “Insurance” shall not include a debt cancellation agreement.
                                    (ii)  “Debt cancellation agreement” is a loan term or contractual arrangement modifying a loan term dealing with motor vehicles under which a lender agrees to cancel all or part of a borrower's obligation to repay an extension of credit from the lender upon the occurrence of a specified event other than the death or disability of the borrower. The agreement may be separate from or a part of other loan documents.

CHAPTER 76 HEALTH MAINTENANCE ORGANIZATIONS
23-76-101. Purpose.
 
(a)  The General Assembly determines that health maintenance organizations, when properly regulated, encourage methods of treatment and controls over the quality of care which effectively contain costs and provide for continuous health care by undertaking responsibility for the provision, availability, and accessibility of services.
(b)  For this reason, and because the primary responsibility of a health maintenance organization lies in providing quality health care services on a prepaid basis without regard to the type and number of services actually rendered, rather than providing indemnification against the cost of the services, the General Assembly finds it necessary to provide a statutory framework for the establishment and continuing regulation of health maintenance organizations which is separate from the insurance laws of this state, except as otherwise provided in this chapter.

23-76-102. Definitions.
 
As used in this chapter:
            (1)  “Commissioner” means the Insurance Commissioner;
            (2)  “Domestic corporation” means any corporation organized pursuant to the Arkansas Business Corporation Act, § 4-26-101 et seq., and the Arkansas Nonprofit Corporation Act, § 4-28-201 et seq.;
            (3)  “Enrollee” means an individual who has been enrolled in a health care plan;
            (4)  “Evidence of coverage” means any certificate, agreement, contract, identification card, or document issued to an enrollee setting out the coverage to which the enrollee is entitled;
            (5)  “Health care plan” means any arrangement whereby any person undertakes to provide, arrange for, pay for, or reimburse any part of the cost of any health care services through an individually underwritten or group master contract, and at least part of the arrangement consists of arranging for, or the provision of, health care services as distinguished from mere indemnification against the cost of the services on a prepaid basis through insurance or otherwise;
            (6)  “Health care services” means any services included in the furnishing to any individual of medical or dental care, or hospitalization, or services incident to the furnishing of care or hospitalization, as well as the furnishing to any person of all other services or goods for the purpose of preventing, alleviating, curing, or healing human illness or injury;
            (7)  “Health maintenance organization” means any person which undertakes to provide or arrange for one (1) or more health care plans;
            (8)  “Health professional” means physicians, dentists, optometrists, nurses, podiatrists, pharmacists, and other individuals engaged in the delivery of health services as are or may be designated under the Health Maintenance Organization Act of 1973 or any amendment thereto or regulation adopted thereunder;
            (9)  “Person” means any natural or artificial person, including, but not limited to, individuals, partnerships, associations, trusts, or corporations; and
            (10)  “Provider” means any person who is licensed in this state to furnish health care services as a health professional.