Tennessee Direct Primary Care Bill

Tennessee Direct Primary Care Bill

The State of Tennessee has introduced a Direct Primary Care bill. The Tennessee Direct Primary Care  Bill has been dubbed as “the alternative to expanding Medicaid”.  I am working on the further development of the legislation. Contact me directly to learn more.

Tennesee Direct Primary Care Bill can be viewed below in it’s current state:

HOUSE BILL 2323 By Kumar

AN ACT to amend Tennessee Code Annotated, Title 56; Title 63; Title 68 and Title 71, relative to direct primary care agreements.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE: SECTION 1. Tennessee Code Annotated, Title 63, Chapter 1, is amended by adding the following as a new part: 63-1-501. This part shall be known and may be cited as the “Health Care Empowerment Act”.
63-1-502. As used in this part:

(1) “Direct primary care membership agreement” means a written contractual agreement between a primary care provider and an individual patient, or the patient’s legal representative, in which:

(A) The provider agrees to provide primary care services to the individual patient for an agreed fee over an agreed period of time;

(B) The direct primary care provider will not bill third parties on a fee-for- service basis;

(C) Any per-visit charges under the agreement will be less than the monthly equivalent of the periodic fee;

(D) The agreement describes the scope of primary service that is covered by the periodic fee;

(E) The agreement contains a statement that the agreement does not constitute health insurance;

(F) The agreement specifies the duration of the agreement, including automatic renewal periods; and

(G) The patient is not required to pay more than twelve (12) months of the fee in advance;

(2) “Direct primary care provider” means an individual or legal entity that is licensed, registered, or otherwise authorized to provide primary care services in this state under this title, and who chooses to enter into a direct primary care membership agreement. A direct primary care provider includes an individual primary care provider or other legal entity, alone or with others professionally associated with the provider or other legal entity;

(3) “Medical products” include medical drugs and pharmaceuticals; and

(4) “Primary care service” includes the screening, assessment, diagnosis, and treatment for the purpose of promotion of health or the detection and management of disease or injury within the competency and training of the direct primary care provider. 63-1-503.

(a) Nothing in state law shall be construed as prohibiting a patient or a legal representative of a patient from seeking care outside of an insurance plan, or outside of the TennCare or medicare program, and paying for such care.

(b) Nothing in the law of this state shall be construed as prohibiting a physician licensed under chapter 6 or 9 of this title, other medical professional licensed under this title, or a healthcare facility, licensed under title 33 or 68, from accepting payment for services or medical products outside of an insurance plan. Nothing in the law of this state shall prohibit a physician, other medical professional, or a medical facility from accepting payment for services or medical products provided to a TennCare or medicare beneficiary.

(c) A patient or legal representative shall not forfeit insurance benefits, TennCare benefits, or medicare benefits by purchasing medical services or medical products outside the system.

(d) The offer and provision of medical services or medical products purchased and provided under this act shall not be deemed an offer of insurance nor regulated by the insurance laws of the state.

(a) A direct primary care membership agreement is not insurance and is not subject to regulation by the department of commerce and insurance.

(b) Entering into a direct primary care membership agreement is not the business of insurance and is not subject to regulation under title 56.

(c) A direct primary care provider or the agent of a direct primary care provider is not required to obtain a certification of authority or license under the Tennessee Insurance Producer Licensing Act of 2002, compiled in title 56, chapter 6 to market, sell, or offer to sell a direct primary care agreement.

(d) A direct primary care membership agreement is not a discount medical plan. (e) A direct primary care membership agreement shall:

(1) Allow either party to terminate the agreement upon written notice to the other party;

(2) Provide that fees are not earned by the direct primary care provider until the month paid by the periodic fee has been completed; and

(3) Provide that, upon termination of this agreement by the individual patient, all unearned fees are to be returned to the patient.

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Tennessee Direct Primary Care Bill – Information

Tennessee Direct Primary Care Bill – Fiscal Note

Fiscal note of the bill can be found Here.

 

Tennessee Direct Primary Care Bill – Committee and Floor Videos

Tennessee has begun debating the bill. Clip of debate in the TN State House Health Subcommittee on February 9, 2016 is below.

Clip from the debate in the House Health Subcommittee on 2/16/16.

Clip from Senate Floor Debate and Vote on 3/14/16.

Clip from House Insurance Committee Debate and Vote on 3/29/16.

Clip from House Floor Debate and  Vote on 4/4/16.

Tennessee Direct Primary Care Bill – Status

March 1, 2016          – Passed 9-0 in Senate Commerce Committee
March 8, 2016         –  Passed House Health Subcommittee
March 14, 2016         – Passed 32-0 in Senate
April 4, 2016              – Passed 82-5 in House
April 11, 2016             – Re-Passed 33-0 in Senate with 2 amendments
April 13, 2016             – Enrolled and Signed by Lt. Gov Ron Ramsey
April 13, 2016             – Enrolled and Signed by Speaker Beth Harwell
April 27, 2016             – Signed into law by Gov Bill Haslam

Tennessee Direct Primary Care Law   –  Language

PUBLIC CHAPTER NO. 996

SENATE BILL NO. 2443

By Roberts, Crowe, Bowling, Bell, Bailey, Gresham, Hensley, Jackson, Tracy, Stevens, Green, Norris, Watson, Yager, Harris

Substituted for: House Bill No. 2323

By Kumar; Madam Speaker Harwell; Cameron Sexton, Butt, Littleton, Byrd, Pody, Casada, Sargent, Kevin Brooks, Halford, Marsh, Weaver, Terry, Rogers, Mark White, Zachary, Jerry Sexton, Reedy, Carr

AN ACT to amend Tennessee Code Annotated, Title 56; Title 63; Title 68 and Title 71, relative to direct primary care agreements.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:

SECTION 1. Tennessee Code Annotated, Title 63, Chapter 1, is amended by adding the following as a new part:

63-1-501. This part shall be known and may be cited as the “Health Care Empowerment Act”.

