A membership when no DPC statute covers you: designing it as a prepaid services contract

Does your state's DPC statute reach a physical therapist or dietitian?

Read your own state's statute before assuming the answer, because the exclusion may not work the way the question assumes. Washington's direct-practice chapter defines an eligible "health care provider" as "a person regulated under Title 18 RCW or chapter 70.127 RCW to practice health or health-related services," and that definition sweeps in physical therapists, dietitians and counselors along with physicians 1Ref 1Washington State Legislature (2013).RCW 48.150.010 — Definitions (Chapter 48.150 RCW: Direct Patient-Provider Primary Health Care).Washington's definitions: "health care provider" as a person regulated under Title 18 RCW or chapter 70.127 RCW, and "primary care" as routine services including screening, assessment, diagnosis and treatment; the article uses it to show one state's statute narrowing by service definition rather than by profession..

But the same chapter narrows everything two definitions later. A direct practice must furnish primary care, and the statute defines primary care on its own terms: "routine health care services, including screening, assessment, diagnosis, and treatment for the purpose of promotion of health, and detection and management of disease or injury" 1Ref 1Washington State Legislature (2013).RCW 48.150.010 — Definitions (Chapter 48.150 RCW: Direct Patient-Provider Primary Health Care).Washington's definitions: "health care provider" as a person regulated under Title 18 RCW or chapter 70.127 RCW, and "primary care" as routine services including screening, assessment, diagnosis and treatment; the article uses it to show one state's statute narrowing by service definition rather than by profession.. The gate is the service, not the license. A dietitian holds an eligible license under that text; whether the chapter reaches the membership turns on whether its service list amounts to primary care, and a stand-alone nutrition or mobility program ordinarily reads as something narrower.

Every state writes this differently, and some put the rules in unexpected corners of their codes. So the first hour of this project goes to one page of law: find your state's direct care or direct primary care chapter, often in the insurance title, and read only the definitions. Two questions come out. Who counts as an eligible provider, and what services must the agreement cover. Fail either and the statute's permissions and obligations both pass you by, which leaves you drafting what the rest of this page calls a prepaid services contract: a flat periodic fee, paid in advance, for an enumerated list of services you deliver yourself, which is a step earlier than the DPC or concierge fork physicians weigh.

Without a statute, who says the membership is not insurance?

You do, in the design and in the contract, because no statute says it for you. The not-insurance declaration is the main thing a DPC law gives a covered practice. Arizona wrote its version straight into the section of code that defines insurance: a direct primary care agreement, a contract for primary care services at an agreed periodic fee and period of time, is not insurance, and the state's insurance title does not apply to it 2Ref 2Arizona State Legislature (2019).Arizona Revised Statutes § 20-103 — Definition of insurance; exemptions.Arizona's definition-of-insurance statute states that a direct primary care agreement, a contract for primary care services at an agreed periodic fee and period of time, is not insurance and that Title 20 does not apply to it; the article uses it as the statutory not-insurance declaration a non-covered membership does not get..

A legislature does not spend a session answering a question nobody was asking. That sentence exists because a flat fee collected now, against health services delivered later, sits near the thing insurance regulators police: a promise to absorb costs nobody can predict. Primary care practices wanted the question closed in statute. Your membership never gets that closure, so the design has to keep the question from opening.

Sell only services you deliver yourself, name each one, and cap the quantity per period. A set number of visits a month, a defined review cadence, a named class of sessions. Priced that way, the fee reads as prepayment for enumerated services. But a membership that promises to handle whatever comes up, or to cover charges other providers generate, has started absorbing risk, and the further the promise drifts from your own hands the worse the question gets.

Whether a specific design lands on the safe side is its own analysis, and the membership-not-insurance-test walks through the factors. The two habits above cover most of the distance. A plain written sentence that the membership is not insurance and does not replace the member's health plan covers much of the rest, and a service list that reaches beyond your own practice is a conversation with a healthcare attorney before it is a marketing page.

Borrow the direct agreement's terms even though nobody makes you

Draft the membership agreement as if a DPC statute did govern you, because the statutes double as drafting checklists that cost nothing to follow. Arizona's version is explicit about what a direct primary care agreement must contain, from the signature line to a prescribed disclaimer, and other states enumerate their own, usually shorter, lists 3Ref 3Arizona State Legislature (2025).44-1799.92. Direct primary care agreements; requirements; notice.Arizona's required-terms list for a direct primary care agreement: writing, signatures, 30-day termination notice with relocation and military-duty terms, scope of services, periodic and additional fees, duration and renewal, and the prescribed not-insurance disclaimer; the article borrows it as a drafting checklist and notes other states enumerate different, usually shorter, lists..

