In March, Governor Scott signed legislation that provides that direct primary care agreements are not insurance and are not regulated by the Florida Insurance Code. The new law defines direct primary care agreement as a contract between a primary care provider and a patient, which eliminates third party payers. These agreements typically include a monthly fee physicians charge in advance, which allows patients to access healthcare services at no extra cost.
The law requires that direct primary agreements be set forth in a written document signed by the parties. The agreement must also: (i) permit termination upon 30 days’ notice, (ii) describe the health services covered under the arrangement, (iii) specify the fees to be charged and the duration of the arrangement, (iv) include an offer to refund fees to the patient if physician stops providing care, and (v) contain a disclaimer stating that the arrangement is not insurance. The law does not define how much patients can be charged or what healthcare services need to be included in the agreement.
Physicians should be aware of Medicare rules applicable to concierge practices, which Medicare defines as an arrangement between a physician or group practice and a patient under which the physician or physician group charges a membership fee for the concierge services to be offered. Medicare prohibits physicians from charging extra for services already covered by Medicare. The Office of Inspector General warns participating physicians that they could face liability for billing Medicare patients for such services.