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      RS 37:1360.81     



§1360.81. Definitions

            For the purposes of this Part, the terms stated in this Section have the meanings assigned to them, respectively, unless the context otherwise requires:

            (1) "Board" means the Louisiana State Board of Medical Examiners.

            (2) "Direct agreement" means a written agreement entered into between a direct practice and an individual direct patient, the parent or legal guardian of the direct patient, or a family of direct patients whereby the direct practice charges a direct fee as consideration for being available to provide and providing primary care services to the individual direct patient. A direct agreement shall describe the specific health care services the direct practice will provide and be terminable at will upon written notice by the direct patient.

            (3) "Direct fee" means a fee charged by a direct practice as consideration for being available to provide and providing primary care services as specified in a direct agreement.

            (4) "Direct patient" means a person who is party to a direct agreement and is entitled to receive primary care services under the direct agreement from the direct practice.

            (5) "Direct patient-provider primary care practice" and "direct practice" means a physician, group, or entity that meets the following criteria:

            (a) Is any of the following:

            (i) A physician who provides primary care services through a direct agreement.

            (ii) A group of physicians who provide primary care services through a direct agreement.

            (iii) An entity that sponsors, employs, or is otherwise affiliated with a group of physicians who provide primary care services only through a direct agreement, which entity is wholly owned by the group of physicians or is a nonprofit corporation exempt from taxation under Section 501(c)(3) of the Internal Revenue Code and is not otherwise regulated under Title 22 of the Louisiana Revised Statutes of 1950. Such entity shall not be prohibited from sponsoring, employing, or being otherwise affiliated with other types of health care providers not engaged in a direct practice.

            (iv) "Direct patient-provider primary care practice" or "direct practice" shall not include an organization or an entity that contracts with a primary care practice for the provision of research, technological, operational, and administrative support, but such an entity or an organization does not provide a direct medical care service.

            (b) Enters into direct agreements with direct patients or parents or legal guardians of direct patients.

            (c) Does not accept payment for health care services provided to direct patients from any entity subject to regulation under Title 22 of the Louisiana Revised Statutes of 1950.

            (d) Does not provide, in consideration for a direct fee, services, procedures, or supplies such as prescription drugs except as provided in R.S. 37:1360.84(B), hospitalization costs, major surgery, dialysis, high level radiology, including but not limited to X-ray computed tomography, positron emission tomography, magnetic resonance imaging, or invasive radiology, rehabilitation services, procedures requiring general anesthesia, or similar advanced procedures, services, or supplies.

            (6) "Health insurance issuer" means an entity subject to the insurance laws and regulations of this state or subject to the jurisdiction of the insurance commissioner that contracts or offers to contract or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including a sickness and accident insurance company, a health maintenance organization, a preferred provider organization, or any similar entity, or any other entity providing a plan of health insurance or health benefits.

            (7) "Physician" means a natural person who is the holder of an allopathic (MD) degree or an osteopathic (DO) degree from a medical college in good standing with the board who holds a license, permit, certification, or registration issued by the board to engage in the practice of medicine in the state of Louisiana.

            (8) "Primary care" means routine health care services, including screening, assessment, diagnosis, and treatment for the purpose of promotion of health, and detection and management of disease or injury.

            Acts 2014, No. 867, §1.

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