Louisiana Revised Statutes 37:798 – Direct primary care agreement with a dental practice
Terms Used In Louisiana Revised Statutes 37:798
- Board: means the Louisiana State Board of Dentistry. See Louisiana Revised Statutes 37:751
- Contract: A legal written agreement that becomes binding when signed.
- Dentistry: means the evaluation, diagnosis, prevention, or treatment, including nonsurgical, surgical, or related procedures, of diseases, disorders, or conditions of the oral cavity, maxillofacial areas or the adjacent and associated structures and their impact on the human body provided by a dentist within the scope of his education, training, and experience, in accordance with the ethics of the profession and applicable law. See Louisiana Revised Statutes 37:751
- Fraud: Intentional deception resulting in injury to another.
- person: includes a body of persons, whether incorporated or not. See Louisiana Revised Statutes 1:10
- unprofessional conduct: means :
(1) Advertisement of fees for or of free dental services without:
(a) Fully disclosing all procedures to be included by the dentist in the advertised service, including but not limited to necessary diagnosis, radiographs, restorative treatment, laboratory fees, and post-operative care. See Louisiana Revised Statutes 37:775
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 La. Rev. Stat. 37:775 and result in sanctions by the board as authorized in this Chapter.
Acts 2019, No. 55, §1.