An Act Governing Direct Primary Care Membership Agreements
Maine Legislature, Session 128, LD 1385
Committee Amendment CA_A_S127 (Senate)

COMMITTEE AMENDMENT "A " to S.P. 472, L.D. 1385, Bill, "An Act 
Governing Direct Primary Care Membership Agreements" 
Amend the bill by striking out the title and substituting the following: 
'An Act Governing Direct.Primary Care Service Agreements' 
Amend the bill by striking 'out eterything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 22 MRSA c. 403-A is enacted to read: 
CHAPTER 403-A 
DIRECT PRIMARY CARE SERVICE AGREEMENTS 
§1771. Direct primary care service agreements 
1. Definitions. As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A. "Direct primary care service agreement" means a contractual agreement between 
a direct primary care provider and an individual patient. or the patient's legal 
representative, in which: 
(1) The direct primary care provider agrees to provide primary care services to 
the individual patient for an agreed-to fee over an agreed-to period of time; and 
(2) The direct primary care provider agrees not to bill 3rd parties on a fee-for-
service or capitated basis for services already covered in the direct primary care 
service agreement. 
B. "Direct primaiy care provider" means an individual who is a licensed physician or 
osteopathic physician or other advanced health care practitioner who is authorized to 
engage in independent medical practice in this State, who is qualified to provide 
primary care services and who chooses to practice direct primary care by entering 
COMMITTEE AMENDMENT 
A.dS. 
COMMITTEE AMENDMENT" A "to S.P. 472, L.D. 1385 
into a direct primary care service agreement with patients. The term includes, but is 
not limited to, an individual primary care provider or a group of primary care 
providers. 
C. 
"Primary care" means outpatient, nonspecialty health care services or the 
coordination of health care for the purpose of: 
(1) Promoting or maintaining mental and physical health and wellness; and 
(2) 
The diagnosis, treatment or management of acute or chronic conditions 
caused by disease, injury or illness. 
2. Not insurance. A direct primary care service agreement is not an insurance 
policy and is not subject to regulation by the Department of Professional and Financial 
Regulation, Bureau oflnsurance. 
3. Ability to contract. A direct primary care service agreement is an agreement 
between the direct primary care provider and either an individual or the individual's 
representative, regardless of whether the periodic fee or other fees are paid by the 
individual, the individual's representative or a 3rd party. 
4. 
Covered services. A direct primary care service agreement covers only the 
services specified in the agreement. Any goods or services that are not covered by the 
direct primary care service agreement may be billed separately. 
5. Disclosure. A direct primary care service agreement must clearly state within the 
agreement-that direct primary care services are not considered health insurance and do 
not meet requirements of any federal law mandating individuals to purchase health 
insurance and that the fees charged in the agreement may not be reimbursed or apply 
towards a deductible under a health insurance policy with an insurer. 
6. Other care not prohibited. A primary care provider is considered a direct 
primary care provider only when the provider is engaged in a direct primary care service 
agreement with a patient or group of patients. A primary care provider is not prohibited 
from providing care to other patients under a separate agreement or contract with an 
insurer. 
7. 
Other agreements not prohibited. This section does not prohibit a direct 
primary care provider from entering into: 
A. 
An agreement with an insurer offering a policy specifically designed to 
supplement a direct primary care service agreement; or 
B. 
A pilot program for direct primary care with a federal or state agency that 
provides health coverage.' 
SUMMARY 
This amendment replaces the bill. The amendment provides that a direct primary 
care service agreement is not insurance and is not subject to regulation by the Department 
of Professional and Financial Regulation, Bureau of Insurance. A direct primary care 
service agreement is defined as a contract between a direct primary care provider and an 
individual patient or legal representative of a patient in which the provider agrees to 
COMMITTEE AMENDMENT 
R. <JS. 
COMMITTEE AMENDMENT "A "to S.P. 472, L.D. 1385 
provide primary care services to the individual patient for an agreed-to fee over an 
agreed-to period of time and the provider agrees not to bill 3rd parties on a fee-for-service 
or capitated basis. The amendment also clarifies that a direct primary care provider is not 
prohibited from entering into an agreement with an insurer offering a policy specifically 
designed to supplement a direct primary care service agreement or from entering into a 
pilot program for direct primary care with a federal or state agency that provides health 
coverage. 
COMMITTEE AMENDMENT