§ 37:798 — Direct primary care agreement with a dental practice

§798. Direct primary care agreement with a dental practice
A. As used in this Section, the following words have the meanings ascribed to them
unless the context requires otherwise:
(1) "Board" means the Louisiana State Board of Dentistry.
(2) "Dentist" means a person licensed to practice dentistry in this state.
(3) "Direct dental practice" means a dentist or dental practice of a dentist that charges
a periodic fee for dental services and which does not bill a third party, including any entity
subject to regulation under Title 22 of the Louisiana Revised Statutes of 1950, for any
additional fee for services for patients covered under a direct primary care agreement. The
per-visit charge of the practice shall be less than the monthly equivalent of the periodic fee.
(4) "Direct primary care agreement" means a written agreement between a direct
dental practice and a patient or his or her legal representative whereby the direct dental
practice agrees to provide dental services to the patient for an agreed-upon fee and period of
time.
B. A direct primary care agreement that complies with the provisions of this Section
is not health or dental insurance and is not subject to the provisions or regulations provided
for under Title 22 of the Louisiana Revised Statutes of 1950.
C. A patient or legal representative shall not forfeit any insurance benefits, Medicaid
benefits, or Medicare benefits by purchasing healthcare services or products outside the
system.
D. A direct dental practice offering, marketing, selling, or entering into a direct
primary care agreement shall not be required to obtain a certificate of authority or license
other than to maintain a current license to practice dentistry in this state.
E. To be considered a direct primary care agreement for the purposes of this Section,
the agreement shall satisfy all of the following:
(1) Be in writing.
(2) Be signed by a dentist, or agent of the dentist, and the patient, or his legal
representative.
(3) Allow either party to terminate the agreement upon written notice of at least thirty
days to the other party.
(4) Describe the scope of dental services that are covered by the periodic fee.
(5) Specify the periodic fee and any additional fees outside of the periodic fee for
ongoing dental services.
(6) Specify the duration of the agreement and any automatic renewal periods and
require that no more than twelve months of the periodic fee be paid in advance.
(7) Prominently state in writing that is conspicuously visible and in bold font all of
the following:
(a) The agreement does not constitute health or dental insurance under the laws of
this state.
(b) Patients insured by health insurance plans that are compliant with the Patient
Protection and Affordable Care Act may already have coverage for pediatric dental benefits.
(c) Payments made by a patient for services rendered under a direct primary care
agreement may not count toward the patient's health insurance deductibles and maximum
out-of-pocket expenses.
(d) A patient is encouraged to consult with the patient's health insurance plan before
entering into the agreement and receiving care.
(8) Provide that, upon termination of the agreement by the patient, all unearned fees
are to be returned to the patient.
F. A direct dental practice may accept payment of periodic fees directly or indirectly
from third parties. A direct dental practice may accept a periodic fee paid by an employer on
behalf of an employee who is a direct patient. However, a dental practice shall not enter into
a contract with an employer relating to the direct primary care agreements between the direct
dental practice and employees of that employer other than to establish the timing and method
of the payment of the periodic fee by the employer.
G. A direct dental practice shall not decline to accept a new direct primary care
patient or discontinue care to an existing patient solely because of a patient's health status,
race, religion, national origin, the presence of any sensory, mental or physical disability,
education, or economic status. A direct dental practice may decline to accept a patient if
either:
(1) In the dentist's opinion, the patient's health condition is such that the provider is
unable to provide the appropriate level and type of dental services the patient requires.
(2) The dental practice has reached its maximum capacity.
H. A direct dental practice may discontinue care for patients under the direct primary
care agreement under any of the following conditions:
(1) The patient fails to pay the periodic fee.
(2) The patient has performed an act of fraud concerning the direct primary care
agreement.
(3) The patient repeatedly fails to adhere to the recommended treatment plan.
(4) The patient is abusive or presents an emotional or physical danger to the staff or
other patients of the dental practice.
(5) The direct dental practice discontinues operation as a dental practice.
I. A direct dental practice shall not:
(1) Enter into a participating provider contract with any health or dental insurance
issuer or with any health or dental insurance issuer's contractor or subcontractor to provide
healthcare or dental services through a direct agreement except as set forth in Subsection J
of this Section.
(2) Submit a claim for payment to any health or dental insurance issuer or any health
or dental insurance issuer's contractor or subcontractor for healthcare or dental services
provided to direct patients as covered by their direct agreement.
(3) Pay for healthcare or dental services covered by a direct agreement rendered to
direct patients by providers other than the providers in the direct practice or their employees,
except as described in Subsection J of this Section.
J. A direct dental practice may:
(1) Enter into a participating provider contract with a health or dental insurance
issuer for purposes other than payment of claims for services provided to direct patients
through a direct agreement. Such dentists shall be subject to all other provisions of the
participating provider contract applicable to participating providers.
(2) Pay for charges associated with:
(a) Dispensing, at no additional cost to the direct patient, of prescription drugs
prescribed by the direct provider in accordance with state law and regulations promulgated
by the board.
(b) Dental laboratory products ordered for a direct patient.
(3) Charge an additional fee to direct patients for supplies, medications, materials,
and devices provided to direct patients that are specifically excluded under the agreement,
provided the direct practice notifies the direct patient of the additional charge, prior to their
administration or delivery.
K. The board may promulgate all rules and regulations that are necessary and proper
to effectuate the provisions of this Section.
L. A violation of this Section shall constitute unprofessional conduct under R.S.
37:775 and result in sanctions by the board as authorized in this Chapter.

Legislative History

Acts 2019, No. 55, §1.