Translated out of statute, Arizona requires seven things of the agreement 3Ref 3Arizona State Legislature (2025).44-1799.92. Direct primary care agreements; requirements; notice.Arizona's required-terms list for a direct primary care agreement: writing, signatures, 30-day termination notice with relocation and military-duty terms, scope of services, periodic and additional fees, duration and renewal, and the prescribed not-insurance disclaimer; the article borrows it as a drafting checklist and notes other states enumerate different, usually shorter, lists.:

• It is in writing.
• Both parties sign it.
• Either side can terminate on 30 days' written notice, with terms covering a member who relocates or leaves on military duty.
• The scope of services is stated.
• The periodic fee is stated, along with every additional fee that can arrive on top of it.
• The duration is stated, and so is how the agreement renews.
• A disclaimer, in words the statute prescribes, says the agreement is not insurance.

None of that binds a practice outside the statute's reach. All of it answers a question that otherwise gets asked mid-dispute, when answers are expensive. What the statutes call the direct agreement is, stripped of its primary care scoping, a well-specified prepaid services contract, and that is the document you are writing.

Two additions earn their place in a membership no regulator supervises. Say what happens to money already paid when a member cancels mid-period; a common convention is a prorated refund of the unearned balance, and whichever answer you pick, the contract should pick it rather than leave it to the dispute. And keep renewal boring: fee changes announced in writing, well before they bill. The renewal clause is also where this contract meets the consumer laws two sections down, because an agreement that renews on a stored card is a subscription in the eyes of those statutes, whatever its clinical content.

Medicare splits the dietitian from the physical therapist

If Medicare patients are in your panel, the two professions in this page's question stop being interchangeable. Medicare's private-contracting rules, the same opt-out machinery DPC physicians use to charge patients directly, recognize eight non-physician practitioner types, and "registered dietitian or nutrition professional" is one of them. A physical therapist appears in neither that list nor the rule's narrow definition of a physician 4Ref 4Centers for Medicare & Medicaid Services (HHS) (2023).42 CFR Part 405, Subpart D — Private Contracts (§§405.400 Definitions, 405.405 General rules, 405.410 Conditions for properly opting-out, 405.415 Requirements of the private contract, 405.420).Medicare's private-contracting framework: the eight-type practitioner list including registered dietitian or nutrition professional, the narrow physician definition, the absence of physical therapists from both, and the affidavit-based opt-out running in 2-year periods that renew unless cancelled..

The machinery itself is plain. A practitioner on the list opts out by filing an affidavit, and the opt-out runs in two-year blocks that renew automatically unless the practitioner cancels 4Ref 4Centers for Medicare & Medicaid Services (HHS) (2023).42 CFR Part 405, Subpart D — Private Contracts (§§405.400 Definitions, 405.405 General rules, 405.410 Conditions for properly opting-out, 405.415 Requirements of the private contract, 405.420).Medicare's private-contracting framework: the eight-type practitioner list including registered dietitian or nutrition professional, the narrow physician definition, the absence of physical therapists from both, and the affidavit-based opt-out running in 2-year periods that renew unless cancelled.. For a dietitian the pathway exists, and whether a membership needs it depends on whether it includes services Medicare would otherwise cover for those members. Plenty of designs skip the question by excluding covered services outright.

For a physical therapist there is no slot to opt into, so exclusion carries all the weight. But the rules cited here govern the opt-out mechanism and nothing more. Whether a Medicare-enrolled therapist can run a cash membership alongside covered care without creating a billing conflict is a separate question those rules do not answer, and no source in this article settles it. Bring that one to a healthcare attorney before enrollment opens, with the membership's service list in hand and every item Medicare currently pays you for marked.

Whatever the answer, it belongs in the scope-of-services clause, where the member reads it.

The subscription law that applies before any health law

Sell the membership online with a card on file and federal consumer law reaches you before anything in a health code does. The Restore Online Shoppers' Confidence Act conditions any recurring online charge on three things: clear and conspicuous disclosure of the material terms before you take billing information, the buyer's express informed consent, and a simple mechanism to stop the charges 5Ref 5United States Congress (2010).§8403. Negative option marketing on the Internet.The three statutory conditions on online negative-option charges: clear and conspicuous disclosure of material terms before obtaining billing information, express informed consent, and simple mechanisms to stop recurring charges; and that the requirement is statutory, distinct from the FTC's vacated implementing rule..

The card-on-file design has a legal name, the negative option, and the conditions on it are statutory, on the books since 2010. The 2025 court decision that struck the Federal Trade Commission's click-to-cancel rule struck the implementing rule alone; the statute stands 5Ref 5United States Congress (2010).§8403. Negative option marketing on the Internet.The three statutory conditions on online negative-option charges: clear and conspicuous disclosure of material terms before obtaining billing information, express informed consent, and simple mechanisms to stop recurring charges; and that the requirement is statutory, distinct from the FTC's vacated implementing rule.. A clinical license changes none of this. The law reads your membership the way it reads a streaming service.

