§1360.85. Acceptance or discontinuation of care of patients; third-party payments
A. A direct practice shall not decline to accept new direct patients or discontinue care to existing patients solely because of the patient's health status. A direct practice may decline to accept a patient if the practice has reached its maximum capacity, or if the patient's medical condition is such that the provider is unable to provide the appropriate level and type of health care services in the direct practice. As long as a direct practice provides a patient notice and the opportunity to obtain care from another physician, a direct practice may discontinue care for a direct patient if any one of the following conditions is satisfied:
(1) The patient fails to pay the direct fee under the terms required by the direct agreement.
(2) The patient has performed an act that constitutes fraud.
(3) The patient repeatedly fails to comply with the recommended treatment plan.
(4) The patient is abusive and presents an emotional or physical danger to the staff or other patients of the direct practice.
(5) The direct practice discontinues operation as a direct practice.
B. Subject to the restrictions established in this Part, a direct practice may accept payment of direct fees directly or indirectly from third parties. A direct practice may accept a direct fee paid by an employer on behalf of an employee who is a direct patient. However, a direct practice shall not enter into a contract with an employer relating to direct practice agreements between the direct practice and employees of that employer other than to establish the timing and method of the payment of the direct fee by the employer.
C. Subject to the restrictions established in this Part, a direct practice may accept payment of direct fees directly or indirectly from the Louisiana Medical Assistance Program or any entity contracting with the state of Louisiana to provide managed care in the Louisiana Medical Assistance Program, subject to any necessary approval from the Centers for Medicare and Medicaid Services.
Acts 2014, No. 867, §1.
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