AB 953

This bill exempts valid direct primary care agreements from the application of

insurance law. A direct primary care agreement, as defined in the bill, is a contract

between a health care provider that provides primary care services under the

provider's scope of practice and an individual patient, or the patient's legal

representative, or an employer in which the health care provider agrees to provide

primary care services to the patient or employee for an agreed-upon subscription fee

and period of time.

A valid direct primary care agreement is in writing and satisfies all of the

following:

1. It is signed by the health care provider or an agent of the health care provider

and the individual patient, the patient's legal representative, or a representative of

the patient's employer.

2. It allows either party to terminate the agreement upon written notice.

3. It describes and quantifies the specific primary care services that are

provided under the agreement.

4. It specifies the subscription fee for the agreement and specifies terms for

termination of the agreement.

5. It specifies the duration of the agreement.

6. It prohibits the provider and patient from billing an insurer or any other

third party on a fee-for-service basis for the primary care services included in the

subscription fee under the agreement.

7. It prominently states, in writing, several provisions including that the

agreement is not health insurance and the agreement alone may not satisfy

individual or employer insurance coverage requirements under federal law; that the

individual patient is responsible for paying, or directing the individual's employer

to pay, the provider for all services that are not included in the subscription fee under

the agreement; that the patient is encouraged to consult with a health insurance

advisor, the patient's health insurance carrier, or the patient's employer-sponsored

health plan, as applicable, before entering into the agreement; and that direct

primary care fees might not be credited toward deductibles or out-of-pocket

maximum amounts under any health insurance the patient has.

Under the bill, a health care provider may not decline to enter into or terminate

a direct primary care agreement with a patient solely because of the patient's health

status. The bill allows a health care provider to decline to accept a patient for a direct

primary care agreement only if the health care provider's practice has reached its

maximum patient capacity or if the patient's medical condition is such that the

health care provider is unable to provide the appropriate level and type of primary

care services the patient requires. The bill also provides that a health care provider

may not decline to enter into a direct primary care agreement with a patient,

terminate a direct primary care agreement with a patient, or otherwise discriminate