Louisiana

- In 2014 Louisiana became the sixth state to pass DPC legislation with Senate Bill No. 516.  The law has now been made a part of the Louisiana Revised Statutes sections 37:1360.81 through 1360.91.  The links to each section of the law are as follows:

- Louisiana's "Direct Primary Care Practice" laws were the best legislative example at the time of their passage.  These laws appropriately protected DPC physicians from "business of insurance" accusations and provided a reasonable definition of DPC.  The legislation stopped short of using language to clarify DPC from concierge practices.    At the time, Louisiana was the first state to pass DPC legislation without any legislative resistance or DPC practice "business of insurance" allegations from the office of the state insurance commissioner.  A white paper about DPC prepared by Flood International Consulting Agency was likely helpful for the legislators.  In spite of this legislation one should still review the Louisiana Insurance Code when setting up a practice.  

- Multiple DPC practices are now operating within the state of Louisiana and the Louisiana Academy of Family Physicians openly promotes and supports direct primary care.  A Louisiana Direct Primary Care Coalition has formed as well and they are a great resource for physicians considering DPC in Louisiana.  

- In office dispensing in Louisiana can be a bit onerous.  The Louisiana State Board of Medical Examiners lists their requirements for obtaining a permit on their website (scroll half way down the page under "other forms / applications" to find the dispensing physician permits).  Here are the highlights:

1) You must pay a $75.00 application fee, and a $50 (presumably yearly) fee for each renewal period
2) Controlled substances are difficult to dispense (probably a good thing) - limited to 48 hour supply, this option is only available to physicians that have been in practice for greater than three years
3) The initial application asks that you "list all medications proposed to be dispensed. Include brand or generic name, CDS schedule, dosage, quantity."

For full details you will also want to read Chapter 65 of Title 46 Professional and Occupational Standards (starting on page 37 of this link).  Note the detailed requirements in Subchapter D (Record keeping of purchases, acquisitions, medication inventories, dispensation records, other transaction records, computerized records, and retention of records), Subchapter E (labeling and packaging) and Subchapter F (Security).  

Louisiana Medicaid - Here is a link to the Louisiana Medicaid Provider Manual. There is a promising phrase under Section 5.1 Acute Hospital Precertification "Physician Billing When Pre-Certification Is Not Authorized." "A provider may bill the Medicaid recipient when the recipient presents to the hospital as a private-pay patient and does not inform the hospital of his/her Medicaid coverage." This enrollment form includes two problematic phrases:

“18. I agree to participate as a provider of medical services and shall bill Medicaid for Medicaid covered services performed on behalf of an eligible individual who has been accepted by me as a Medicaid patient;”

“19. I agree to accept Medicaid payment for covered services as payment in full and not seek additional payment from any recipient for any unpaid portion of a bill, with the exception of state-funded spend-down Medically Needy recipients as indicated by the agency’s form 110-MNP or any recipient co-payments as established by LDH;”

So... given the language above I suspect that unless an ordering, referring and prescribing only status option is made available DPC physicians will elect to NOT enroll in Medicaid - at least under a standard participating agreement.