MISSISSIPPI LEGISLATURE
2020 Regular Session
To: Accountability, Efficiency, Transparency
By: Senator(s) Younger
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 DELETE THE DEFINITION OF "PRIMARY CARE PROVIDER" AND INSERT THE DEFINITION OF "HEALTH CARE PROVIDER" IN LIEU THEREOF; 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) " * * *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. "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 * * * health care provider and an
individual patient or his or her legal representative or between a * * * 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 * * * 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) " * * *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 * * *
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 * * * 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 * * * provider or agent of a * * * 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 * * * health care service, the * * * provider must obtain a completed
direct * * *
health care agreement for each patient obtaining direct * * * health care services. In order
to be considered a direct * * * primary health care agreement for the purposes of this
section, the direct * * * health care 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 * * * provider or agent of the * * * provider;
(c) Allow either party to terminate the agreement on written notice to the other party;
(d) Describe the scope
of * * *
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 * * * providers who offer direct * * * health care services to their
patients may not decline to accept new direct * * * health care patients or
discontinue care to existing patients solely because of the patient's health
status. A direct * * * 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 * * * services the patient requires. So long as the direct * * * health care provider provides
the patient notice and opportunity to obtain care from another physician, the
direct * * *
health care provider may discontinue care for direct * * * 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 * * * health care provider
discontinues operation as a direct * * * health care provider; or
(f) The direct * * * 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.