AB 798

The bill allows a health care provider and an individual patient or employer to

enter into a direct primary care agreement and requires the Department of Health

Services to establish and implement a direct primary care program for Medical

Assistance recipients. A direct primary care agreement is a contract in which the

health care provider agrees to provide routine health services such as screening,

assessment, diagnosis, and treatment for the purpose of promotion of health or the

detection and management of disease or injury, dispensing of medical supplies and

prescription drugs, and certain laboratory services for a specified fee over a specified

duration. A valid direct primary care agreement outside of the Medical Assistance

program must, among other things, state that the agreement is not health insurance

and that the agreement alone may not satisfy individual or employer insurance

coverage requirements under federal law. The bill exempts direct primary care

agreements from the application of insurance law. The bill also allows DHS to

investigate complaints related to private direct primary care agreements.

For the direct primary care program for Medical Assistance recipients, the bill

specifies requirements that must be in an agreement between a direct primary care

provider and DHS and requires DHS to submit a report on implementation of the

program. If necessary, DHS must seek federal approval for the program and may not

implement the program if the federal government disapproves.