Background:

A direct patient-provider primary care practice (direct practice) is a health care provider or a group of health care providers that furnishes primary care services through a direct agreement with a patient. Under the direct agreement, the direct practice charges a monthly fee in exchange for being available to provide primary care services to the patient. While direct practices are not insurance carriers, they are required to register annually with the Office of the Insurance Commissioner (OIC).

The Insurance Commissioner (Commissioner) reports annually to the Legislature on direct practices including participation trends, complaints received, voluntary data reported by the direct practices, and any necessary modifications to the law on direct practices.

In addition to the annual reports, the Commissioner is required to submit to the Legislature, by December 1, 2012, a study of direct practices. This study must include an analysis of the extent to which direct practices:

improve or reduce access to primary health care services;
provide adequate protection for consumers;
increase premium costs for individuals covered through traditional health insurance;
impact a health carrier's ability to meet network adequacy standards; and
cover a population different from that covered through traditional health insurance.

The study must also examine the extent to which participation in a direct practice maintains health coverage for conditions not covered by the direct practice. The Commissioner must make recommendations to the Legislature on whether direct practice authority should be continued, modified, or repealed.

Votes on Final Passage:

House	98	0
Senate	49	0