West Virginia became the first state to pass DPC related legislation largely due to the efforts of Vic Wood, DO who faced threats of legal action from an aggressive insurance commissioner. The legislation was originally enacted as a three year pilot program in 2006 and set to expire in June of 2011. The pilot clinics that began under the program continued to operate after the expiry date, and in 2013 with the passage of Senate Bill 557 the program was renewed with a new expiration date of June 30, 2016. For the text of this old (NOW REPEALED) law see the West Virginia Code §16-2J-1. More historic details can be found (for now) on the application page of the West Virginia Health Care Authority (the same entity in charge of West Virginia's certificate of need laws). HB 2301 is an excellent DPC law that was signed by Governor Justice on 03/24/17. It contains excellent definitions and disclosure requirements.
Medicaid - The state of West Virginia apparently has not created (per Affordable Care Act guidelines) a category of “ordering, prescribing and referring only” physicians. Instead the West Virginia Bureau for Medical Services Policy Manual describes “Provider Participation Requirements” in Chapter 300. This chapter clarifies that if you want to open your DPC practice to Medicaid patients then you must be careful that you (as a physician) are not "enrolled" in Medicaid. Enrolling as a participating provider will cause you to lose your ability to privately contract with Medicaid patients. Section 300.19.2 entitled “Restrictions on Billing Medicaid Members” states:
“If a West Virginia Medicaid enrolled provider accepts the Medicaid member as a patient, the provider must bill WV Medicaid for covered services and must accept the Medicaid reimbursement amount as full payment. No charge may be billed to a Medicaid member for a covered service unless a co-payment is applicable by regulation. The provider may not accept the Medicaid member as a “cash-only” patient or accept cash/private-payment for any Medicaid covered services.”
This old (NOW REPEALED) pilot program tied the hands of physicians in many ways (although Oregon's is not much better):
The Insurance Commissioner and the Health Care Authority are responsible for the regulatory oversight of the pilot project.
DPC practices face severe reporting obligations
Severe marketing restrictions apply (you may only market to those that you know have a "high deductible plan" or those that are uninsured - you are in violation if you attempt to present DPC as a viable alternative to those already possessing traditional insurance)
Scope of practiced is narrowed by the Health Care Authority
Price setting - the Health Care Authority may approve or disapprove of your monthly charges
A separate license is needed from the Health Care Authority to participate in the Preventive Care Pilot Program
- If you want to practice as a DPC physician in West Virginia you be aware of the history of the Preventive Care Pilot Program, but begin by looking to the language of HB 2301 for guidance. It is still wise to review West Virginia Code Chapter 33 Insurance.
- For a detailed analysis of the old law please see my article in the West Virginia Medical Journal comparing West Virginia and Washington DPC laws (the first two states to pass DPC legislation). A link (open access) to the March / April 2014 edition can be found here. The manuscript appears on pages 8-11.
- Dr. Eskew is a family physician that started his medical training in West Virginia, and he is often asked why he did not return to the state. In this manuscript in the West Virginia Medical Journal he explains some of the reasons he chose to move to Wyoming.
Why this West Virginia Trained Physician Moved to Wyoming, Eskew, P. WV J Med, 2015;111(6):8-9.
(Available open-access online via the West Virginia Medical Journal website)
- Three DPC practices were already operating within the strict confines of the West Virginia Preventive Care Pilot Program. Vic Wood's practice, Primary Care One is the original West Virginia DPC practice and hopefully many more will follow.