Direct Primary Care regulatory framework by state.
A state-by-state reference of publicly available DPC legislation status, common agreement provisions, and regulatory categories.
Important Disclaimer
What Is the DPC Regulatory Framework?
DPC regulatory framework refers to the body of state-level statutes, administrative guidance, and insurance exemptions that govern Direct Primary Care agreements. These frameworks vary by state and address how DPC practices structure membership agreements, handle billing, interact with government payer programs, and comply with licensing requirements.
As of 2026, over 30 states have enacted legislation specifically addressing Direct Primary Care, while others operate under administrative guidance or general medical practice authority. Regulatory data referenced on this page draws from publicly available state statutes and the Taft Law DPC state legislation survey. Physicians exploring the DPC model benefit from understanding the regulatory landscape in their state as part of Direct Primary Care consulting and practice planning.
Common DPC Agreement Provisions
The following provisions are commonly observed across enacted DPC statutes. Requirements vary by state.
- Written agreement between physician and patient
- Signed by both parties (or their authorized representatives)
- Termination permitted by either party with written notice (commonly 30 days)
- Description of the scope of health care services covered
- Specification of the periodic fee and any additional fees
- Duration of the agreement and automatic renewal terms
- Prominent disclosure that the agreement is not health insurance
- Notice regarding ACA individual coverage requirements
- Return of unearned fees upon patient termination
Understanding these common provisions is a foundational element when developing a DPC business model and structuring membership agreements. State-specific requirements should be confirmed with licensed counsel.
State-by-State DPC Legislation Status
States are organized by their current approach to DPC regulation. States with detailed survey data include expanded information on agreement requirements, billing, Medicaid, dispensing, privacy, and licensing.
32
Enacted Laws
4
Administrative Guidance
15
No Specific Legislation
States with Enacted DPC Laws (32)
States with Administrative Guidance (4)
States without Specific DPC Legislation (15)
Key Regulatory Categories for DPC Practices
The following categories represent common areas of regulatory consideration for DPC practices across states.
DPC Agreement Structure
Contractual elements observed in enacted DPC statutes, including written agreement provisions, termination clauses, and required disclosures.
Billing & Payment Models
How periodic fees are structured, including advance billing permissibility, quarterly/annual billing options, and trust account requirements observed across states.
Medicaid & Government Payer Considerations
Patterns observed across states regarding Medicaid opt-out requirements, private contracting with Medicaid beneficiaries, and Ordering/Referring Provider (OPR) enrollment.
Drug Dispensing & Sales of Goods
State-level patterns related to physician dispensing registration, supply limitations, markup restrictions, and sales tax exemptions for medical goods.
Privacy & Patient Data
Privacy policy requirements observed across states, including HIPAA considerations, state-specific privacy laws, and patient medical record access rights.
Clinic Licensing & Registration
Facility licensing patterns for DPC practices, including states that exempt private physician offices and states requiring registration with insurance commissioners.
Medicaid & Ordering/Referring Status
Across the states reviewed, many allow or require physicians who order, refer, or prescribe for Medicaid patients to maintain an Ordering, Referring, and Prescribing (OPR) enrollment. This enrollment pathway is commonly available without requiring full Medicaid participation.
OPR enrollment patterns observed across states:
- • Most states with enacted DPC legislation offer some form of OPR enrollment
- • OPR enrollment generally does not obligate the provider to see Medicaid patients or accept Medicaid reimbursement
- • Some states require OPR enrollment for any provider who orders, refers, or prescribes for Medicaid beneficiaries
- • The application process and terminology varies by state (OPR, ORP, ROPA, nonbilling provider)
Navigating Medicaid considerations is an important step when starting a DPC practice. State-specific requirements should be confirmed with licensed counsel.
This summary reflects publicly available information and may not reflect current law. Consult licensed legal counsel for state-specific guidance.
Drug Dispensing & In-Office Sales
Physician dispensing regulations vary significantly by state. Patterns observed across the states reviewed include:
- • Some states require registration with the Board of Pharmacy for dispensing physicians
- • Supply limitations range from 3-day to 30-day supplies depending on the state
- • Some states restrict dispensing to specific drug categories (e.g., controlled substances require separate registration)
- • Markup restrictions vary — some states cap physician markup at 10%, while others have no specific restriction
- • Sales tax exemptions for prescription drugs, DME, and medical supplies are common but not universal
- • In-office sale of non-health-related goods is generally not prohibited but may raise ethical considerations per AMA guidance
Dispensing and in-office sales strategies are part of the broader revenue model discussed in employer-based Direct Primary Care and practice design engagements.
This summary reflects publicly available information and may not reflect current law. Consult licensed legal counsel for state-specific guidance.
Frequently Asked Questions
Work With Freedom Healthworks
Freedom Healthworks provides operational consulting for physicians launching, structuring, and scaling Direct Primary Care practices. We coordinate with licensed professionals where appropriate.
Services described represent guidance, coordination, and support — not legal, insurance, or medical advice. Freedom Healthworks does not provide legal advice. All legal determinations are reviewed by licensed counsel retained by the physician.