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Direct Primary Care Agreements; No Special Certificate or License; Requirements for Agreement and Discontinuation of Services; Refunding

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As used in this Code section, the term:
1. "Direct primary care agreement" means a contract between a physician and an individual patient or his or her legal representative in which the physician or the physician's medical practice agrees to provide health care services to the individual patient for an agreed-upon fee and period of time.
2. "Direct primary care practice" means a physician or physician's medical practice that charges a periodic fee for services, does not bill any third parties on a fee for service basis, and whose per visit charge is less than the monthly equivalent of the periodic fee.
3. "Physician" means a person licensed to practice medicine pursuant to Article 2 of Chapter 34 of Title 43.
A direct primary care agreement is not insurance, shall not be deemed an insurance arrangement nor agreement, and is not subject to state insurance laws.
A physician offering, marketing, selling, or entering into a direct primary care agreement shall not be required to obtain a certificate of authority or license other than to maintain a current license to practice medicine with the State of Georgia.
To be considered a direct primary care agreement for the purposes of this Code section, such agreement shall:
1. Be in writing;
2. Be signed by a physician or agent of the physician and the individual patient or his or her legal representative;
3. Allow either party to terminate such agreement upon written notice; provided, however, that a physician shall be required to give a patient adequate notice of at least 30 days to allow a patient a reasonable amount of time to find another health care provider, and a patient shall be required to give a physician notice of no more than 30 days;
4. Describe the scope of health care services that are covered by the periodic fee;
5. Specify the periodic fee and any additional fees outside of the periodic fee for ongoing care;
6. Specify the duration of such agreement and any automatic renewal periods and require that no more than 12 months of the periodic fee be paid in advance; and
7. Prominently state in writing that such agreement is not health insurance.
A physician providing health care services under a direct primary care agreement may decline to accept a patient if, in the physician's opinion, such patient's medical condition is such that the provider is unable to provide the appropriate level and type of health care services such patient requires. The physician may discontinue care for patients under the direct primary care agreement if:
1. The patient fails to pay the periodic fee or any additional fees specified by the agreement;
2. The patient has performed an act of fraud;
3. The patient repeatedly fails to adhere to the recommended treatment plan;
4. The patient is abusive and presents an emotional or physical danger to the staff or other patients of the direct primary care practice; or
5. The physician or the physician's medical practice discontinues operation as a direct primary care practice.
In the event that either party terminates an agreement pursuant to this Code section, any unearned portion of any fees paid pursuant to such agreement shall be refunded by the physician to the patient within 30 days of termination.

(Code 1981, §33-7-2.1, enacted by Ga. L. 2019, p. 217, § 2/SB 18.)

Editor's notes.

- Ga. L. 2019, p. 217, § 1/SB 18, not codified by the General Assembly, provides: "This Act shall be known and may be cited as the 'Direct Primary Care Act.'"

Law reviews.

- For article on the 2019 enactment of this Code section, see 36 Ga. St. U.L. Rev. 135 (2019).

RESEARCH REFERENCES

Am. Jur. 2d.

- 61 Am. Jur. 2d, Physicians, Surgeons, and Other Healers, § 114 et seq.

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