Governor Signs Bill Allowing Direct Patient Care Contracts

HELENA — Gov. Greg Gianforte signed a bill Wednesday that allows health care providers to contract directly with patients for certain basic care, such as annual checkups, office visits, vaccines, bloodwork and stitches, in an effort to reduce health care costs.

“One of the reasons why our health care is so expensive in America is because of insurance,” Republican state Sen. Cary Smith of Billings told the state Senate in January. “When you can set up an arrangement with a health care provider and you don’t have to deal with the red tape, with the paperwork, with the government regulation … you can cut those expenses way down.”

Eight clinics in the state are working as direct primary care providers as allowed under a 2017 memo issued by then-Insurance Commissioner Matt Rosendale. Smith’s bill puts the terms of the memo into law and allows dentists, chiropractors and other health providers to offer similar direct care contracts to patients.

The average monthly costs are $70 for adults and $20 for children, medical providers said in testifying in support of the bill.

“We’re committed to making affordable, high-quality health care more accessible to Montanans by increasing choice, eliminating regulations, and promoting competition,” Gianforte said.

Dr. Todd Bergland of Whitefish said the direct primary care model allows him to spend more time with patients and less time entering information into a computer to file insurance claims.

The law makes it clear that such contracts aren’t insurance and aren’t regulated by the insurance commissioner. Contracts are required to spell out the charges and services and any complaints would be handled under consumer protection laws.

Supporters argued the direct care coverage could be used in combination with lower-cost catastrophic health coverage or a health care sharing ministry to help reduce health care costs.

Lawmakers are moving other health-care related bills. One would put into law another 2017 memo by Rosendale, who is now Montana’s lone U.S. House member, that allows health care sharing ministries to offer services in Montana with the understanding that they are not insurance.

Under such programs, people who share similar ethical or religious values pay a monthly fee and share each other’s eligible medical costs after a deductible has been met. Basic care, such as office visits and vaccinations, are typically not covered.

Two bills passed the House on second reading Wednesday related to prescription drugs. One would require licensing and allow oversight of pharmacy benefit managers — the companies that manage drug costs on behalf of health insurers.

The other would allow medical practitioners to dispense drugs they prescribe to their own patients with the exception of controlled substances. The providers would have to register with the board of pharmacy and meet storage and record-keeping requirements.

Both measures face a third reading before they would be forwarded to the governor for consideration.