Wisconsin

Wisconsin has no DPC laws at present, but there are multiple DPC practices in operation. Prior legislative efforts were made in 2017 with Senate Bill 670 and in 2019 with Senate Bill 28. We anticipate that another effort will be made in the 2022 legislative session to clarify that DPC is not insurance while simultaneously initiating a Medicaid direct primary care pilot program.  

Here were some of my comments about PRIOR legislative efforts in 2017 and 2019:

Section 1(3)(a) comes dangerously close to the old HMO gatekeeper provision and I am not convinced that the language in Section 1(3)(b) will be easily enforced.  

Section 2(2)(h) is missing important language.  As written this section prohibits employers, Medicaid (the pilot proposed in Section 1) or theoretically the patient's Grandma from paying the monthly DPC fee.  I would propose the following language addition.  "The health care provider and the patient are prohibited from billing an insurer or any other third party on a fee for service basis for the routine health care services provided under the Agreement.  

Section 2(3) is not the ideal scenario.  If this language was what it took to get the insurance commissioner's office to withdraw their objection, then okay.  Ideally this entire section should not be needed.  DPC physicians should be policed by the medical board, not the department of insurance.

Be sure to review the Wisconsin Insurance Code when planning your DPC practice.

Nurse Practitioners are not permitted to dispense medications in Wisconsin. According to Published under s. 35.93, Wis. Stats., by the Legislative Reference Bureau Chapter N, 8, Certification of Advanced Practice Nurse Prescribers: N 8.09 Dispensing. (1) Except as provided in sub. (2), advanced practice nurse prescribers shall restrict their dispensing of prescription drugs to complimentary samples dispensed in original containers or packaging supplied by a pharmaceutical manufacturer or distributor. (2) An advanced practice nurse prescriber may dispense drugs to a patient at the treatment facility at which the patient is treated.