If you are starting a direct primary care (DPC) practice in Georgia, begin by matching your intended services and payment model to the agreement patients will sign. Georgia’s Direct Primary Care Act provides a specific framework, but calling a practice “DPC” does not establish that every part of the arrangement fits it.
The agreement should describe the care you will provide and explain how membership starts, renews and ends. Your website, payment process and staff instructions should support those same terms.
Review the model as well as the document
Georgia’s enacted SB 18 added O.C.G.A. § 33-7-2.1. Its definition of a DPC practice requires periodic fees and no third-party fee-for-service billing; any per-visit charge must be less than the monthly equivalent of the periodic fee. Its treatment of DPC agreements outside state insurance regulation comes with definitions and conditions that need to be reviewed together. O.C.G.A. § 33-7-2.1.
Give counsel the proposed service list and payment flow before asking for a contract. Explain any per-visit charges, external billing arrangements and employer involvement. Do not assume that a concierge or Direct Specialty Care model fits the same provision because it also charges a membership fee.
Make cancellation and advance payments clear
The enacted text requires a written, signed agreement covering services, fees, duration, renewal and an insurance disclosure. It distinguishes physician notice of at least 30 days from patient notice of no more than 30 days, limits required advance payment to 12 months, and addresses refunding unearned fees within 30 days after termination. The statute also lists circumstances in which a physician may discontinue care under a DPC agreement. Review those grounds and any separate patient-transition obligations when drafting termination procedures. See O.C.G.A. § 33-7-2.1(d)–(f).
Think through a patient who prepays and later leaves the practice. Who receives the notice? Where is receipt recorded? Who calculates the unearned amount and issues the refund? The agreement and billing system should make that process understandable and usable.
A refund clause does little practical good if the payment platform or staff workflow cannot carry it out. Test the process with sample information before enrollment opens.
Explain exactly what the membership purchases
Prepare a patient-friendly service schedule. Distinguish included care from services supplied or billed by others. Describe messaging access, response expectations, visits, procedures, labs and medications where relevant to your model.
For example, if a lab service is arranged through a separate provider, clarify who charges the patient and whether the membership fee includes any part of it. Avoid broad promises such as “everything included” if the arrangement has exclusions or additional fees.
Review these materials together:
- The membership agreement and service schedule.
- The website’s pricing and enrollment language.
- Recurring-payment authorization and receipts.
- Welcome messages and after-hours instructions.
- Cancellation, refund and patient-transition procedures.
Use this review to identify inconsistencies, not to certify that the documents cover every legal obligation.
Keep professional setup and federal questions in view
The insurance provisions do not replace a review of the practice’s ownership, professional obligations or existing contracts. Discuss who will own and operate the practice, and bring any employment, lease or vendor agreement that could affect the launch.
Medicare needs its own analysis. Serving a Medicare beneficiary does not automatically require opting out; evaluate the services involved and the clinician’s Medicare participation status. The Centers for Medicare & Medicaid Services (CMS) explains that eligible practitioners using the opt-out process need an affidavit and private contracts, with timing and other conditions tied to their circumstances. A DPC membership agreement alone is not the Medicare private contract. Decide how you will serve Medicare beneficiaries before accepting membership payments from them. See 42 C.F.R. §§ 405.410 and 405.415.
Determine HIPAA covered-entity status by whether the provider transmits health information electronically in connection with a covered transaction. Electronic records or messaging alone do not establish that status. Inventory your patient-information systems and vendor relationships rather than assuming that a cash-pay arrangement eliminates privacy duties. See 45 C.F.R. § 160.103. Read more about HIPAA questions for DPC practices.
Questions to bring to your Georgia DPC agreement review
Bring a draft fee schedule, service outline, cancellation process and list of payment arrangements. Identify any terms already promised to prospective patients and any contracts already signed.
Ask how the current Georgia definitions and requirements apply to your model, which terms need revision, and what operational changes are needed to carry them out. Discuss any uncertainties before launching the enrollment page.
Common questions
Is a “not insurance” statement enough for a Georgia DPC agreement?
No. Review the definitions and agreement conditions together. A disclosure alone does not establish that an arrangement fits the statutory framework.
Should patient and physician cancellation language be identical?
Do not assume so. The enacted Georgia text distinguishes their notice requirements. The agreement should reflect the applicable rules and a workable process for ending care.
Get help planning your Georgia practice
Kim Cunningham is licensed in Georgia and works with DPC practices on setup, agreements, contracts and policies. Learn about Cunningham Law’s healthcare legal services or request a consultation. Share a general description of your plans without patient information or confidential records.
General information, not legal advice. Review current law and the circumstances of your practice with counsel. Reading this article or contacting the firm does not create an attorney/client relationship.