- New DPC physicians should proceed with caution when relying on this legislation. It fails to provide a clear definition of DPC, fails to provide a clear path for protection from the insurance commissioner (note the emphasized phrase below "if the plan does not assume financial risk" - which leaves the debate open and makes the law meaningless) and has no consumer protections of any kind, increasing the chance that it would fail to survive judicial scrutiny. I would recommend that DPC physicians proceed in Arizona in the same manner they would in most states that simply do not have any DPC legislation.
- Multiple DPC practices are already known to be operating within Arizona. In fact, the mapper demonstrates that is has a higher than average density of DPC practices.
- Physician Dispensing is permitted in Arizona. Physicians do need to register with their appropriate board of medicine. DOs may use this form and MDs may use this form. This DO FAQ form might also be a useful reference.
- When designing your contract be sure to review Title 20 (Insurance) of the Arizona Revised Statutes. Please note Section 20-103
20-103. Definition of insurance; exceptions
A. For the purposes of this title, except as otherwise provided, "insurance" is a contract by which one undertakes to indemnify another or to pay a specified amount upon determinable contingencies.
B. Private ambulance service contracts or private fire protection service contracts are not insurance, and this title does not apply to those contracts.
C. Charitable gift annuities that are issued pursuant to section 20-119 are not insurance and, except as provided in section 20-119, this title does not apply to agreements for those annuities.
D. Collision damage waivers are not insurance, and this title does not apply to those waivers.
E. Direct primary care provider plans that are issued pursuant to title 44, chapter 11, article 25 are not insurance, and this title does not apply to those plans.
20-123. Direct primary care provider; exemption from regulation; definitions (this is the entire DPC law)
A. A direct primary care provider plan issued pursuant to title 44, chapter 11, article 25 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 if the plan does not assume financial risk or agree to indemnify for services provided by a third party.
B. For the purposes of this section:
1. "Direct primary care provider plan" means a primary care provider, group, entity or practice 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.
Also of note:
ARS Section 44-1799.91 references the same DPC definition from Section 20-123 discussed above.
ARS Section 44-1799.92 lists helpful additional requirements of DPC practices. A written contract must be used to describe the scope of care provided, mandatory disclosures must be included, and physicians are barred from "double dipping" (billing a health insurance plan for services provided under the DPC agreement). While these additional defining characteristics of DPC are helpful the original problematic phrase in section 20-123 "if the plan does not assume financial risk" remains a fatal hurdle to the original intent of the legislation. With the language of section 44-1799.92 in place, simply striking the quoted phrase above would take away any unnecessary doubt and make Arizona a safer and more predictable state for DPC physicians.