Maryland

Multiple DPC practices are in operation in Maryland.  In 2009 A former Maryland insurance commissioner issued harsh guidance to prevent a planned DPC practice transition.  The Report on “Retainer” or “Boutique” or “Concierge” Medical Practices and the Business of Insurance can still be viewed, but is not necessarily endorsed by the current insurance commissioner.  In this report the commissioner recommended:

1) Limiting the services provided in the year for an annual fee to an annual physical exam, a follow-up office visit and a limited number of other office visits;
2) Establishing the annual fee by reviewing the market value of the annual physical exam and a follow-up office visit as well as each office visit, with the annual fee equal to sum of the market value for each specified service;
3) Defining the services to be provided in a written agreement;
4) Allowing a consumer or the physician to terminate the retainer agreement for any reason and provide for the pro rata reimbursement of the retainer fee if the written agreement is terminated; and
5) Placing a cap on the number of patients based on the physician’s ability to provide all the services specified in the written agreement to each patient on the panel.

In 2015 a dental practice was forced to abandon a "premium plus dental plan" because it appeared to be an unlawful insurance plan.  Here is a link to the initial order and another to the final consent order.  Note the aggressive language that they used to market their plan, stating it "works similar to many dental plans on the market.  You pay a monthly membership fee for benefit coverage on your dental expenses... All questions regarding plan coverage, verifying benefits, changing coverage types, or any other questions should be directed to our staff..."  The plan was "designed to cover preventive services such as cleanings and oral exams" and "offers excellent coverage for major dental procedures like crowns, root canals, bridges, and dentures."  A better approach would have been to charge a clearly described up front nonrefundable enrollment fee, and then otherwise bill a monthly fee in arrears (at the end of the month).  Allow the patients to leave at any time (obviously no refunds would be owed if they are paying at the end of the month) and list a maximum patient panel size.

Please be sure to also review Title 31 of the Maryland Insurance Administration, note that Maryland makes it very difficult to conduct any in-office dispensing.  One of the motivations for states to have restrictive dispensing laws were historic abuses within the workers compensation arena (and also here).

For a Maryland physician to dispense medications the physician must submit a detailed application to the Maryland Board of Physicians and include a $1,050 fee.  A litany of requirements must be met (some are listed at the bottom of this page).  Customized continuing education related to dispensing is required (here is a group of them available from the Maryland State Medical Society). One must submit to inspections and submit information to the board. Dispensing must be "in the public interest" - which in the board's eyes means that a pharmacy is not conveniently available to the patient.

"Licensed dentists, physicians, and podiatrists are required to obtain a dispensing permit if they dispense prescription drugs to patients under their direct care who have informed the provider that a pharmacy is not conveniently available. The licensee shall maintain documentation that should include a single form in each patient's chart for each patient to whom prescription drugs are dispensed. At a minimum, the form shall:
(1) Indicate the reason, as stated by the patient, that a pharmacy is not conveniently available to that patient;
(2) Include a statement signed by the patient indicating that the patient understands that the determination that a pharmacy is not conveniently available is made solely by the patient; and
(3) Be signed and dated by the patient before dispensing prescription drugs to the patient for the first time. See COMAR 10.13.01.04."