AN ORDINANCE OF THE COUNTY OF______ AUTHORIZING PHYSICIANS TO OFFER DIRECT PRIMARY CARE ARRANGEMENTS TO COUNTY RESIDENTS.
- FINDINGS: The Board of Supervisors find that there are many residents of the county who have difficulty accessing primary care services, either because they are self-employed and cannot afford private health insurance, are uninsured or their insurance does not cover all necessary primary care visits and services.The Board further finds that despite the reduction in the number of uninsured individuals in the county many residents can only afford limited coverage of a catastrophic nature, while others remain uninsured, or cannot afford the premiums charged by the limited number of private insurers in the market.
The Board further finds that many physicians are willing to provide services to these individuals by establishing arrangements that are not dependent upon the traditional insurance coverage model.
The Board further finds that it is appropriate for the county to facilitate access to these physicians by authorizing arrangements between residents of the county and physicians providing services in the county for access to and provision of medical services when residents do not have that access through insurance.
- DIRECT PRIMARY CARE ARRANGEMENTS: In order for a physician to provide direct primary care services to county residents through fixed fee arrangements, a physician must offer an arrangement via exclusive contract substantially similar to that set forth in item III. of this ordinance, and must meet the following requirements:
- The physician is licensed as a physician by the state and is in good standing.
- The physician provides primary care clinical services to residents of the county and has a physical location in the county.
- The physician is a Medi-Cal provider.
- The physician will accept patients under this program regardless of the patient’s health status.
- The physician will provide patients with a complete list of services available under this program and the arrangement offered by the physician.
- FORM OF DIRECT PRIMARY CARE AGREEMENTS: A Direct Primary Care Agreement must meet the following requirements:
- In writing and executed by the individual or his/her legal representative, the treating provider, and where applicable, the executive officer of the professional association or group to which the treating provider belongs.
- Individual agrees to a waiver on litigation under this Agreement in favor of other dispute resolution alternatives, such as mediation or arbitration.
- Be no longer than 12 months in duration, with periodic payments no more than six months in advance. Any advance payments in excess of one month shall be placed in a trust or escrow account from which payment may be made to the provider for each month of services rendered.
- Allow for termination by the individual with five days’ notice and without cause.
- Limit the right to termination by the provider to the following circumstances:
- Declaration of bankruptcy or dissolution by the affiliated association.
- Discontinuation of practice by the treating provider. However, in cases of termination by the treating provider, the individual shall have the right to select another provider within the association and continue the terms of the Agreement.
- The individual’s habitual non-payment of the required fees.
- In the event of termination of the agreement by the provider, the provider shall inform the patient that the provider can supply a list of providers that are accepting new patients upon referral.
- Notice of termination by the provider or association must be in writing with verification of receipt by the individuals or his/her representative. The individual must receive notice at least 30 days prior to the date of the termination. If an individual opts to terminate the agreement because of the discontinuation of practice by the treating provider, he/she shall be entitled to a refund of all amounts paid for services that otherwise would have been available subsequent to the date of termination.
- Specify the amount of the periodic fee, schedule for payment, and any additional fees or costs associated with the services available under the agreement.
- A description of the services available under the agreement and a specific delineation of those services not available under the agreement. Enrollment fees or similar charges separate from the periodic payment are prohibited
- Any primary care provider or professional association offering a Direct Primary Care Agreement may not decline to accept an individual under such an arrangement or discontinue care to an existing patient based in whole or in part on an individual’s health status unless the provider states in writing he/she lacks the competency or training to care for the individual based upon the individual’s medical condition.
- Any primary care provider or professional association offering a Direct Primary Care Agreement is exempt from certain state and federal regulations governing the practice of medicine.
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