Wisconsin

Quick Facts

Key Provisions

• No Official Legal Status: Wisconsin state law does not officially define "Direct Primary Care agreement" or provide a specific legal framework for the model. Practices must operate under general business contract law and medical board regulations.
• Risk of Insurance Reclassification: Without a statutory exemption, DPC practices face uncertainty regarding their legal status. There is a risk that the Office of the Commissioner of Insurance could classify DPC monthly membership agreements as "the business of insurance," which would subject them to extensive and costly insurance regulations.
• Failed Legislative Efforts (AB 798): A significant attempt to legitimize DPC, Assembly Bill 798, failed to pass in 2018. The bill proposed to explicitly state that DPC agreements are not insurance, thereby providing legal certainty for practices. It also outlined requirements for patient contracts.
• Guidance from Proposed Legislation: Although not law, the failed AB 798 provides a best-practice framework that many Wisconsin DPC practices follow. This includes using clear, written contracts that detail the scope of services, monthly fees, termination policies, and a prominent disclosure stating the agreement is not a health insurance policy.
• Ongoing Legislative Interest: The legal landscape in Wisconsin may evolve. New legislation has been introduced following the failure of AB 798, indicating continued interest among lawmakers in formally recognizing and creating a secure legal environment for the DPC model in the state.

Medication Dispensing

Wisconsin lacks DPC-specific regulations for in-office medication dispensing. Therefore, DPC physicians who wish to dispense medications directly to their patients must comply with the general state laws and rules governing physician dispensing. These regulations are primarily overseen by the Wisconsin Medical Examining Board and the Pharmacy Examining Board. Key requirements typically involve proper drug sourcing, storage, labeling, and record-keeping. Physicians are generally limited to dispensing prescription drugs or devices only to their own patients for a specific course of treatment. DPC providers considering this service should consult the current Wisconsin Statutes and Administrative Code (such as Med 8 and 9) to ensure full compliance.

Medicaid Provisions

Wisconsin does not currently have any provisions integrating Direct Primary Care with its Medicaid program, known as Medical Assistance. A proposal to create a DPC pilot program for Medicaid recipients was included in the 2017-2018 legislative session's Assembly Bill 798. However, this bill failed to become law, and the pilot program was never established. Consequently, there is no formal mechanism for DPC practices to contract with the state to serve the Medicaid population under a monthly membership model, nor are there any DPC options available for state employees through their health plans.