LRB-3960/1
JPC:wlj&amn
2023 - 2024 LEGISLATURE
January 11, 2024 - Introduced by Senators Cabral-Guevara and Felzkowski,
cosponsored by Representatives Duchow, Dittrich, Kitchens, Murphy,
Mursau, O'Connor and Rozar. Referred to Committee on Health.
SB905,1,2 1An Act to create 146.78 and 600.01 (1) (b) 13. of the statutes; relating to:
2agreements for direct primary care.
Analysis by the Legislative Reference Bureau
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
against a patient in the provision of health care services under a direct primary care
agreement on the basis of race, color, national origin, religious belief or affiliation,
sex, disability, age, sexual orientation, or gender identity. A health care provider may
terminate a direct primary care agreement with a patient only if the patient or the
patient's employer fails to pay the subscription fee, the patient fails repeatedly to
adhere to the treatment plan, the patient has performed an act of fraud related to
the direct primary care agreement, the patient is abusive in a manner described in
the bill, the health care provider discontinues operation as a direct primary care
provider, or the health care provider believes that the relationship is no longer
therapeutic for the patient due to a dysfunctional relationship between the provider
and the patient.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB905,1 1Section 1. 146.78 of the statutes is created to read:
SB905,2,2 2146.78 Direct primary care agreement. (1) Definitions. In this section:
SB905,3,23 (a) “Direct primary care agreement" means a contract between a health care
4provider and an individual patient or the patient's legal representative or an
5employer in which the health care provider agrees to provide primary care services

1to the individual patient or employee for an agreed-upon subscription fee and period
2of time.
SB905,3,43 (b) “Health care provider" means a health care provider under s. 146.81 (1) (a)
4to (p) that provides primary care services under the provider's scope of practice.
SB905,3,85 (c) “Primary care services” means outpatient, general health care services of
6the type provided by a main source for regular health care services for patients at the
7time a patient seeks preventive care or first seeks health care services for a specific
8health concern and includes all of the following:
SB905,3,99 1. Care that promotes and maintains mental and physical health and wellness.
SB905,3,1010 2. Care that prevents disease.
SB905,3,1211 3. Screening, diagnosis, and treatment of acute or chronic conditions caused by
12disease, injury, or illness.
SB905,3,1313 4. Patient counseling and education.
SB905,3,1514 5. Provision of a broad spectrum of preventive and curative health care over a
15period of time.
SB905,3,1616 6. Coordination of care.
SB905,3,19 17(2) Valid agreement. A health care provider and an individual patient or the
18patient's legal representative or an employer may enter into a direct primary care
19agreement. A valid direct primary care agreement meets all of the following criteria:
SB905,3,2020 (a) The agreement is in writing.
SB905,3,2321 (b) The agreement is signed by the health care provider or an agent of the
22health care provider and the individual patient, the patient's legal representative,
23or a representative of the employer.
SB905,4,3
1(c) The agreement allows either party to the agreement to terminate the
2agreement upon written notice to the other party subject to the requirements under
3sub. (3) for termination of the agreement by the health care provider.
SB905,4,54 (d) The agreement describes and quantifies the specific primary care services
5that are provided under the agreement.
SB905,4,86 (e) The agreement specifies the subscription fee for the agreement and specifies
7terms for termination of the agreement, including any possible refund of fees to the
8patient or the patient's employer.
SB905,4,99 (f) The agreement specifies the duration of the agreement.
SB905,4,1210 (g) The health care provider and the patient are prohibited from billing an
11insurer or any other 3rd party on a fee-for-service basis for the primary care services
12included in the subscription fee under the agreement.
SB905,4,1313 (h) The agreement prominently states, in writing, all of the following:
SB905,4,1514 1. The agreement is not health insurance and the agreement alone may not
15satisfy individual or employer insurance coverage requirements under federal law.
SB905,4,1916 2. The individual patient is responsible for paying the provider for all services
17that are not included in the subscription fee under the agreement or directing the
18individual's employer to pay the provider for all services that are not included in the
19subscription fee under the agreement, if applicable.
SB905,4,2320 3. The patient is encouraged to consult with a health insurance advisor, the
21patient's health insurance carrier, or the patient's employer-sponsored health plan,
22as applicable, before entering into the agreement regarding coverage options for
23health care services that may not be covered through the agreement.
SB905,4,2524 4. Some services provided under the agreement may be covered under any
25health insurance the patient has.
SB905,5,3
15. Direct primary care fees might not be credited toward deductibles or
2out-of-pocket maximum amounts under the patient's health insurance, if the
3patient has health insurance.
SB905,5,8 4(3) Patient selection; termination. (a) A health care provider may not decline
5to enter into a direct primary care agreement or terminate a direct primary care
6agreement with a patient solely because of the patient's health status. A health care
7provider may decline to accept a patient for a direct primary care agreement for only
8any of the following reasons:
SB905,5,109 1. The health care provider's practice has reached its maximum patient
10capacity.
SB905,5,1311 2. The patient's medical condition is such that the health care provider is
12unable to provide the appropriate level and type of primary care services the patient
13requires.
SB905,5,1514 (b) A health care provider may terminate a direct primary care agreement with
15a patient for only any of the following reasons:
SB905,5,1616 1. The patient or the patient's employer fails to pay the subscription fee.
SB905,5,1817 2. The patient repeatedly fails to adhere to the treatment plan recommended
18by the health care provider.
SB905,5,2019 3. The patient has performed an act of fraud related to the direct primary care
20agreement.
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