Indiana

Quick Facts

Key Provisions

• A direct primary care agreement is legally defined as a contract between a provider and a patient for a periodic fee, and it is not considered an insurance product under state law (IC 25-22.5-13-2).
• Eligible providers under the statute are defined specifically as physicians licensed in Indiana to provide primary care services (IC 25-22.5-13-1).
• All DPC agreements must be in writing and signed by the provider (or their agent) and the patient (or their legal representative).
• The written agreement must prominently state that it is not a health insurance policy and does not meet any individual health insurance mandate.
• The contract must clearly describe the scope of primary care services covered by the periodic fee, the amount of the fee, and any additional fees for services not included.
• Patients have the right to terminate the agreement at any time, without penalty or reason.
• A provider wishing to terminate an agreement must provide the patient with at least thirty (30) days' written notice.
• The agreement must specify the duration of the contract and include a policy for refunding any unearned portion of the periodic fee if the provider ceases to practice.

Medicaid Provisions

While Indiana's primary DPC law does not address Medicaid, the state has explored integrating the model. Senate Bill 470 was introduced to create a DPC pilot program for Medicaid recipients. The proposed program aimed to serve up to 400 individuals across various eligibility categories, including children, parents, and seniors, with a maximum average monthly fee of $70. Under the proposal, participating physicians would contract exclusively with the program, providing primary care services without accepting third-party payments. While this specific bill was assigned to committee, it signals the state's interest in leveraging DPC to improve access and care for its Medicaid population.