US – The ADA supports dentist-patient agreements as a form of direct primary care arrangements, the Association told the Internal Revenue Service in response to the agency’s proposed rule for Certain Medical Care Arrangements.
The Treasury Department and the IRS requested comments from stakeholders on whether the final regulations should “clarify the treatment of other types of arrangements that are similar to direct primary care arrangements but do not meet the definition in the proposed regulations.” In an Aug. 7 letter to IRS Commissioner Charles P. Rettig, ADA President Chad P. Gehani and Executive Director Kathleen T. O’Loughlin told IRS Commissioner Charles P. Rettig that the ADA supports “the inclusion of an agreement between dentists and patients as a direct primary care arrangement.” “Indeed, most state laws use ‘direct primary care agreements’ in their statutory language, though they are also commonly referred to as ‘in-office plans’ or ‘membership savings plans'” wrote Drs. Gehani and O’Loughlin. “States are trending in the last few years toward having dental practices included as part of in-office plans. Including dental care in the final rule as being a service eligible towards a tax benefit would categorize services performed by dentists in line with state statutes.” In the letter, the ADA pointed out that “while there are many variants of direct primary care agreements, in general the patient pays the doctor or dental office a fixed amount of money on a monthly or annual basis.” “Preventive services may be covered at no charge,” Drs. Gehani and O’Loughlin wrote. “Procedures other than preventive are then offered at a discounted fee. These plans provide flexibility to both patients and dentists as the plan design is up to the dental office, and the dental office then determines the cost to the patient for participating in the plan.” They also noted that more than half of states have enacted direct primary care agreement laws within the last few years — at least 16 of which include dental. “While state laws vary a bit in their particulars almost all of them include a provision that allows the ability to establish these plans without health care providers having to register with the state insurance commissioner,” Drs. Gehani and O’Loughlin wrote. “Most laws include provisions ensuring patients are aware that these agreements are not insurance. States also provide direction on how to properly terminate the agreement and how unused funds are to be refunded to patients. The laws are consistent in establishing protections that ensure patients’ care is maximized under plans that help manage expenses.”