Kentucky

Quick Facts

Key Provisions

• Exemption from Insurance Code: Direct Primary Care membership agreements are not considered insurance and are explicitly exempt from regulation under the Kentucky insurance code (KRS 304.1-120(9)).
• Eligible Providers: The law permits licensed physicians (MDs and DOs) and Advanced Practice Registered Nurses (APRNs) to enter into DPC agreements with patients (KRS 311.6201, KRS 314.198).
• Written Agreement Required: All DPC arrangements must be documented in a written contract that clearly describes the scope of primary care services provided, the membership fee, and the duration of the agreement (KRS 311.6201).
• Billing Restrictions: A provider operating under a DPC agreement is prohibited from billing a patient's health benefit plan or the Medicaid program for any services already covered by the membership fee (KRS 311.6201(c)).
• No Forfeiture of Health Coverage: Patients who enter into a DPC agreement do not forfeit or lose their existing health benefit plan coverage. DPC is designed to coexist with traditional insurance (KRS 311.6202).
• Prepayment Limitation: Practices cannot require patients to prepay membership fees for more than a twelve (12) month period at a time (KRS 311.6201(f)).
• Termination Without Penalty: The DPC agreement must allow either the patient or the provider to terminate the contract at any time, without penalty, after providing proper notice as outlined in the agreement (KRS 311.6201(h)).
• Mandatory Refund of Unearned Fees: Upon termination of a DPC agreement by either party, the provider is legally required to return all unearned fees that have been prepaid by the patient (KRS 311.6201(i)).

Medication Dispensing

Kentucky's DPC law does not contain specific statutes governing medication dispensing within a DPC practice. However, DPC physicians in the state may be able to dispense pre-packaged medications directly to their patients, often at or near wholesale cost, provided they comply with the general state laws and regulations overseen by the Kentucky Board of Pharmacy and the Kentucky Board of Medical Licensure. These broader regulations typically cover physician dispensing, including requirements for proper labeling, record-keeping, and storage. Practices interested in offering this service should consult directly with these regulatory boards to ensure full compliance with all applicable rules, as they are not detailed within the DPC-specific legislation (KRS 311.6201 et seq.).

Medicaid Provisions

Kentucky law places specific restrictions on the interaction between DPC practices and the state's Medicaid program. A DPC provider is expressly forbidden from billing the Medicaid program for any services that are covered under a patient's DPC membership agreement (KRS 311.6201). Furthermore, providers who accept Medicaid are generally prohibited from charging Medicaid beneficiaries a private membership fee for services that would otherwise be covered by the Medicaid program. While the original 2017 law was passed, there were notes of a potential executive order that could further restrict Medicaid patients from entering DPC agreements, though the status of such an order is not clarified in the statute. The law does not include any specific provisions or pilot programs related to the Kentucky Employees' Health Plan.