Montana's state auditor on Monday released an advisory memo saying agreements for treatment and payment made between patients and primary care providers without involving insurance are allowed and not regulated by his office.

Direct primary care plans have been advocated for before in Montana, including in a bill passed in the last legislative session and vetoed by Gov. Steve Bullock. They involve a patient paying a monthly fee, similar to a membership, to a provider in exchange for care.

In a press release, state Auditor Matt Rosendale said his memo would help expand health care options but also said people should still have insurance coverage for major or unexpected health care expenses. He called direct primary care a "good alternative for many people seeking routine or basic health care treatment."

“Montanans should have as many options on the table as possible to meet their health care needs as they see fit,” Rosendale said. “Direct primary care is yet another way for consumers to access routine, preventative, or preliminary health care.”

Rosendale, a Republican, said there are already some direct primary care providers operating in Montana, but the advisory memo makes things more clear for physicians who want to establish those care practices.

In his release, Rosendale included comments from Carol Bridges, a doctor with CostCare Direct in Missoula, which will transition to a direct primary care model Jan. 1.

CostCare will use a monthly membership mode, Bridges wrote, saying that arrangement would save money and make providers more accessible.

In his veto of a direct primary care bill this year, Bullock wrote the plans "offer little or no added value to most consumers" and "charge fees for treatments already covered by a consumer's health insurance, such as preventative care that insurance covers at no out-of-pocket cost to the consumer."

Direct primary care "is bad for Montanans, because it allows providers to charge unnecessary fees for services already covered by insurance and fails to deliver the administrative savings it promises."

The bill Bullock, a Democrat, vetoed also was "touted as cutting insurance-related administrative expenses," the governor wrote, but did not prevent providers from selling plans to patients while accepting insurance from others, meaning the provider would still have the same insurance-related overhead "but receives another income stream at the consumer's expense."

In 2015, when Rosendale was a state senator, he also carried legislation to allow direct primary care that was vetoed by Bullock. In that veto, Bullock wrote almost exactly the same objections as he did in 2017.

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State Bureau reporter for The Independent Record.

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