South Dakota

Quick Facts

Key Provisions

• DPC Agreement is Not Insurance: Under SDCL § 58-17E-2, a direct primary care agreement is explicitly defined as not being a contract of insurance. Consequently, DPC practices are not subject to the regulations and requirements of the state's insurance code, which simplifies their operational and financial structure.
• Eligible Healthcare Providers: The law specifies which licensed professionals can enter into DPC agreements. Eligible providers include physicians, advanced practice registered nurses (APRNs), and physician assistants (PAs) who hold a valid license to practice in South Dakota (SDCL § 58-17E-1 and § 58-17E-6).
• Mandatory Written Agreement: All DPC arrangements must be documented in a written agreement signed by both the provider and the patient. This contract must clearly outline the scope of primary care services included, the periodic fee amount, the agreement's duration, and the terms for termination (SDCL § 58-17E-3).
• Required Patient Disclosures: The patient agreement must contain specific, prominent disclosures. It must state that the agreement is not health insurance, that the provider will not bill an insurer for services covered by the fee, and include a recommendation that the patient obtain and maintain separate health insurance coverage for services not included in the DPC agreement (SDCL § 58-17E-3).
• Termination Rights: The law grants both the patient and the provider the right to terminate the DPC agreement at any time by providing written notice. If a patient terminates the agreement, the provider may be required to refund a pro-rata portion of any prepaid fees for the remainder of the month (SDCL § 58-17E-4).
• Non-Discrimination Protections: A DPC provider cannot decline to accept a new patient or discontinue care for an existing patient based on their health status. However, the law permits a provider to decline new patients if their practice has reached its maximum capacity (SDCL § 58-17E-5).
• Prohibition on Double Billing: To prevent conflicts with insurance, the statute explicitly prohibits a DPC provider from submitting a claim or billing a health insurance plan for any primary care services that are already covered under the patient's direct primary care agreement fee (SDCL § 58-17E-3).

Medication Dispensing

South Dakota law permits licensed medical practitioners, including physicians, to dispense medications directly to their own patients during the regular course of their professional practice. This regulatory environment is highly beneficial for DPC clinics, allowing them to maintain an in-office formulary of common, low-cost generic medications. Practices that choose to dispense must comply with the same labeling, packaging, and record-keeping requirements as a traditional pharmacy, ensuring patient safety. This capability enables DPC providers to offer medications at or near wholesale cost, saving patients time and money by avoiding a separate trip to the pharmacy.