311.6201 Definitions for KRS 311.6201 and 311.6202.

385 words·~2 min read·/ky/chapter-311/311-6201

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

As used in this section and KRS 311.6202:

(1)"Direct primary care membership agreement" means a written contractual

agreement between a primary care provider and an individual patient or his or

her legal guardian that:

(a)Is for an agreed-upon fee over an agreed-upon period of time;

(b)Describes the primary care services to be provided in exchange for the

agreed-upon fee;

(c)States that the primary care provider shall not bill a health benefit plan or

the Medicaid program on a fee-for-service basis for the primary care

services provided under the agreement;

(d)Specifies automatic agreement renewal periods;

(e)Specifies any additional fees that may be charged for primary care

services that are not included in the agreement;

(f)States that the patient is not required to pay more than twelve

months of the agreed-upon fee in advance;

(g)States that the agreed-upon fee and any additional fees may be paid by a

third party;

(h)Allows either party to terminate the agreement in writing, without penalty

or payment of a termination fee, after notice;

(i)Provides that, upon termination of the agreement by the patient or his or

her legal guardian, all unearned fees are to be returned to the patient, his

or her legal guardian, or any third-party payor; and

(j)Contains a conspicuous and prominent statement that the agreement

does not constitute a health benefit plan and does not meet any individual

health benefit plan mandate that may be required by federal law;

(2)"Health benefit plan" has the same meaning as in KRS 304.17A-005;

(3)"Primary care provider" means a physician as defined by KRS 311.550 or a

physician's medical practice that enters into a direct primary care membership

agreement;

(4)"Primary care service" means the screening, assessment, diagnosis, and

treatment for the purpose of promotion of health or the detection and

management of disease or injury within the competency and training of the

primary care provider; and

(5)"Third party" means a legal guardian, the individual patient's employer, a

spouse's employer, a family member of the patient, or a state-sponsored direct

primary care payment program. "Third party" does not include a network

designed to merely accept payment from a patient and then direct the patient

to one

(1)of several independently owned clinics for the delivery of care.