Whether you run an independent practice, a group, or a DSO, compliance questions around dental membership plans are among the most misunderstood. At Plan Forward, we have spent years navigating the regulatory landscape so our partners do not have to. Here, we will set the record straight on a few of these questions. Please reach out if you need additional clarification, whether you’re a current client or not. Note: this is not legal advice
Fiction #1
“A dental membership plan is, by definition, a discount medical plan.”
The reality is nuanced.
Whether your plan constitutes a Discount Medical Plan subject to DMPO regulation depends entirely on how it is structured and who operates it.
A plan operated by a third-party platform that charges patients a fee to access a network of discounted providers is, in most states, a discount medical plan subject to DMPO oversight.
But a plan operated by a dental provider directly for their own patients structured as a direct care agreement is explicitly not a discount medical plan under the laws of over 20 states (ADA list here) that have enacted Direct Primary Care statutes. Here, the relationship between the provider & the patient is governed by an agreement/contract.
The distinction is of vital importance. Treating every dental membership plan as a DMPO regardless of structure creates an unnecessary compliance burden and obscures the legitimate options available. Many vendors lean into this as a selling point, take on this regulatory burden, and “lock-in” the practice or DSO unnecessarily.
The reality is: The structure of your membership plan will determine the regulations that apply.
Fiction #2
“None of the states that regulate discount plans have created an express statutory exception for providers charging their own patients a fee.”
This is incorrect, and can be proven.
Multiple state statutes explicitly carve out provider-operated in-office plans from DMPO regulation. For example:
South Carolina’s SECTION 37-17-30 “does not require a provider who provides discounts to his or her own patients to obtain and maintain a license pursuant to this chapter as a discount medical plan organization.” Many other states have similar carve-outs, and it requires some additional research.
The result is that a dental practice in any of these states operating a compliant direct care agreement is not operating a Discount Medical Plan and is not subject to DMPO regulation, regardless of what a competitor’s general counsel may claim.
Understanding which framework applies to your specific situation is exactly the kind of guidance Plan Forward provides.
Fiction #3
“Many SaaS platforms disclaim all compliance responsibility.”
This is misleading and overly simplified.
The right platform vendor actively works to ensure compliance; complying with required state registrations as needed, requiring state-specific agreements and contracts to be signed by the provider & the patient, and staying current with regulatory changes as they happen.
As a buyer, the key is not to let misinformation be used in the sales process to steer you a certain direction. Ask around, be sure that you have the facts straight.
Fiction #4
“DMPO registration is not cheap or easy.”
For some states, it is both cheap & easy.
State DMPO registration requirements vary dramatically, and so do the fees required. In states where the registration is both costly & onerous, look for a vendor partner. In other states, the application may be simple & approved in a week or two. Check state websites to find which vendors have licenses, as needed.
The Plan Forward Difference
Compliance is not a feature we added to our software. It is the foundation our platform was built on. Plan Forward holds state DMPO licenses, ensures compliance with all DPC & DMPO requirements, uses state-specific language in members agreements, marketing materials & websites, and actively monitors legislative and regulatory changes.
The information provided here is for educational purposes only and does not constitute legal advice. For questions about Plan Forward’s compliance infrastructure, contact us.
