Ann K. Breitinger, Esq., Business & Corporate; Health Care Law

The new Direct Primary Care (DPC) model law will take effect July 1, 2018. DPC practice models eliminate the fee-for-service payment structure and instead accept one monthly flat fee intended to cover all of the comprehensive primary care needs of the patient for the month.

Advocates of the DPC practice model tout the model as a means to allow physicians to focus on patient care rather than the financial incentives of increased procedures and tests.  Increased time spent with the patient and unhurried interactions are also advantages of the DPC model.

House Bill 37 “Direct Primary Care Agreements” specifies that DPC agreements do not constitute insurance and are not subject to the Florida Insurance Code and provides requirements for agreements between the physician and patient.  The law pertains to medical doctors, doctors of osteopathy, chiropractors and nurses.

Pursuant to the new law, a DPC agreement must:

  • Be in writing.
  • Be signed by the primary care provider or an agent of the primary care provider and the patient, the patient’s legal representative, or the patient’s employer.
  • Allow a party to terminate the agreement by giving the other party at least 30 days’ advance written notice. The agreement may provide for immediate termination due to a violation of the physician-patient relationship or a breach of the terms of the agreement.
  • Describe the scope of primary care services that are covered by the monthly fee.
  • Specify the monthly fee and any fees for primary care services not covered by the monthly fee.
  • Specify the duration of the agreement and any automatic renewal provisions.
  • Offer a refund to the patient, the patient’s legal representative, or the patient’s employer of monthly fees paid in advance if the primary care provider ceases to offer primary care services for any reason.
  • Contain, in contrasting color and in at least 12-point type, the following statement on the signature page: “This agreement is not health insurance and the primary care provider will not file any claims against the patient’s health insurance policy or plan for reimbursement of any primary care services covered by the agreement. This agreement does not qualify as minimum essential coverage to satisfy the individual shared responsibility provision of the Patient Protection and 74 Affordable Care Act, 26 U.S.C. s. 5000A. This agreement is not workers’ compensation insurance and does not replace an employer’s obligations under chapter 440.”

If you are interested in developing a DPC model practice or need to update your existing DPC model documents, please contact a member of our health law department at  941.748.0100.  To reach Ann Breitinger, please email abreitinger@blalockwalters.com.

Share This