Kentucky enacted excellent DPC legislation (SB 79 can be tracked here and viewed here) on 03/17/17 when it was signed by the governor! This made Kentucky the 18th state with DPC legislation on the books! There are multiple DPC practice in Kentucky. Be sure to review the Kentucky Insurance Code when designing your DPC patient agreements.
Dispensing: Fortunately Kentucky does not have any prohibition of in-office dispensing. According to KRS 217.182 Sale, distribution, administration, prescription, or possession of legend drugs: “A duly licensed manufacturer, distributor, or wholesaler may sell or distribute a legend drug to… a practitioner” and “[a] practitioner may: (a) Administer, dispense, or prescribe a legend drug for a legitimate medical purpose and in the course of professional practice; or (b) Distribute a legend drug to a person licensed to administer, dispense, distribute, or possess a legend drug. Please see pages 75 and 76 of this detailed KMA Legal Handbook. If a scheduled medication is dispensed this must be reported to KASPER and separate regulations apply (also summarized by the KMA here).
Medicaid Private Contracting Prohibition: Medicaid changes required through the ACA are creating hurdles ordering tests, medications, and labs in many states by physicians that are not "participating" in Medicaid. In Kentucky this fight has been exacerbated by an executive order from the (former) governor.
Consider the following language from 907 KAR 3:005. Coverage of physicians' services: The language around the phrase "Non-Medicaid basis" has grown problematic.
"Non-Medicaid basis" means a scenario in which:
(a) A provider provides a service to a recipient;
(b) The Medicaid Program is not the payer for the service; and
(c) The recipient is liable for payment to the provider for the service."
"Notify the recipient referenced in paragraph (b) of this subsection of the provider’s decision to accept or not accept the recipient on a Medicaid basis prior to providing any service to the recipient.
(b) A provider may provide a service to a recipient on a non-Medicaid basis:
1. If the recipient agrees to receive the service on a non-Medicaid basis before the service begins; and
2. The service is not a Medicaid-covered service.
(c)1. If a provider renders a Medicaid-covered service to a recipient, regardless of if the service is billed through the provider’s Medicaid provider number or any other entity including a non-Medicaid provider, the recipient shall not be billed for the service."
As written, the effect of the governor's executive order is to prohibit Medicaid patients from signing up for DPC memberships regardless of the provider's status. This must be corrected!
Insurance Related Definitions from the Kentucky Revised Statutes:
304.1-030 "Insurance" defined. "Insurance" is a contract whereby one undertakes to pay or indemnify another as to loss from certain specified contingencies or perils called "risks," or to pay or grant a specified amount or determinable benefit or annuity in connection with ascertainable risk contingencies, or to act as surety.
304.1-040 "Insurer" defined. "Insurer" includes every person engaged as principal and as indemnitor, surety, or
contractor in the business of entering into contracts of insurance.
304.5-040 "Health insurance" defined. "Health insurance" is insurance of human beings against bodily injury, disablement, or
death by accident or accidental means, or the expense thereof, or against disablement or
expense resulting from sickness, and every insurance appertaining thereto.
304.38-030 Definitions for subtitle (regarding Health Maintenance Organizations).
"Health care services" means any services included in the furnishing to any individual of medical, optometric, or dental care, or hospitalization or incident to the furnishing of such care or hospitalization, as well as the furnishing to any person of any and all other services and goods for the purpose of preventing, alleviating, curing, or healing human illness, physical disability, or injury;
"Health maintenance organization" means any person who undertakes to provide, directly or through arrangements with others, health care services to individuals enrolled with such an organization on a per capita or a predetermined, fixed prepayment basis. A health maintenance organization is authorized to provide all health care services.