Starting a direct primary care (DPC) practice in South Carolina calls for a clear description of your services, a workable patient agreement and a careful review of the rules that apply to your arrangement. Before collecting membership fees, connect those decisions with your business structure, payer relationships and plans for handling patient information.
One early question deserves particular attention: what authority supports the proposed membership model’s treatment under South Carolina law? Be careful not to rely on an article describing another state’s DPC law or the text of a bill that has not been enacted.
Check the legal basis for your proposed model
South Carolina H. 3966 proposes adding a provision concerning the insurance treatment of DPC agreements. As of September 21, 2026, this is still just a proposal and not law. As such, your DPC is not required to comply with this proposed bill, but understanding what may happen can be helpful in your structure. For example, if passed, the bill provides that a DPC agreement provide for termination by either party with notice not to exceed 60 days. One might consider including that provision in their patient agreement now to potentially avoid having to amend later if the bill passes. But of course, the bill could also be passed with different terms, so that is not a failsafe. H. 3966 legislative record, South Carolina Code, Title 38, Chapter 61.
Consider your desired arrangement, then prepare for legal review. Explain who provides care, who pays, which services the recurring payment covers, and whether any outside organization is involved. Ask counsel to evaluate the current insurance and professional practice rules against those facts.
Avoid importing a template from another state on the assumption that its statutory disclosures and cancellation terms comply with South Carolina requirements.
Describe the membership before writing the agreement
A useful service outline begins with the patient’s experience. If someone pays the monthly fee, what can they expect from the practice, and what do they need to arrange elsewhere?
Start by writing down:
- The visits, procedures and communications included in the fee;
- Any separate charges for labs, medications or other services;
- Hours, response expectations and coverage during absences;
- Services outside the arrangement, including emergency and hospital care; and
- The proposed process for cancellation, refunds and continuity of care.
Consider your hours of accessibility. You may commit to responding to patients in 24 hours no matter the time of day. That’s different from checking messages only during business hours. Clarify the arrangement in both the agreement and the enrollment materials before the mismatch becomes part of everyday operations.
These are planning questions, not a claim that a particular set of clauses will secure an insurance exemption.
Plan the transition from your current work
If you are leaving an employed position, review your existing agreements before announcing the new practice or contacting patients. Bring notice provisions, restrictive covenants, records arrangements and malpractice coverage questions to counsel. Do not assume another physician’s departure plan complies with your employment agreement.
Discuss proposed owners, clinicians and service locations before signing a lease or selecting the business entity. Your lawyer and tax advisor can identify the questions that need to be coordinated; this article does not prescribe one structure for every South Carolina practice, and in fact, there isn’t one structure that works for every physician. There are countless options, what matters is that the agreement accurately describes the way you will run the practice and complies with all applicable laws.
Address Medicare and privacy separately
A membership arrangement does not itself resolve Medicare status. The Centers for Medicare & Medicaid Services (CMS) describes Medicare opt-out requirements for eligible physicians and practitioners, including affidavits and private contracts. Review your participation history, intended patients and covered services before choosing a payment approach. CMS Medicare enrollment and opt-out guidance.
For privacy, first determine whether the practice is a HIPAA covered entity based on its actual activities, including relevant electronic transactions. Then map intake, records, appointment messages and vendor access. Cash payment alone does not determine whether a DPC becomes a HIPAA covered-entity. HHS covered-entity guidance.
Review other applicable confidentiality obligations as well. Cunningham Law’s guide to HIPAA and DPC practices explains questions to bring to that discussion.
Prepare for a South Carolina DPC planning meeting
Gather your service outline, proposed fee schedule, ownership information, existing employment and payer contracts, and any draft membership terms. Include a list of the systems that will handle patient information and any proposed employer-paid memberships.
Mark which commitments are already signed and which are still negotiable. That distinction helps organize the review before you commit to a launch date or enrollment promise.
Common questions
Does a proposed South Carolina DPC bill establish an exemption?
No. A proposal must be distinguished from enacted law. Verify the current legislative record and applicable law before relying on it for your practice.
Can I use a DPC agreement from another state?
It can help you identify questions, but it may not meet applicable requirements. Review the actual model, agreement and patient-facing promises together.
Discuss your practice with Kim Cunningham
Kim Cunningham is based in Beaufort, SC and works with physicians on DPC practice setup, agreements and policies in South Carolina, Georgia, and Ohio. Explore her healthcare legal services or request a consultation about your plans. Keep the first inquiry general and leave out patient information and confidential records.
General information, not legal advice. Applicable requirements depend on your circumstances and current law. Reading this article or contacting the firm does not create an attorney/client relationship.