63-1-502. As used in this part:

(1) “Direct primary care agreement” means a written contractual agreement between a primary care physician and an individual patient, or the patient’s legal representative, in which:

(A) The physician agrees to provide primary care services to the individual patient for an agreed fee over an agreed period of time;

(B) The direct primary care physician will not bill third parties on a fee- for-service basis;

(C) Any per-visit charges under the agreement will be less than the monthly equivalent of the periodic fee;

(D) The agreement describes the scope of primary service that is covered by the periodic fee;

(E) The agreement contains the following disclosures, or substantially similar disclosures, that are conspicuously visible in the agreement in bold font:

(i) The agreement does not constitute health insurance under the laws of this state;

(ii) An uninsured patient that enters into a direct primary care agreement may still be subject to tax penalties under the Patient Protection and Affordable Care Act, Public Law 111-148, for failing to obtain insurance;

(iii) Patients insured by health insurance plans that are compliant with the Patient Protection and Affordable Care Act already have coverage for certain preventative care benefits at no cost to the patient;

SB 2443

(iv) Payments made by a patient for services rendered under a direct primary care agreement may not count towards the patient’s health insurance deductibles and maximum out-of-pocket expenses;

(v) A patient is encouraged to consult with the patient’s health insurance plan, before entering into the agreement and receiving care; and

(vi) A physician who breaches the agreement may be liable for damages and may be subject to professional discipline by the board of medical examiners;

(F) The agreement specifies the duration of the agreement, including automatic renewal periods; and

(G) The patient is not required to pay more than twelve (12) months of the fee in advance; provided, that the contracted fee may be paid on a payment schedule agreed to by physician and patient that may be due on a monthly, quarterly, or yearly basis;

(2) “Direct primary care physician” means an individual or legal entity that is licensed, registered, or otherwise authorized to provide primary care services in this state under this title, and who chooses to enter into a direct primary care agreement. A direct primary care physician includes an individual primary care physician or other legal entity, alone or with others professionally associated with the physician or other legal entity;

(3) “Medical products” include medical drugs and pharmaceuticals;
(4) “Physician” means a physician licensed under chapter 6 or 9 of this title;

and

(5) “Primary care service” includes the screening, assessment, diagnosis, and treatment for the purpose of promotion of health or the detection and management of disease or injury within the competency and training of the direct primary care physician.

63-1-503.

(a) Nothing in state law shall be construed as prohibiting a patient or a legal representative of a patient from seeking care outside of an insurance plan, or outside of the TennCare or medicare program, and paying for such care.

(b) Nothing in the law of this state shall be construed as prohibiting a physician, other medical professional licensed under this title, or a healthcare facility, licensed under title 33 or 68, from accepting payment for services or medical products outside of an insurance plan. Nothing in the law of this state shall prohibit a physician, other medical professional, or a medical facility from accepting payment for services or medical products provided to a TennCare or medicare beneficiary.

(c) A patient or legal representative shall not forfeit insurance benefits, TennCare benefits, or medicare benefits by purchasing medical services or medical products outside the system.

(d) The offer and provision of medical services or medical products purchased and provided under this part shall not be deemed an offer of insurance nor regulated by the insurance laws of the state.

63-1-504.

(a) A direct primary care agreement is not insurance and is not subject to regulation by the department of commerce and insurance.

(b) Entering into a direct primary care agreement is not the business of insurance and is not subject to regulation under title 56.

(c) A direct primary care physician or the agent of a direct primary care physician is not required to obtain a certification of authority or license under the Tennessee Insurance Producer Licensing Act of 2002, compiled in title 56, chapter 6 to market, sell, or offer to sell a direct primary care agreement.

(d) A direct primary care agreement is not a discount medical plan. (e) A direct primary care agreement shall:

(1) Allow either party to terminate the agreement upon written notice to the other party;

(2) Provide that fees are not earned by the direct primary care physician until the month paid by the periodic fee has been completed; and

(3) Provide that, upon termination of this agreement by the individual patient, all unearned fees are to be returned to the patient.

SECTION 2. This act shall take effect July 1, 2016, the public welfare requiring it.

SIGNED INTO LAW :  APRIL 27, 2016


Physicians. Are you tired of filling out paperwork and dealing with insurance companies? Are you tired of seeing you reimbursement and hard earned revenue be cut by insurance companies? Do you want a consistent and dependable revenue stream? Please click Here.

Matthew D.  Taber, M.S. is Chief Operating Officer of Direct Care For Me (www.directcareforme.com),  a company which offers full access to medical care to patients and  100  percent reimbursement to primary care physicians through direct primary care (no insurance necessary) models. Low cost health insurance for business owners and employees. On site health care for employees. Exclusive savings on x-rays, labs, surgery, specialty office visits. See a doctor (family practitioner, internist, ob/gyn, pediatrician) anytime on your smartphone tablet, or computer (telemedicine). Reach him by e-mail at matthew at direct care for me dot com or by phone at 615-669-8347 to sign up today.  

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2 Responses to Tennessee Direct Primary Care Bill

  1. I am a DPC physician, and I am glad to see a law that acknowledges and protects DPC practices. However, it also mentions the relationship between physicians and Medicare beneficiaries. Can the state of Tennessee do that, or is that a matter of federal law?

    • admin says:

      Thank you Dr. Ames for your comments. That is a very good question. I am currently asking my legislative contacts to clarify that.

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