MISSISSIPPI LEGISLATURE
2020 Regular Session
To: Insurance
By: Senator(s) McDaniel
AN ACT TO AMEND SECTION 83-81-1, MISSISSIPPI CODE OF 1972, TO CHANGE THE NAME OF THE MISSISSIPPI DIRECT PRIMARY CARE ACT TO THE MISSISSIPPI DIRECT HEALTH CARE ACT; TO AMEND SECTION 83-81-3, MISSISSIPPI CODE OF 1972, TO REVISE THE DEFINITION OF "PRIMARY CARE PROVIDER" TO INCLUDE OTHER HEALTH CARE PROVIDERS; TO AMEND SECTIONS 83-81-5, 83-81-7, 83-81-9, 83-81-11 AND 83-1-101, MISSISSIPPI CODE OF 1972, TO CONFORM; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 83-81-1, Mississippi Code of 1972, is amended as follows:
83-81-1. This chapter shall
be known as the "Mississippi Direct * * * Health Care Act."
SECTION 2. Section 83-81-3, Mississippi Code of 1972, is amended as follows:
83-81-3. As used in this chapter, the following words and phrases have the meanings as defined in this section unless the context clearly indicates otherwise:
(a) "Primary or
other health care provider" means an individual or other legal entity
that is licensed, registered, or otherwise authorized to provide * * * medical care services in this
state under * * * existing state law. "Primary
or other health care provider" includes an individual or other legal
entity alone or with others professionally associated with the individual or
other legal entity.
(b) "Direct * * * health care agreement"
means a contract between a primary or other health care provider and an
individual patient or his or her legal representative or between a primary or
other health care provider and an employer on behalf of its employees in
which the * * * provider agrees to provide * * * services to the individual
patient for an agreed-upon fee and period of time.
(c) "Direct
primary or other health care service" means a service that is
provided by charging a periodic fee-for-services; not billing any third parties
on a fee-for-service basis for the individual covered by the * * * care agreement; and allowing
for a per-visit fee to be charged to the patient at the time of service.
(d) "Primary or other health care service" includes, but is not limited to, the screening, assessment, diagnosis, and treatment for the purpose of promotion of health or the detection and management of disease or injury within the competency, training, and scope of the primary or other health care provider. This may also include fees for advanced technology or techniques used within the practice that may offer benefits for improved patient engagement.
SECTION 3. Section 83-81-5, Mississippi Code of 1972, is amended as follows:
83-81-5. A direct * * * health care agreement shall not
be considered to be an insurance product nor shall the primary or other
health care provider be considered to be engaging in the business of
insurance for the purpose of this Title 83, Mississippi Code of 1972.
SECTION 4. Section 83-81-7, Mississippi Code of 1972, is amended as follows:
83-81-7. A primary or other
health care provider or agent of a primary or other health care
provider is not required to obtain a certificate of authority or license under
this chapter to market, sell, or offer to sell a direct * * * health care agreement.
SECTION 5. Section 83-81-9, Mississippi Code of 1972, is amended as follows:
83-81-9. To offer a direct
primary or other health care service, the primary or other health
care provider must obtain a completed direct * * * health care agreement for each
patient obtaining direct primary or other health care services. In
order to be considered a direct * * * health care agreement for the
purposes of this section, the * * * agreement must meet all of
the following requirements:
(a) Be in writing;
(b) Be signed by the individual patient or his or her legal representative and be made available for the records of the primary or other health care provider or agent of the primary or other health care provider;
(c) Allow either party to terminate the agreement on written notice to the other party;
(d) Describe the scope of primary or other health care services that are covered by the periodic fee;
(e) Specify the periodic fee for ongoing care under the agreement;
(f) Specify the duration of the agreement, any automatic renewal periods, and prohibit the prepayment of the agreement. Upon discontinuing the agreement, all unearned funds, as determined by the lesser of normal undiscounted fee-for-service charges that would have been billed in place of the agreement or the remainder of the membership contract, are returned to the patient. Upon termination of the agreement, the patient shall not be liable for the remainder of payment associated with the agreement or membership contract. However, the patient shall be responsible for the true cost of services rendered regardless of when the contract is terminated.
(g) Prominently state in writing the following:
(i) That the agreement is not health insurance;
(ii) That the agreement standing alone does not satisfy the health benefit requirements as established in the federal Affordable Care Act; and
(iii) That, without adequate insurance coverage in addition to this agreement, the patient may be subject to fines and penalties associated with the federal Affordable Care Act.
SECTION 6. Section 83-81-11, Mississippi Code of 1972, is amended as follows:
83-81-11. Those primary or other health care providers who offer direct primary or other health care services to their patients may not decline to accept new direct primary or other health care patients or discontinue care to existing patients solely because of the patient's health status. A direct primary or other health care provider may decline to accept a patient if the practice has reached its maximum capacity, or if the patient's medical condition is such that the provider is unable to provide the appropriate level and type of primary or other health care services the patient requires. So long as the direct primary or other health care provider provides the patient notice and opportunity to obtain care from another physician, the direct primary or other health care provider may discontinue care for direct primary or other health care patients if:
(a) The patient fails to pay the periodic fee;
(b) The patient has performed an act of fraud;
(c) The patient repeatedly fails to adhere to the recommended treatment plan;
(d) The patient is abusive and presents an emotional or physical danger to the staff or other patients of the direct practice;
(e) The direct primary or other health care provider discontinues operation as a direct primary or other health care provider; or
(f) The direct primary
or other health care * * * provider
feels that the relationship is no longer therapeutic for the patient due to a
dysfunctional * * * provider/patient relationship.
SECTION 7. Section 83-1-101, Mississippi Code of 1972, is amended as follows:
83-1-101. Notwithstanding any other provision of law to the contrary, and except as provided herein, any person or other entity which provides coverage in this state for medical, surgical, chiropractic, physical therapy, speech pathology, audiology, professional mental health, dental, hospital, or optometric expenses, whether such coverage is by direct payment, reimbursement, or otherwise, shall be presumed to be subject to the jurisdiction of the State Insurance Department, unless:
(a) The person or other entity shows that while providing such services it is subject to the jurisdiction of another agency of this state, any subdivisions thereof, or the federal government; or
(b) The person or
other entity is providing coverage under the Direct * * * Health Care Act in Sections 83-81-1
through 83-81-11.
SECTION 8. This act shall take effect and be in force from and after July 1, 2020, and shall stand repealed on June 30, 2020.