Madison Reporter

A new bill authored by State Sen. Chris Kapenga in the Wisconsin Senate seeks to establish a clear framework for direct primary care agreements between providers and patients, according to the Wisconsin State Senate.

According to the Wisconsin State Legislature's official website, the bill was described as follows: "agreements for direct primary care".

The following is our breakdown, based on the actual bill text, and may include interpretation to clarify its provisions.

In essence, this bill exempts valid direct primary care agreements from the scope of insurance law, providing a framework for contractual relationships between health care providers and patients. Such agreements must be in writing, signed by both parties, and allow for termination upon written notice. They must outline the specific primary care services covered, subscription fees, terms of termination, and prohibit billing insurers for services included in the subscription fee. The agreements must explicitly state they do not constitute health insurance and that fees might not count toward insurance deductibles or out-of-pocket maximums. The bill prohibits providers from refusing or terminating agreements based on a patient's health status but allows termination under specific conditions, such as non-payment or breach of conduct. Providers may only decline patients if at full capacity or unable to meet the required care level. The bill also ensures that nothing limits regulatory authority over agreements that do not meet these criteria. It will take effect upon enactment.

The bill was co-authored by Representative Cindi Duchow (Republican-97th District), Senator Rob Hutton (Republican-5th District), Senator Steve L. Nass (Republican-11th District), Senator Patrick Testin (Republican-24th District), Senator Cory Tomczyk (Republican-29th District). It was co-sponsored by Representative David Armstrong (Republican-67th District), Representative Robert Brooks (Republican-59th District), and Representative Barbara Dittrich (Republican-99th District), along four other co-sponsors.

Kapenga graduated from Calvin College in 1994 with a BA.

Kapenga, a Republican, was elected to the Wisconsin State Senate in 2015 to represent the state's 33rd Senate district, replacing previous state senator Paul Farrow.

In Wisconsin, the legislative process starts when a senator, constituent, group, or agency proposes an idea for a bill. After drafting, the bill is introduced, numbered, and referred to a committee for review and public input. If approved, it moves through three readings and votes in both the Senate and Assembly. Once both chambers pass the same version, the bill goes to the governor, who can sign it, veto it, or let it become law without a signature. Only a small share of bills introduced each session ultimately become law. You can learn more about the Wisconsin legislative process here.

Bill Number	Date Introduced	Short Description
SB4	01/24/2025	Agreements for direct primary care