Idaho

Quick Facts

Key Provisions

• Insurance Regulation Exemption: The Idaho Direct Medical Care Act (Idaho Code Title 39, Chapter 92) clearly states that a direct primary care agreement is not considered an insurance product and is therefore not subject to regulation under the state's insurance code.
• Eligible Provider Types: The law specifically defines eligible primary care providers as those licensed in pediatrics, family medicine, internal medicine, or dentistry.
• Mandatory Written Agreement: All DPC relationships must be governed by a written agreement that details the scope of services, the periodic fee amount, the agreement's term, and the locations where care will be provided.
• Patient's Right to Terminate: The agreement must explicitly state that the patient has the right to terminate the contract at any time, for any reason, by providing written notice to the provider.
• Provider Billing Restrictions: A DPC provider is prohibited from submitting claims to any insurance company for services that are covered under the direct care agreement.
• Patient Reimbursement Clause: While providers cannot bill insurance, the law does not prevent a patient from submitting a claim for reimbursement to their own insurer, provided their specific insurance policy allows for it.
• Individual Patient Focus: Idaho's law limits DPC agreements to individual patients. A provider is not permitted to enter into a direct care agreement with an employer or other group on behalf of its members.
• Agreement Transferability: A direct care agreement cannot be sold or transferred to another party without the express written consent of the patient. If sold, it can only be transferred to another qualifying primary care provider.
• Termination by Provider: The agreement must outline the specific conditions under which the provider may choose to terminate the contract with the patient.
• Broad Service Definition: 'Direct primary care services' are broadly defined to include screening, assessment, diagnosis, treatment, health promotion, and even routine or diagnostic dental care, giving providers flexibility in their offerings.

Medication Dispensing

Physicians operating a Direct Primary Care practice in Idaho must adhere to all state Board of Pharmacy regulations when dispensing medications. The law specifically highlights the need to follow established rules for dispensing controlled substances. The provided research does not offer further details on the specific statutes governing in-office dispensing of non-controlled substances, so DPC providers should consult the Idaho Board of Pharmacy directly to ensure full compliance with all dispensing, labeling, and record-keeping requirements.