Idaho

Idaho is the 10th state to pass DPC legislation. Senate Bill No. 1062 (the Idaho Direct Medical Care Act) was signed by the governor on April 9, 2015.  The law's passage is now reflected in Idaho Code Title 39 Chapter 92. DPC practices were already operational within the state.  Even though the newly passed law in section 39-9206 clearly states that "direct care agreements are not subject to regulation as insurance under title 41, Idaho Code" out of abundant precaution one still might wish to review the insurance code. Also note that the law did not contemplate potential "managed care plan" (HMO-type) issues, so those definitions are included below as well.  Be sure to review the Idaho Statutes Title 41 Insurance when planning your DPC practice.  Here is a link to a brief presentation given at the Idaho Dept of Health and Welfare promoting DPC as a potential Medicaid option for the state and another by a local attorney discussing the law.

Title 41 Insurance - Chapter 1

41-102.  "INSURANCE" DEFINED. "Insurance is a contract whereby one undertakes to indemnify another or pay or allow a specified or ascertainable amount or benefit upon determinable risk contingencies."

Readers should note that in Idaho there is helpful precedent for "not insurance" exceptions in the form of health sharing ministry legislation.

41-121  EXEMPTION OF HEALTH CARE SHARING MINISTRIES FROM THE INSURANCE CODE.

(1)  A health care sharing ministry shall not be considered to be engaging in the business of insurance for purposes of this title.
(2)  As used in this section, "health care sharing ministry" means a faith-based nonprofit organization that is tax exempt under the Internal Revenue Code which:
(a)  Limits its participants to those who are of a similar faith;
(b)  Acts as a facilitator among participants who have financial or medical needs and matches those participants with other participants with the present ability to assist those with financial or medical needs in accordance with criteria established by the health care sharing ministry;
(c)  Provides for the financial or medical needs of a participant through contributions from one (1) participant to another;
(d)  Provides amounts that participants may contribute with no assumption of risk or promise to pay among the participants and no assumption of risk or promise to pay by the health care sharing ministry to the participants;
(e)  Provides a written monthly statement to all participants that lists the total dollar amount of qualified needs submitted to the health care sharing ministry, as well as the amount actually published or assigned to participants for their contribution; and
(f)  Provides a written disclaimer on or accompanying all applications and guideline materials distributed by or on behalf of the organization that reads, in substance: "Notice: The organization facilitating the sharing of medical expenses is not an insurance company, and neither its guidelines nor plan of operation is an insurance policy. Whether anyone chooses to assist you with your medical bills will be totally voluntary because no other participant will be compelled by law to contribute toward your medical bills. As such, participation in the organization or a subscription to any of its documents should never be considered to be insurance. Regardless of whether you receive any payment for medical expenses or whether this organization continues to operate, you are always personally responsible for the payment of your own medical bills."
(3)  It is hereby declared that participation in or operation of a health care sharing ministry does not constitute an unfair or deceptive act or practice in the conduct of trade or commerce prohibited by chapter 6, title 48, Idaho Code.

Readers should note that Idaho has a "General Managed Care Plan" rather than a "Health Maintenance Organization" which is defined in TITLE 41 INSURANCE CHAPTER 39 MANAGED CARE REFORM:
41-3903 DEFINITIONS.

"General managed care plan" means a managed care plan which provides directly or arranges to provide, at a minimum, basic health care services. A general managed care plan shall include basic health care services.

 "Managed care plan" means a contract of coverage given to an individual, family or group of covered individuals pursuant to which a member is entitled to receive a defined set of health care benefits through an organized system of health care providers in exchange for defined consideration and which requires the member to use, or creates financial incentives for the member to use, health care providers owned, managed, employed by or under contract with the managed care organization.

"Basic health care services" means the following services: preventive care, emergency care, inpatient and outpatient hospital and physician care, hospital-based rehabilitation treatment, diagnostic laboratory and diagnostic and therapeutic radiological services. It does not include mental health services or services for alcohol or drug abuse, dental or vision services or long-term rehabilitation treatment."