HF 1157

Introduction - 94th Legislature (2025 - 2026)

Posted on 02/24/2025 05:55 p.m.

A bill for an act
relating to health care; establishing direct primary care service agreements;
amending Minnesota Statutes 2024, sections 62A.01, by adding a subdivision;
62A.011, subdivision 3; proposing coding for new law in Minnesota Statutes,
chapter 62Q.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2024, section 62A.01, is amended by adding a subdivision
to read:

new text begin Subd. 5. new text end

new text begin Direct primary care service agreements. new text end

new text begin (a) A direct primary care service
agreement under section 62Q.20 is not insurance and is not subject to this chapter. Entering
into a direct primary care service agreement is not the business of insurance and is not
subject to this chapter or chapter 60A.
new text end

new text begin (b) A health care provider or agent of a health care provider is not required to obtain a
certificate of authority or license under this chapter or chapter 60A, 62C, 62D, or 62N to
market, sell, or offer to sell a direct primary care service agreement that meets the
requirements of section 62Q.20.
new text end

Sec. 2.

Minnesota Statutes 2024, section 62A.011, subdivision 3, is amended to read:

Subd. 3.

Health plan.

"Health plan" means a policy or certificate of accident and sickness
insurance as defined in section 62A.01 offered by an insurance company licensed under
chapter 60A; a subscriber contract or certificate offered by a nonprofit health service plan
corporation operating under chapter 62C; a health maintenance contract or certificate offered
by a health maintenance organization operating under chapter 62D; a health benefit certificate
offered by a fraternal benefit society operating under chapter 64B; or health coverage offered
by a joint self-insurance employee health plan operating under chapter 62H. Health plan
means individual and group coverage, unless otherwise specified. Health plan does not
include coverage that is:

(1) limited to disability or income protection coverage;

(2) automobile medical payment coverage;

(3) liability insurance, including general liability insurance and automobile liability
insurance, or coverage issued as a supplement to liability insurance;

(4) designed solely to provide payments on a per diem, fixed indemnity, or
non-expense-incurred basis, including coverage only for a specified disease or illness or
hospital indemnity or other fixed indemnity insurance, if the benefits are provided under a
separate policy, certificate, or contract for insurance; there is no coordination between the
provision of benefits and any exclusion of benefits under any group health plan maintained
by the same plan sponsor; and the benefits are paid with respect to an event without regard
to whether benefits are provided with respect to such an event under any group health plan
maintained by the same plan sponsor;

(5) credit accident and health insurance as defined in section 62B.02;

(6) designed solely to provide hearing, dental, or vision care;

(7) blanket accident and sickness insurance as defined in section 62A.11;

(8) accident-only coverage;

(9) a long-term care policy as defined in section 62A.46 or 62S.01;

(10) issued as a supplement to Medicare, as defined in sections 62A.3099 to 62A.44, or
policies, contracts, or certificates that supplement Medicare issued by health maintenance
organizations or those policies, contracts, or certificates governed by section 1833 or 1876,
section 1851, et seq.; or section 1860D-1, et seq., of title XVIII of the federal Social Security
Act, et seq., as amended;

(11) workers' compensation insurance;

(12) issued solely as a companion to a health maintenance contract as described in section
62D.12, subdivision 1a, so long as the health maintenance contract meets the definition of
a health plan;

(13) coverage for on-site medical clinics; deleted text begin or
deleted text end

(14) coverage supplemental to the coverage provided under United States Code, title
10, chapter 55, Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS) deleted text begin . deleted text end new text begin ; or
new text end

new text begin (15) coverage provided under a direct primary care service agreement under section
62Q.20.
new text end

Sec. 3.

new text begin [62Q.20] DIRECT PRIMARY CARE SERVICE AGREEMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have
the meanings given.
new text end

new text begin (b) "Direct primary care service agreement" or "direct agreement" means a written
agreement entered into between a direct primary care practice and a direct patient, or the
direct patient's legal representative, in which the direct primary care practice charges a direct
fee as consideration for being available to provide and for providing direct primary care
services to the direct patient.
new text end

new text begin (c) "Direct fee" means a fee charged by a direct primary care practice as consideration
for being available to provide and for providing primary care services to a direct patient as
specified in the direct agreement.
new text end

new text begin (d) "Direct patient" means an individual who is party to a direct agreement and is entitled
to receive primary care services under the direct agreement from the direct primary care
practice.
new text end

new text begin (e) "Direct primary care practice" or "direct practice" means a primary care provider
who furnishes primary care services through a direct agreement.
new text end

new text begin (f) "Primary care provider" means a physician who is licensed under chapter 147 or an
advanced practice registered nurse licensed under sections 148.171 to 148.285, authorized
to engage in independent practice, and who is qualified to provide primary care services.
Primary care provider includes an individual primary care provider or a group of primary
care providers.
new text end

new text begin (g) "Primary care services" means:
new text end

new text begin (1) routine health care services, including screening, assessment, diagnosis, and treatment,
to promote health and to detect and manage disease or injury, performed within the
competency and training of the primary care provider;
new text end

new text begin (2) medical supplies and prescription drugs that are administered or dispensed in the
primary care provider's office or clinic; and
new text end

new text begin (3) laboratory work, including routine blood screening and routine pathology screening
performed by a laboratory, that is (i) associated with the direct primary care practice, or (ii)
not associated with the direct primary care practice but the laboratory has entered into a
contract with the practice to provide laboratory work without charging a fee to the patient
for the laboratory work.
new text end