States stack their own mechanics on top, and the stack is where the specifics live. California is the sharp example: a membership sold online there must be cancellable exclusively online, at will, "without engaging any further steps that obstruct or delay," alongside disclosure before the purchase completes and a retainable acknowledgment that names the way out 6Ref 6California State Legislature (2022).California Business and Professions Code Section 17602 (Automatic Purchase Renewals).California's automatic-renewal mechanics for an online signup: exclusively-online at-will cancellation without steps that obstruct or delay, disclosure before the purchase completes, and a retainable acknowledgment naming the cancellation method, as one state's layer above the federal floor.. Other states differ on the particulars, so search your own state's code for its automatic-renewal law before the sales page goes up, and read the text rather than a summary of it.

Then cancel a test membership yourself, end to end, the way a member would. If it takes a phone call, fix the flow before a regulator or a chargeback makes the same point.

What the fee is at tax time

Business revenue on your side, and on the member's side, usually no deduction at all, whatever a competitor's sales page implies. IRS Publication 502 keeps "health club dues or amounts paid to improve one's general health" out of the medical-expense definition, and a wellness membership pitched on general health sits closer to that sentence than to anything else in the publication 7Ref 7Internal Revenue Service (2025).Publication 502, Medical and Dental Expenses.The member-side tax facts: the 7.5-percent-of-AGI floor, the exclusion of health club dues and amounts paid to improve general health, the physician-prescription condition on health-institute fees, and the scope-limiting fact that the 2025 law amended the HSA statute without changing the general medical-expense definition..

The nearest passage that allows a recurring fee cuts the other way: treatment fees at a health institute count only when a physician prescribes the treatment and certifies it as necessary 7Ref 7Internal Revenue Service (2025).Publication 502, Medical and Dental Expenses.The member-side tax facts: the 7.5-percent-of-AGI floor, the exclusion of health club dues and amounts paid to improve general health, the physician-prescription condition on health-institute fees, and the scope-limiting fact that the 2025 law amended the HSA statute without changing the general medical-expense definition.. And even a qualifying expense deducts on an itemized return only past a floor, the amount above 7.5 percent of adjusted gross income 7Ref 7Internal Revenue Service (2025).Publication 502, Medical and Dental Expenses.The member-side tax facts: the 7.5-percent-of-AGI floor, the exclusion of health club dues and amounts paid to improve general health, the physician-prescription condition on health-institute fees, and the scope-limiting fact that the 2025 law amended the HSA statute without changing the general medical-expense definition..

Publication 502 never names a physical therapy, dietitian or counseling membership, so anything firmer than analogy is invention. The analogy runs against deductibility for a general-wellness pitch and leaves the physician-referred, treatment-scoped case as a question for the member's own tax preparer. Keep tax claims off the sales page accordingly, and let members ask their own advisors.

The physician side of this story has its own moving part, covered at DPC fees and the HSA: a 2025 federal law amended the health savings account statute and left the general medical-expense definition alone, and nothing in that change names a therapy or nutrition membership 7Ref 7Internal Revenue Service (2025).Publication 502, Medical and Dental Expenses.The member-side tax facts: the 7.5-percent-of-AGI floor, the exclusion of health club dues and amounts paid to improve general health, the physician-prescription condition on health-institute fees, and the scope-limiting fact that the 2025 law amended the HSA statute without changing the general medical-expense definition..

The sequence, from statute check to first payment

Six steps, in the order that keeps later steps from undoing earlier ones. The expensive mistakes on this page, an insurance question with no statute behind you, a Medicare conflict, a cancellation flow that fails its own test, are all cheaper to prevent than to unwind, and most of the prevention is reading and drafting rather than spending.

• Read the definitions in your state's direct care chapter and know in writing whether you are inside it or out. Inside brings the statute's own obligations with it, so read past the definitions before relying on the status.
• Check your licensing board's rules on fee arrangements and advertising. Boards differ by state and by profession, and no source on this page covers yours for you.
• Draft the agreement with the borrowed checklist above, the not-insurance sentence included.
• Run the numbers the way a DPC physician would. The DPC equation, members times monthly fee against the hours your service list costs, tells you whether the model clears your floor, and pricing the tiers is its own working session.
• Settle the Medicare posture with counsel if Medicare patients will enroll, and write it into the scope clause.
• Build the signup and cancellation flow to the federal floor and your state's renewal law, then cancel a test membership before the first real member can fail to.