Louisiana

Quick Facts

Key Provisions

• A DPC agreement is not considered an insurance product and is therefore exempt from regulation under Louisiana's insurance code (Title 22). This is the foundational principle of the state's DPC law.
• A 'direct practice' must be operated by a licensed physician, a group of physicians, or a qualifying entity that is either wholly owned by physicians or is a 501(c)(3) nonprofit organization (R.S. 37:1360.81).
• Practices must utilize a written 'direct agreement' with patients. This contract must detail the specific primary care services included, state the periodic fee, and be terminable at will by the patient.
• Patients have the right to terminate their DPC agreement at any time for any reason, provided they give written notice to the practice, as stipulated in R.S. 37:1360.81.
• DPC practices are strictly prohibited from billing any third-party payers, such as private insurance companies or government programs, for services rendered to a patient under a direct agreement (R.S. 37:1360.85).
• The scope of services is limited to 'primary care,' defined as routine screening, assessment, diagnosis, and treatment. The law specifically excludes services like major surgery, hospitalization, dialysis, and high-level radiology from being included in the direct fee.
• The legal definition of a 'direct patient-provider primary care practice' centers the model on physicians (MDs or DOs), establishing it as a physician-led healthcare service.

Medication Dispensing

In Louisiana, DPC practices operate under specific medication dispensing regulations. The primary DPC statute (R.S. 37:1360.81) states that a practice may not provide prescription drugs as part of its direct fee, but it provides for an exception under R.S. 37:1360.84(B). For any in-office dispensing, physicians must also comply with the general rules set by the Louisiana State Board of Pharmacy. According to Title 46, Chapter 65 of the pharmacy regulations, this includes registering with the board and providing a list of all medications to be dispensed. Furthermore, practices must adhere to strict requirements for record-keeping, secure storage of medications, and proper labeling and packaging for any drugs provided to patients.

Medicaid Provisions

Louisiana's DPC legislation does not include specific provisions for integrating with Medicaid or state employee health plans, and no state-sponsored pilot programs have been established. However, DPC physicians can still serve the Medicaid population on a private-pay basis, where the patient pays the monthly fee directly. For a DPC physician to write prescriptions or make referrals that are covered by a patient's Medicaid plan, they can enroll with Louisiana Medicaid as an Ordering/Referring Provider (ORP). This special enrollment status allows them to order services without becoming a full billing provider, thus navigating the 'payment in full' restrictions that can complicate direct participation with Medicaid.