Journal of the Louisiana State Medical Society
earned direct fees must be refunded to the patient following termination of the relationship. 3. Notify patients 60 days prior to changing the direct fee and may only increase the fee once a year. A DPC practice is prohibited from: 1. Submitting a claim for payment to any insurance entity, directly or through a subcontractor, for services covered by the direct primary care fee and agreement. 2. From being identified by any insurance entity for purpose of network adequacy, or being available by an enrollee under a health insurer issuers ben- efit plan. 3. Prohibited from paying for healthcare services covered by a direct agreement rendered to patients by providers other than the providers in the direct practice or their employees. ADPC practice or provider may enter into a participat- ing provider contract with an insurance entity other than for payment of claims of services provided. That practice or physicianwill be subject to all provisions of the participating provider contact, including but not limited to: 1. Making referrals to other participating providers. 2. Admit the carriers’ members to participating hos- pitals and healthcare facilities. 3. Prescribe prescription drugs. 4. Implement other customary provisions of the con- tract not dealing with reimbursement of services. A DPC practice may pay for charges associated with: 1. Routine lab and imaging services. 2. Dispensing prescribed prescription drugs at no ad- ditional costs in line with all laws and regulations. 3. Charge for any vaccinations or medical supplies not specifically included in the DPC agreement, as long as the patient is made aware of additional charge ahead of time. A DPC practice must maintain an equal opportunity patient panel: 1. A DPC cannot discontinue or deny services based on the patient’s health status. 2. ADPC can decline a patient if they are at maximum capacity or unable to provide the appropriate level of care. A DPC practice can discontinue care to patient but is required to give notice and opportunity for the patient to find another provider, if the patient: 1. Fails to pay their fee. 2. Commits an act that constitutes fraud against the practice. 3. Repeatedly fails to comply with the recommended treatment plan. 4. Is abusive or puts the practice staff or patients in emotional or physical danger. If the practice discontinues to operate as DPC practice. The law requires the following regarding the direct agreement between the DPC practice and the patient: 1. A disclaimer must be included which states, “This
agreement does not provide comprehensive health insurance coverage. It provides only the healthcare services specifically described.” 2. The agreement must also include a disclosure statement distributed to all patients, which in- forms the patient of his or her financial rights and responsibilities. 3. Language must encourage patients to maintain insurance for services not provided by the prac- tice and states that the DPC practice will not bill insurance for services covered under the direct agreement. 4. A statement must also include contact information for the LSBME. In the 18 states direct primary care has already been implemented, physicians report increased satisfaction and a renewed commitment to providing the kind of care that initially inspired them to dedicate their lives to medicine. In short, direct primary care facilities enable physicians to do what they were trained to do, treat patients. We believe in the near future, DPC practices will transform the physician and patient medical environment in Louisiana, and we are proud to have been part of the process.
218 J La State Med Soc VOL 166 September/October 2014
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