Tennessee

Quick Facts

Key Provisions

• Legal Status: Direct primary care agreements are legally defined as contracts for medical services and are explicitly declared not to be insurance, exempting them from regulation by the Tennessee Department of Commerce and Insurance (Tenn. Code Ann. § 63-1-501).
• Written Agreement Required: All DPC arrangements must be formalized in a written contract that clearly outlines the specific primary care services provided, the fee structure, and the duration of the agreement.
• Provider Eligibility: The law permits medical care providers licensed under Title 63 (which includes physicians) and healthcare facilities licensed under Title 33 or 68 to enter into direct care agreements.
• Patient Protection: Patients do not lose or forfeit their existing insurance, TennCare (Medicaid), or Medicare benefits by entering into a private contract for DPC services (Tenn. Code Ann. § 63-1-503).
• Termination and Refunds: Either the patient or the provider may terminate the agreement with 30 days' written notice. The law requires providers to issue a pro-rata refund for any prepaid fees for services not yet rendered.
• Consumer Disclosure: The DPC agreement must clearly state that it is not a health insurance plan and does not satisfy any individual health insurance mandates.
• Scope of Practice: Services provided under a DPC agreement are limited to ongoing primary care and explicitly exclude emergency services, inpatient hospital care, and most specialty consultations.

Medication Dispensing

In Tennessee, DPC physicians (MDs and DOs) are permitted to dispense medications directly to their patients from their offices, subject to regulations from the Board of Medical Examiners (Tenn. Comp. R. & Regs. 0880-2-.14). To do so, they must maintain detailed dispensing logs, with separate records for controlled substances, and ensure all medications are properly labeled with patient information, directions, and provider details. Similarly, Advanced Practice Nurses (APNs) with prescriptive authority can dispense under nearly identical rules set by their own board (Tenn. Comp. R. & Regs. 1000-04-.09). The legal authority for Physician Assistants (PAs) to dispense remains unclear, as legislation to grant this authority (SB1171/HB1272) did not pass in 2023.

Medicaid Provisions

Tennessee law is favorable for DPC practices wishing to serve Medicaid beneficiaries. Tenn. Code Ann. § 63-1-503 explicitly permits providers to accept direct, private payments from patients enrolled in TennCare (Tennessee's Medicaid program) or Medicare. The statute also protects patients, clarifying that they do not forfeit their public benefits by paying out-of-pocket for DPC services. A notable exception exists, prohibiting physicians from privately contracting with Medicaid patients specifically for buprenorphine treatment. The state has not established any DPC-specific pilot programs or provisions for state employee health plans.