LRB-5716/1
TJD:amn
2021 - 2022 LEGISLATURE
2021 Assembly BILL 956
February 2, 2022 - Introduced by Representatives Cabral-Guevara, Allen,
Armstrong, Brandtjen, Duchow, Gundrum, Horlacher, James, Knodl,
Murphy, Sortwell, Tittl and Wichgers, cosponsored by Senators Bernier,
Ballweg, Felzkowski and Kapenga. Referred to Committee on Health.
AB956,1,2 1An Act to create 146.78 and 600.01 (1) (b) 13. of the statutes; relating to:
2agreements for direct primary care.
Analysis by the Legislative Reference Bureau
This bill exempts valid direct primary care agreements from the application of
insurance law. A direct primary care agreement, as defined in the bill, is a contract
between a health care provider that provides primary care services under the
provider's scope of practice and an individual patient, or his or her legal
representative, or an employer in which the health care provider agrees to provide
primary care services to the patient or employee for an agreed-upon subscription fee
and period of time. A valid direct primary care agreement is signed and in writing
and does all of the following: 1) allows either party to terminate the agreement upon
written notice and specifies the terms for termination and the subscription fee; 2)
describes and quantifies the specific primary care services that are provided under
the agreement; 3) specifies the duration of the agreement; 4) prominently states that
the agreement is not health insurance and may not satisfy insurance coverage
requirements under federal law; 5) prohibits the provider and patient from billing
an insurer or any other third party on a fee-for-service basis for the primary care
services included in the subscription fee under the agreement; 6) prominently states
that the individual patient, or employer if applicable, is responsible for paying the
provider for all services that are not included in the subscription fee under the
agreement; and 7) prominently states that the patient is urged to consult with any
health insurance carrier the patient has before entering the agreement, that some
services provided under the agreement may be covered by any health insurance the

patient has, and that direct primary care fees may not be credited toward deductibles
or out-of-pocket maximum amounts under any health insurance the patient has.
Under the bill, a health care provider may not decline to enter into or may not
terminate a direct primary care agreement with a patient solely because of the
patient's health status. The bill allows a health care provider to decline to accept a
patient for a direct primary care agreement only if the health care provider's practice
has reached its maximum capacity or if the patient's medical condition is such that
the health care provider is unable to provide the appropriate level and type of
primary care services the patient requires. A health care provider is allowed to
terminate a direct primary care agreement with a patient only if the patient fails to
pay the subscription fee or fails repeatedly to adhere to the treatment plan, the
patient has performed an act of fraud or is abusive in a manner described in the bill,
the health care provider discontinues operation as a direct primary care provider, or
the health care provider believes that the relationship is no longer therapeutic for
the patient due to a dysfunctional relationship between the provider and the patient.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB956,1 1Section 1. 146.78 of the statutes is created to read:
AB956,2,2 2146.78 Direct primary care agreement. (1) Definitions. In this section:
AB956,2,73 (a) “Direct primary care agreement" means a contract between a health care
4provider and an individual patient or his or her legal representative or an employer
5in which the health care provider agrees to provide primary care services to the
6individual patient or employee for an agreed-upon subscription fee and period of
7time.
AB956,2,98 (b) “Health care provider" means a health care provider under s. 146.81 (1) (a)
9to (p) that provides primary care services under the provider's scope of practice.
AB956,2,1310 (c) “Primary care services” means outpatient, general health care services of
11the type provided by a main source for regular health care services for patients at the
12time a patient seeks preventive care or first seeks health care services for a specific
13health concern and includes all of the following:
AB956,2,1414 1. Care that promotes and maintains mental and physical health and wellness.
AB956,3,1
12. Care that prevents disease.