Minnesota primary care providers could offer written direct care agreements

A primary care provider and patient would sign an agreement describing covered care, fees, and how long it lasts. The agreement is between an eligible physician or independent-practice advanced practice registered nurse, individually or as a group, and a patient or the patient's legal representative. Covered services include routine care, some office supplies and medicines, and certain lab work. The agreement must state that it is not health insurance, does not satisfy federal requirements to buy health insurance, and its fees may not be reimbursed or count toward a health plan deductible.

A direct care practice could not refuse a new patient or stop care solely because of the patient's health status. These rules apply to practices and patients covered by a direct agreement. A practice that closes its direct care operation must give notice in time for the patient to seek care elsewhere. A practice may refuse a new patient if it has reached capacity, cannot provide the care the patient needs, or the patient ended an agreement with that practice within the past year. A practice may end an agreement for any reason with at least 30 days' written notice. A patient may end an agreement for any reason by written notice. A practice must give at least 30 days' written notice before ending an agreement. A patient's termination takes effect on the first day of the month after the practice receives notice.

A practice would have to follow rules for fees, refunds, records, and billing. These rules apply to fees and services covered by a direct agreement. Fees may not vary based on a patient's health status or sex. A practice must promptly refund unearned fees when an agreement ends, and may not bill a health plan for care covered by the agreement. A practice must keep records of payments and services and provide them to a patient or representative upon request. A practice may raise an existing patient's monthly fee no more than once a year and must give at least 60 days' advance notice of a fee change.

A qualifying direct agreement would not be treated as insurance under the listed state insurance laws, and a provider or the provider's agent would not need an insurance license to market or sell it. A direct agreement is a written agreement in which a qualifying primary care practice charges a patient a fee for being available to provide and for providing primary care. The agreement must meet the bill's requirements for a direct primary care service agreement.