new text begin Subd. 2. new text end

new text begin Direct primary care service agreement requirements. new text end

new text begin (a) To be considered
a direct primary care service agreement for purposes of this section, the direct agreement
must:
new text end

new text begin (1) be in writing;
new text end

new text begin (2) be signed by the primary care provider or agent of the primary care practice and the
direct patient or the patient's legal representative;
new text end

new text begin (3) allow either party to terminate the direct agreement upon written notice to the other
party as provided under subdivision 3;
new text end

new text begin (4) describe the scope of the primary care services that are covered under the direct
agreement;
new text end

new text begin (5) specify the fee paid on a monthly basis or as specified in the direct agreement;
new text end

new text begin (6) specify the duration of the direct agreement; and
new text end

new text begin (7) not be subject to automatic renewal.
new text end

new text begin (b) The direct agreement must clearly state that a direct primary care service agreement
is not health insurance, does not meet the requirements of federal law mandating individuals
to purchase health insurance, and that the fees charged in the agreement may not be
reimbursed or applied toward a deductible under a health plan offered through a health plan
company.
new text end

new text begin Subd. 3. new text end

new text begin Acceptance and discontinuance of patients. new text end

new text begin (a) A direct practice is prohibited
from declining to accept a new patient or discontinuing care to an existing patient solely on
the basis of the patient's health status. A direct practice may decline to accept a patient if:
new text end

new text begin (1) the practice has reached the practice's maximum capacity;
new text end

new text begin (2) the practice is unable to provide the appropriate level and type of primary care services
that the patient's medical condition requires; or
new text end

new text begin (3) the patient terminated a previous direct agreement with the direct practice within the
preceding year.
new text end

new text begin (b) A direct patient or the patient's legal representative may terminate a direct agreement
for any reason by providing written notice to the direct practice. Termination of the direct
agreement is effective the first day of the month following the month the termination notice
is provided to the direct practice.
new text end

new text begin (c) A direct practice may terminate the direct agreement only if the direct patient:
new text end

new text begin (1) fails to pay the monthly fee;
new text end

new text begin (2) has performed an act of fraud; or
new text end

new text begin (3) is abusive and presents an emotional or physical danger to the direct practice's staff
or other patients.
new text end

new text begin The direct practice must promptly provide notice of termination to the direct patient or the
patient's legal representative. The notice of termination must state the reason for the
termination and the effective date of the termination.
new text end

new text begin (d) Notwithstanding paragraph (c), a direct practice may discontinue care to a direct
patient if the direct practice discontinues operating as a direct primary care practice. The
direct practice must provide notice to the direct patient or the patient's legal representative
specifying the effective date of termination under this paragraph. The notice must be
sufficient to provide the patient with the opportunity to obtain care from another provider.
new text end

new text begin Subd. 4. new text end

new text begin Direct fees. new text end

new text begin (a) The direct fee charged must represent the total amount due for
all primary care services specified in the direct agreement provided to the direct patient
within the specified time period. The direct fee must not vary from patient to patient based
on the patient's health status or sex. The direct fee may be paid by the direct patient, the
patient's legal representative, or on the patient's behalf by a third party. The direct fee may
be billed at the end of each monthly period or may be paid in advance for a period not to
exceed 12 months.
new text end

new text begin (b) If a patient pays the monthly fee in advance, the payment must be held by the direct
practice in a trust account with the monthly fee paid to the direct practice as earned at the
end of each month.
new text end

new text begin (c) Upon receipt of a written notice terminating the direct agreement from a direct patient
or the patient's legal representative, the direct practice must promptly refund the unearned
amount of the direct fees held in trust. If the direct practice discontinues care for any reason
described under subdivision 3, the direct practice must promptly refund to the direct patient
the unearned amount of the direct fees held in trust and at a prorated amount of the direct
fee earned for the current month based on the date the termination notice was sent to the
direct patient or the direct patient's legal representative.
new text end

new text begin (d) A direct practice is prohibited from increasing the monthly fee that has been negotiated
with an existing direct patient more frequently than on an annual basis. A direct practice
must provide advance notice of at least 60 days to existing patients regarding any change
in the direct fee.
new text end

new text begin Subd. 5. new text end

new text begin Conduct of business. new text end

new text begin (a) A direct practice must maintain appropriate accounts
regarding payments made and services received by a direct patient and upon request provide
data requested to the direct patient or the patient's legal representative.
new text end

new text begin (b) A direct practice must not submit a claim for payment to a health plan company for
a primary care service provided to a direct patient that is covered by a direct agreement.
new text end

new text begin (c) A person is prohibited from making a false, deceptive, or misleading representation
or advertisement related to a direct practice's business.
new text end

new text begin (d) A person is prohibited from making, issuing, circulating, or causing to be made,
issued, or circulated a misrepresentation of the terms of a direct agreement or the benefits
or advantages promised, or using the name or title of a direct agreement misrepresenting
the nature of the direct agreement.
new text end

new text begin Subd. 6. new text end

new text begin Other care not prohibited. new text end

new text begin A direct primary care practice is not prohibited
from providing services to other patients under a separate contract with a health plan
company.
new text end

new text begin Subd. 7. new text end

new text begin Enforcement. new text end

new text begin A violation of this section constitutes unprofessional conduct
and may be grounds for disciplinary action under chapters 147 and 148.
new text end