2025 - 2026 LEGISLATURE
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2025 ASSEMBLY BILL 8
February 6, 2025 - Introduced by Representatives DUCHOW, BROOKS, ARMSTRONG,
DITTRICH, HURD, MURPHY, O'CONNOR, RODRIGUEZ and WICHGERS,
cosponsored by Senators CABRAL-GUEVARA, KAPENGA, NASS and TESTIN.
Referred to Committee on Health, Aging and Long-Term Care.
***AUTHORS SUBJECT TO CHANGE***
AN ACT to create 146.78 and 600.01 (1) (b) 13. of the statutes; relating to:
agreements for direct primary care.
Analysis by the Legislative Reference Bureau
This bill exempts valid direct primary care agreements from the application of
insurance law. A Xdirect primary care agreement,Y as defined in the bill, is a
contract between a health care provider that provides primary care services under
the provider[s scope of practice and an individual patient or the patient[s legal
representative or employer in which the health care provider agrees to provide
primary care services to the patient for an agreed-upon subscription fee and period
of time.
A valid direct primary care agreement is in writing and satisfies all of the
following:
1. It is signed by the health care provider or an agent of the health care
provider and the individual patient, the patient[s legal representative, or a
representative of the patient[s employer.
2. It allows either party to terminate the agreement upon written notice.
3. It describes and quantifies the specific primary care services that are
provided under the agreement.
4. It specifies the subscription fee for the agreement and specifies terms for
termination of the agreement.
5. It specifies the duration of the agreement.
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6. It prohibits the provider and patient from billing an insurer or any other
third party on a fee-for-service basis for the primary care services included in the
subscription fee under the agreement.
7. It prominently states, in writing, several provisions, including that the
agreement is not health insurance and the agreement alone may not satisfy
individual or employer insurance coverage requirements under federal law; that the
patient is responsible for paying, or directing the patient[s employer to pay, the
provider for all services that are not included in the subscription fee under the
agreement; that the patient is encouraged to consult with a health insurance
advisor, the patient[s health insurance carrier, or the patient[s employer-sponsored
health plan, as applicable, before entering into the agreement; and that direct
primary care fees might not be credited toward deductibles or out-of-pocket
maximum amounts under any health insurance the patient has.
Under the bill, a health care provider may not decline to enter into or
terminate a direct primary care agreement with a patient solely because of the
patient[s health status. The bill allows a health care provider to decline to accept a
patient for a direct primary care agreement only if the health care provider[s
practice has reached its maximum patient capacity or if the patient[s medical
condition is such that the health care provider is unable to provide the appropriate
level and type of primary care services the patient requires. The bill also provides
that a health care provider may not decline to enter into a direct primary care
agreement with a patient, terminate a direct primary care agreement with a
patient, or otherwise discriminate against a patient in the provision of health care
services under a direct primary care agreement on the basis of race, color, national
origin, religious belief or affiliation, sex, disability, age, sexual orientation, or
gender identity. A health care provider may terminate a direct primary care
agreement with a patient only if the patient or the patient[s employer fails to pay
the subscription fee, the patient fails repeatedly to adhere to the treatment plan,
the patient has performed an act of fraud related to the direct primary care
agreement, the patient is abusive in a manner described in the bill, the health care
provider discontinues operation as a direct primary care provider, or the health
care provider believes that the relationship is no longer therapeutic for the patient
due to a dysfunctional relationship between the provider and the patient.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SECTION 1. 146.78 of the statutes is created to read:
146.78 Direct primary care agreement. (1) DEFINITIONS. In this section:
(a) XDirect primary care agreementY means a contract between a health care
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provider and an individual patient or the patient's legal representative or employer
in which the health care provider agrees to provide primary care services to the
individual patient for an agreed-upon subscription fee and period of time.
(b) XHealth care providerY means a health care provider under s. 146.81 (1) (a)
to (p) that provides primary care services under the health care provider[s scope of
practice.
(c) XPrimary care servicesY means outpatient, general health care services of
the type provided by a main source for regular health care services for patients at
the time a patient seeks preventive care or first seeks health care services for a
specific health concern and includes all of the following:
1. Care that promotes and maintains mental and physical health and
wellness.
2. Care that prevents disease.
3. Screening, diagnosis, and treatment of acute or chronic conditions caused
by disease, injury, or illness.
4. Patient counseling and education.
5. Provision of a broad spectrum of preventive and curative health care over a
period of time.
