With the uncertainties of personal injury protection benefits (“PIP”) lurking, providers who focus their practice on PIP, are thinking of the next plan to stay in business. It is unclear what will come of HB837 and what parts of the bill will be accepted or denied by Gov. Ron DeSantis. What we do know is tort reform is an inevitable thing, and providers, especially Chiropractors must be ready.
So as a Chiropractor how do you stay in business if the PIP law changes? Answer: Concierge Medicine. On July 1, 2018, the Florida legislature enacted the “Direct Primary Care Agreement” (“DPC”) statute. Prior to this, providers had to jump multiple hoops to provide plans to patients that had insurance characteristics, which was limited to primary care only. These types of agreements were only limited to primary care services, the new law allows specialist or group practices to enter into DPC’s for specialty type services. The legislature added a list of the providers who would qualify as allowed specialists, Chiropractors are a type of provider allowed.
The statute has a list of items which are required in the DPC. See below:
- The DPC must be in writing and signed by the provider and the patient.
- Must include termination language allowing termination by either party upon 30 days in writing, immediately if there is a violation of the physician-patient relationship, or a breach of terms in the agreement.
- Describe the scope of the primary care services covered by the monthly fee.
- Specify the monthly fee and any other fees for primary care services not covered by the monthly fee.
- Specify the duration of the agreement and any automatic renewal provisions.
- Offer a refund if the provider ceases offering primary care services for any reason.
- Must include the following statement, in a contrasting color and 12-point font: “This agreement is not health insurance and the primary care provider will not file any claims against the patient’s health insurance policy or plan for reimbursement of any primary care services covered by the agreement. This agreement does not qualify as minimum essential coverage to satisfy the individual shared responsibility provisions of the Patient Protection and Affordable Care Act, 26 USC §5000A. This agreement is not workers compensation insurance and does not replace an employer’s obligations under chapter 440, Florida statutes.”
This list is a minimum requirement of what is required by a provider allowed under the DPC to engage a contract with their patient for concierge services (cash pay). When creating a DPC, having a legal counselor assist you in this type of arrangement is heavily recommend. The agreements not only contain binding terms, but they implicate various concerns that surround a provider.
A few of those concerns are: compliance with current payor agreements, billing patients who may be Medicare, compliance with the No Surprise Act, and proper accounting protocols (specifically relating to Chiropractors). As you can see, the DPC is a blessing but could ultimately be a curse if you fail to engage an attorney to assist you in its creation.
Attorney Carlos Arce works with the Florida Healthcare Law Firm in Delray Beach, FL. He has deep experience with bodily injury trial work and in health law. Carlos has handled multi-million-dollar healthcare transactions and serves as out-of-house counsel to various small to large types of healthcare entities. He can be reached via email at [email protected] or by calling 561-455-7700.