Nebraska

Quick Facts

Key Provisions

• Under the Direct Primary Care Agreement Act (Neb. Rev. Stat. §§ 71-9501 to 71-9511), a DPC agreement is legally defined as a non-insurance product and is explicitly exempt from the state's insurance code.
• All DPC arrangements must be formalized in a written contract that clearly specifies the scope of primary care services covered, the amount of the periodic fee, and a list of any potential additional charges for non-covered services.
• The patient agreement must include a prominent disclosure stating that it is not a health insurance plan and does not, by itself, satisfy federal or employer mandates for health coverage.
• Practices are prohibited from discriminating against patients by refusing to enroll them or by discontinuing their care based on their current or past health status.
• Providers are barred from billing any third-party payer, such as an insurance company, on a fee-for-service basis for any services already included and paid for under the DPC membership fee.
• The DPC agreement must include a clause allowing for termination by either the patient or the provider at any time, provided that written notice is given as stipulated in the contract.
• All healthcare providers offering DPC services must be fully licensed to practice in Nebraska within their respective fields. However, no additional DPC-specific license or registration is required for the practice or its marketing agents.

Medication Dispensing

Nebraska's Direct Primary Care Agreement Act (LB 817) does not contain specific provisions governing in-office medication dispensing by DPC practices. Therefore, physicians and other providers must adhere to the general state laws and regulations concerning physician dispensing. This involves complying with the rules set forth by the Nebraska Board of Medicine and Surgery and the Nebraska Board of Pharmacy. Practices interested in dispensing medications directly to their patients should consult these state boards to ensure they meet all labeling, storage, record-keeping, and registration requirements. While the separate state employee pilot program (LB 1119) integrated pharmaceutical care, the primary DPC law leaves dispensing regulations to existing state frameworks.

Medicaid Provisions

Nebraska has actively integrated Direct Primary Care into its state-level health planning. In 2018, the legislature passed LB 1119, the Direct Primary Care Pilot Program Act, which established a DPC option for state employees and their dependents within the Nebraska State Insurance Program. This pilot created a 'direct primary care health plan' that combines DPC services with wraparound insurance for specialist and hospital care, as well as pharmaceutical benefits. Furthermore, the state's DPC law clarifies the model's interaction with Medicaid, permitting providers to accept payments from Medicaid beneficiaries for DPC services without requiring the patient to forfeit their Medicaid benefits for other covered medical needs.