6. Coordination of care.
(2) VALID AGREEMENT. A health care provider and an individual patient or
the patient[s legal representative or employer may enter into a direct primary care
agreement. A valid direct primary care agreement meets all of the following
criteria:
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(a) The direct primary care agreement is in writing.
(b) The direct primary care agreement is signed by the health care provider or
an agent of the health care provider and the individual patient, the patient[s legal
representative, or a representative of the patient[s employer.
(c) The direct primary care agreement allows either party to the direct
primary care agreement to terminate the direct primary care agreement upon
written notice to the other party subject to the requirements under sub. (3) for
termination of the direct primary care agreement by the health care provider.
(d) The direct primary care agreement describes and quantifies the specific
primary care services that are provided under the direct primary care agreement.
(e) The direct primary care agreement specifies the subscription fee for the
direct primary care agreement and specifies terms for termination of the direct
primary care agreement, including any possible refund of fees to the patient or the
patient[s employer.
(f) The direct primary care agreement specifies the duration of the direct
primary care agreement.
(g) The health care provider and the patient are prohibited from billing an
insurer or any other 3rd party on a fee-for-service basis for the primary care
services included in the subscription fee under the direct primary care agreement.
(h) The direct primary care agreement prominently states, in writing, all of
the following:
1. The direct primary care agreement is not health insurance, and the direct
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primary care agreement alone may not satisfy individual or employer insurance
coverage requirements under federal law.
2. The individual patient is responsible for paying the health care provider for
all services that are not included in the subscription fee under the direct primary
care agreement or directing the patient[s employer to pay the health care provider
for all services that are not included in the subscription fee under the direct
primary care agreement, if applicable.
3. The patient is encouraged to consult with a health insurance advisor, the
patient[s health insurance carrier, or the patient[s employer-sponsored health plan,
as applicable, before entering into the direct primary care agreement regarding
coverage options for health care services that may not be covered through the direct
primary care agreement.
4. Some services provided under the direct primary care agreement may be
covered under any health insurance the patient has.
5. Direct primary care fees might not be credited toward deductibles or out-of-
pocket maximum amounts under the patient[s health insurance, if the patient has
health insurance.
(3) PATIENT SELECTION; TERMINATION. (a) A health care provider may not
decline to enter into a direct primary care agreement or terminate a direct primary
care agreement with a patient solely because of the patient[s health status. A
health care provider may decline to accept a patient for a direct primary care
agreement for only any of the following reasons:
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1. The health care provider[s practice has reached its maximum patient
capacity.
2. The patient[s medical condition is such that the health care provider is
unable to provide the appropriate level and type of primary care services the
patient requires.
(b) A health care provider may terminate a direct primary care agreement
with a patient for only any of the following reasons:
1. The patient or the patient[s employer fails to pay the subscription fee.
2. The patient repeatedly fails to adhere to the treatment plan recommended
by the health care provider.
3. The patient has performed an act of fraud related to the direct primary care
agreement.
4. The patient is abusive and presents an emotional or physical danger to the
staff or other patients of the health care provider.
5. The health care provider discontinues operation as a health care provider
under direct primary care agreements.
6. The health care provider believes that the relationship is no longer
therapeutic for the patient due to a dysfunctional relationship between the health
care provider and the patient.
(c) 1. No health care provider may decline to enter into a direct primary care
agreement with a patient, terminate a direct primary care agreement with a
patient, or otherwise discriminate against a patient in the provision of health care
services under a direct primary care agreement on the basis of race, color, national
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origin, religious belief or affiliation, sex, disability, age, sexual orientation, or
gender identity.
2. Nothing in this section shall be construed to limit the application of s.
106.52 to a health care provider[s practice.
(4) INSURANCE NETWORK PARTICIPATION. A health care provider who has a
practice in which the health care provider enters into direct primary care
agreements may participate in a network of a health insurance carrier only to the
extent that the health care provider is willing and able to comply with the terms of
the participation agreement with the health insurance carrier and meet any other
terms and conditions of network participation as determined by the health
insurance carrier.
(5) CONSTRUCTION. Nothing in this section shall be construed to limit the
regulatory authority of the department of safety and professional services or the
department of agriculture, trade and consumer protection. Nothing in this section
shall be construed to limit the authority of the office of the commissioner of
insurance to regulate contracts that do not satisfy the criteria to be a valid direct
primary care agreement under sub. (2) and that meet the definition of insurance
under s. 600.03 (25).
SECTION 2. 600.01 (1) (b) 13. of the statutes is created to read:
600.01 (1) (b) 13. Valid direct primary care agreements under s. 146.78 (2).
(END)
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