Integrate Direct Primary Care Practices into the Healthcare System in Minnesota

 

This bill aims to reduce the healthcare costs for Minnesotans who chose to participate in a direct primary care practice

by requiring that all health plan companies regulated by the State of Minnesota must treat membership fees paid by an

enrollee to a Direct Primary Care practice as eligible medical expenses that must be credited toward the enrollee’s

deductible and out-of-pocket maximum. This applies only to health plans regulated by the State of Minnesota and does not

apply to self-insured employer health plans governed by federal law.

 

This ensures patients who choose to pursue direct primary care have that payment recognized as a medical expense in

their health plan. Counting these fees toward their deductible recognizes Direct Primary Care as a legitimate medical

expense and encourages more preventative care.

 

I. “Direct Primary Care” shall be defined as a healthcare model where a patient receives primary care services form a

licensed physician in exchange for a periodic fee paid directly by the patient.

II. “Primary Care Services” shall be defined as preventative care, wellness visits, chronic disease management,

treatment for common illnesses, coordination of care with specialists, and minor procedures commonly performed in a

primary care setting.

III. “Health Plan Companies Regulated by the State of Minnesota” shall be defined as any health plan company regulated

under Minnesota Statutes § 62A.011, subdivision 2, which includes Traditional Insurance Companies, Health Service

Corporations, Health Maintenance Organizations, and Community Networks.

IV. “Membership Fees” shall be defined as a periodic fee paid directly by the patient to a licensed physician for

primary care services.

V. “Deductible” shall be defined as the total amount of covered medical expenses that an enrollee is responsible for

paying before the health plan provides payment for covered services.

VI. “Out-of-Pocket Maximum” shall be defined as the maximum sum of deductibles, copayments, and coinsurance that an

enrollee is required to pay for covered services in a plan year. After reaching this maximum, the health plan pays 100%

of covered services for the remainder of the plan year.

VII. “Self-Insured Employer Health Plans” shall be defined as health insurance arrangements where the employer assumes

the financial risk of providing health care benefits to employees, paying for claims directly rather than purchasing

insurance from a third-party insurer.

 

No funding is needed for this bill.

 

This requirement for health plan companies regulated by the State of Minnesota shall be monitored and enforced by the

Department of Commerce and the Commissioner of Commerce using existing statutory powers established in Minnesota

Statutes § 45.027. A health plan company that is in violation of this requirement shall be subject to enforcement

actions and administrative penalties consistent with that authority.

 

January 1, 2028