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Chapter 30     Entire Code

1 - GENERAL PROVISIONS APPLICABLE T

1A - PROCEDURE FOR REGULATION OF OC

1B - PROVISIONS APPLICABLE TO MILIT

1C - INTERSTATE MEDICAL LICENSURE C

1D - PROVISIONS AFFECTING CERTAIN B

2 - ATTORNEYS-AT-LAW

2A - MEDICAL LICENSING BOARD

3 - WEST VIRGINIA MEDICAL PRACTICE

3A - MANAGEMENT OF INTRACTABLE PAIN

3B - MOBILE INTENSIVE CARE PARAMEDI

3C - HEALTH CARE PEER REVIEW ORGANI

3D - PHYSICIAN HEALTH PROGRAMS

3E - PHYSICIAN ASSISTANTS PRACTICE

3F - DIRECT PRIMARY CARE PRACTICE
    30 - 3 F- 1
    30 - 3 F- 2
    30 - 3 F- 3
    30 - 3 F- 4
    30 - 3 F- 5

4 - WEST VIRGINIA DENTAL PRACTICE A

4A - ADMINISTRATION OF ANESTHESIA B

4B - DENTAL LABORATORY SERVICES

5 - PHARMACISTS, PHARMACY TECHNICIA

6 - BOARD OF FUNERAL SERVICE EXAMIN

7 - REGISTERED PROFESSIONAL NURSES

7A - PRACTICAL NURSES

7B - CENTER FOR NURSING

7C - DIALYSIS TECHNICIANS

7D - MEDICATION ASSISTIVE PERSONS

7E - NURSE HEALTH PROGRAMS

7F - NURSE LICENSURE COMPACT

8 - OPTOMETRISTS

8A - EYE CARE CONSUMER PROTECTION L

9 - ACCOUNTANTS

10 - VETERINARIANS

10A - ANIMAL EUTHANASIA TECHNICIAN

11 - CHIROPODISTS-PODIATRISTS

12 - ARCHITECTS

13 - ENGINEERS

13A - LAND SURVEYORS

14 - OSTEOPATHIC PHYSICIANS AND SU

14A - ASSISTANTS TO OSTEOPATHIC PH

15 - NURSE-MIDWIVES

16 - CHIROPRACTORS

17 - SANITARIANS

18 - PRIVATE INVESTIGATIVE AND SEC

19 - FORESTERS

20 - PHYSICAL THERAPISTS

20A - ATHLETIC TRAINERS

21 - PSYCHOLOGISTS; SCHOOL PSYCHOL

22 - LANDSCAPE ARCHITECTS

23 - RADIOLOGIC TECHNOLOGISTS

24 - QUALIFICATION OF ARMED FORCES

25 - NURSING HOME ADMINISTRATORS

26 - HEARING-AID DEALERS AND FITTE

27 - BOARD OF BARBERS AND COSMETOL

28 - WEST VIRGINIA OCCUPATIONAL TH

29 - LAW-ENFORCEMENT TRAINING AND

29A - STANDARDS FOR PROFESSIONAL F

30 - SOCIAL WORKERS

31 - LICENSED PROFESSIONAL COUNSEL

32 - SPEECH-LANGUAGE PATHOLOGISTS

33 - TATTOO STUDIO BUSINESS

34 - BOARD OF RESPIRATORY CARE PRA

35 - BOARD OF DIETITIANS

36 - ACUPUNCTURISTS

37 - MASSAGE THERAPISTS

38 - THE REAL ESTATE APPRAISER LIC

38A - APPRAISAL MANAGEMENT COMPANI

39 - UNIFORM ATHLETE AGENTS ACT

40 - WEST VIRGINIA REAL ESTATE LIC

CHAPTER 30. PROFESSIONS AND OCCUPATIONS.

ARTICLE 3F. DIRECT PRIMARY CARE PRACTICE.

§30-3F-1. Definitions.

As used in this section:  

(1) “Boards” means the West Virginia Board of Medicine; the West Virginia Board of Osteopathic Medicine, the West Virginia Board of Optometry, West Virginia Board of Chiropractic, West Virginia Board of Dentistry and the West Virginia Board of Examiners for Registered Professional Nurses;

(2) “Direct primary care membership agreement” means a written contractual agreement between a primary care provider and a person, or the person’s legal representative;

(3) “Direct primary care provider” means an individual or legal entity, alone or with others professionally associated with the provider or other legal entity, that is authorized to provide primary care services and who chooses to enter into a direct primary care membership agreement;

(4) “Medical products” means any product used to diagnose or manage a disease, including any medical device, treatment or drug;

(5) “Medical services” means a screen, assessment, diagnosis or treatment for the purpose of promotion of health or the detection and management of disease or injury within the competency and training of the direct primary care provider; and

(6) “Primary care provider” means an individual or other legal entity that is authorized to provide medical services and medical products under his or her scope of practice in this state.

§30-3F-2. Direct Primary Care.

(a) A person or a legal representative of a person may seek care outside of an insurance plan, or outside of the Medicaid or Medicare program, and pay for the care.

(b) A primary care provider may accept payment for medical services or medical products outside of an insurance plan.

(c) A primary care provider may accept payment for medical services or medical products provided to a Medicaid or Medicare beneficiary.

(d) A patient or legal representative does not forfeit insurance benefits, Medicaid benefits or Medicare benefits by purchasing medical services or medical products outside the system.

(e) The offer and provision of medical services or medical products purchased and provided under this article is not an offer of insurance nor regulated by the insurance laws of the state.

(f) The direct primary care provider may not bill third parties on a fee for service basis for services provided under the direct primary care membership agreement.

(g) A primary care provider may not bill any third-party payer for services rendered or products sold pursuant to a direct primary care membership agreement.  

§30-3F-3. Prohibited and authorized practices.

(a) A direct primary care membership agreement is not insurance and is not subject to regulation by the Office of the Insurance Commission.

(b) A direct primary care provider or its agent is not required to obtain a certification of authority or license under chapter thirty-three to market, sell or offer to sell a direct primary care agreement.

(c) A direct primary care membership agreement is not a discount medical plan.

(d) A direct primary care membership agreement shall:

(1) Be in writing;

(2) Be signed by the primary care provider or agent of the primary care provider and the individual patient or his or her legal representative;

(3) Allow either party to terminate the agreement on at least 30 days prior written notice to the other party;

(4) Describe the scope of primary care services that are covered by the periodic fee;

(5) Specify the periodic fee and any additional fees outside of the periodic fee for ongoing care under the agreement;

(6) Specify the duration of the agreement and any automatic renewal periods. Any per-visit charges under the agreement will be less than the monthly equivalent of the periodic fee.  The person is not required to pay more than twelve months of the fee in advance. Funds are not earned by the practice until the month of ongoing care is completed.  Upon discontinuing the agreement all unearned funds are returned to the patient; and

(7) Prominently state in writing that the agreement is not health insurance.

§30-3F-4. Rules.

The boards may propose rules for legislative approval in accordance with article three, chapter twenty-nine-a of this code, to effectuate the provisions of this article.

§30-3F-5. Violations.

Violations of this article constitute unprofessional conduct and may subject violators to sanctions which may be pursued by the boards.

Note: WV Code updated with legislation passed through the 2017 Regular Session
The West Virginia Code Online is an unofficial copy of the annotated WV Code, provided as a convenience. It has NOT been edited for publication, and is not in any way official or authoritative.


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