2017 State Legislative Update!

Updated on 03/16/17 - The majority of states across the country either have or are considering DPC legislation!  Things are moving quickly!  

Moving West to East I have been assisting the following states with legislation:

Montana - SB 100 "Authorize Direct Primary Care Provider Plans" was first discussed and passed out of the Committee on Public Health, Welfare, and Safety (the discussion was recorded here - for the first thirty minutes) it then passed the Senate (the discussion can be heard here at 32 minutes into the recording to around 64 minutes into the recording) and was discussed in the House and was passed on its third reading on 03/15/17.  If you live in Montana please pass along your support to the governor since this bill now sits on his desk.  He vetoed DPC legislation previously based on erroneous conclusions about the model.

Colorado - HB17-1115 "Direct Primary Health Care Services" was introduced on 01/20/17 and discussed on the house floor on 03/08/17 with the House Health, Insurance, & Environment committee.  It has passed the House ans is scheduled to be heard by the Senate Business, Labor and Technology Committee meeting on 03/27/17.

The state Medicaid department added an (unnecessary) provision to the bill prohibiting DPC practices from signing private contracts with a Medicaid patient whereby the Medicaid patient elects to pay the DPC fees.  Private contracting with Medicaid patients (regardless of provider status) is already prohibited by Colorado Revised Statutes Title 25.5. Health Care Policy and Financing § 25.5-4-301.  (KY is the only other state I know of with this problem - in the form of a former governor's executive order.)  Since current state law already prohibits private agreements this additional language is NOT necessary.  

Maybe in a few years Medicaid patients will begin to complain and Colorado legislators will want to repeal the prohibition on private contracts with Medicaid patients.  When that happens, it would be much easier if they only need to change language in one law rather than change it in two, three, four, or five different sections of the code.  I fear they might forget to change the DPC version of the code and then DPC physicians (and would-be Medicaid patients) will be at a distinct disadvantage.  

Arkansas - Rep Justin Gonzales introduced HB 2240 on 03/06/17 to exempt DPC agreements from insurance regulation.  This legislation corrects some aspects of a bill passed in an earlier session (covered on the Arkansas state page).  It was passed out of its House committee on 03/15/17.  

Kentucky - SB 79 Defining "Direct Primary Care Membership Agreements" was introduced on 01/03/17 and signed by Governor Bevin on 30/17/17.  Kentucky is the first state in the 2017 session and the 18th state overall to pass DPC "not insurance" legislation!

Indiana - SB 303 Direct Primary Care Agreements has passed the senate by a wide majority and has been assigned to the House committee on insurance.  

Florida SB 240 Direct Primary Care and HB 161 Direct Primary Care Agreements were introduced on 01/12/17 and 01/11/17 respectively and a committee hearing took place on Feb 8th from 3:30 - 6:00 PM EST.  Respective Senate and House Committees have both passed the bills unanimously.  Drs. Lee Gross, Josh Umbehr, and Phil Eskew spoke along with policy analysts Bill Hurley and Katherine Restrepo.  A video recording of the event can be viewed here.

Alabama - Following in Georgia's footsteps AL introduced SB 94 and HB 309.  If you reside in Alabama please contact your Senator to indicate your support for the legislation.  It has a good DPC definition, and it would have been helpful (for clarity and consistency) if they included the commonly accepted phrase direct primary care.  They have borrowed from Georgia with most of their language.  This is the first time I have seen a group add dentistry to "not insurance" legislation. While not necessary, it also is not a problem.  Listing the 6,000 and 3,000 yearly fee caps seems misguided.  GA made the same mistake in their proposal, but no other proposed or enacted law had this provision.  The debate has always been about whether risk transfer was happening (at all).  The exact amount 6,000 or otherwise is not helpful.  The bill has passed the senate and was sent to the house on 03/07/17.

Georgia - Introduced SB 50 on Jan 24th and it has passed the Senate and is now being considered in the House after receiving a positive vote in the Insurance Subcommittee on 03/20/17.  It contains helpful definitions and the earlier fee caps have been removed.  The revised version of the legislation looks wonderful and deserves our full support!  

Virginia Senate Bill 800 has been passed by both the House and Senate and is awaiting the Governor's signature as of 03/08/17.

West Virginia (repeal and replace) - House Bill 2301 would repeal the restrictive and largely unhelpful pilot program discussed in detail here.  The bill passed the house and senate and awaits action by the governor.

South Carolina -House Bill 3546 and Senate Bill 276 were introduced on 01/24/17 and referred to the committee on labor, commerce, and industry.  A series of hearings were held.  For now it appears that these bills will be blocked at the committee level.  

Pennsylvania - The Pennsylvania Academy of Family Physicians has been leading the charge to get DPC legislation introduced, but a bill has not been entered yet.

Texas - This state already has great DPC law on the books, but they are one of a handful of states that currently prohibit any physicians from dispensing medications to patients.  This ability to bypass the pharmacy, PBMs, etc and dispense medications at wholesale cost is a major value add for many DPC practices.  HB 1482 was introduced on 03/07/17 to allow physicians to dispense medications. Please call your representative to indicate your support if you live in Texas!

New York - Assembly Bill A03966 has been proposed.  We are unsure what prompted this bill. It offers a broad definition of "retainer" medicine and establishes a requirement that any kind of retainer practice have an escrow account.  It does not actually mention direct primary care, nor does it offer any "not insurance" protections in spite of implementing an escrow requirement.  It has been sponsored by a republican in a democrat led assembly, so it is not expected to gain much attention.

Michigan's Patrick Colbeck continues to be one of the best DPC supporters.  After previously introducing and passing "not insurance" legislation the Senator has now introduced a resolution designed to encourage the federal government to correct confusion around health savings accounts and DPC.  

If you are from one of the states listed above and have additional updates for other readers (such as the date of an upcoming committee meeting or vote) please comment below.  If you reside in any of the above states, please read the proposed legislation (these are typically quick reads) and if you support it contact your state senators and representatives.  2017 is shaping up to be a great year for Direct Primary Care!  Please do your part!

Make sure to check out upcoming events!  The AAFP, ACOPF, and FMEC will be organizing another DPC Summit in Washington, DC in June of 2017.  For those that want to learn more about DPC first hand in the interim the AAFP is hosing a one day DPC workshop in Atlanta, Georgia on Saturday March 11, 2017.  

Recent Writing - Dr. John Bender wrote an excellent article about DPC earlier this month that was published on the AAFP website.  Dr. Ryan Neuhofel has been defending DPC as well.  The editorial Medical Economics has been very interested in DPC lately and we are grateful they regularly write about the model.

Recent CME style videos - more and more are available all the time.  I have provided links to over 50 free CME videos here.  Check them out when you have the time.