Idaho
LLC
Website link to register:
https://sosbiz.idaho.gov/
Naming conventions
Restricted words (e.g., “Bank,” “Insurance”) require extra licensing. Must include “Limited Liability Company,” “LLC,” or “L.L.C.” Professional LLCs must use “PLLC” or “Professional LLC.”
Licensing Requirements
Submit proof of licensure from the Idaho Board of Medicine. Proof of malpractice insurance required. Additional permits for telemedicine practices may apply.
Required documentation for medical practices
Articles of Organization, Telemedicine Permits, Professional Licenses, Malpractice Insurance
Filing Fee: $100
Annual/Biennial Fee: None
Additional Notes: No annual report fee; however, annual report is required.
Medicaid
Program Name: Idaho Medicaid
Official Website: http://healthandwelfare.idaho.gov/services-programs/medicaid-health
Legislation: Idaho passed HB 189 in 2015, defining DPC agreements as not being insurance and exempting them from state insurance laws.
Private Contracting
Explicitly permitted; DPC agreements are allowed and are not subject to state insurance laws.
Restrictions
No explicit restrictions for DPC providers; compliance with federal and state regulations is necessary.
Medicaid Program
Idaho Medicaid provides health coverage to eligible low-income residents, including children.
Notification Requirements
Notification required for Medicaid patients under private agreements.
Provider Enrollment Requirements
Providers must enroll with Idaho Medicaid to serve beneficiaries directly or offer reimbursable services.
Enrollment Options
"Ordering and Referring Only" status available.
Ordering, Referrals, and Testing
Non-enrolled providers may face challenges with Medicaid recognition for orders and referrals.
Designated PCP Restrictions
DPC physicians cannot act as PCPs without full Medicaid enrollment.
Billing and Reimbursement
DPC practices typically do not bill Medicaid for services covered under private agreements.
Managed Care Plan Exemptions
Exemptions apply for managed care plans.
Billing Clarity
Cannot bill Medicaid patients for covered services without prior notice.
CMS Guidance
CMS highlights enrollment processes for DPC provider compliance.
Opportunities for Collaboration
Opportunities may exist to collaborate with Medicaid Managed Care Organizations (MCOs) or participate in state healthcare programs.
State-Specific Notes
Medicaid Managed Care Organizations in Idaho support innovative primary care access.
Dispensing Medication
Board of Pharmacy Official Link: https://bop.idaho.gov/
State Licensing
Physicians must register with the Idaho Board of Pharmacy and DEA for controlled substances.
Scope of Practice
Direct dispensing of medications is allowed within the physician’s scope of practice under state law.
Inventory Management
Maintain accurate logs and secure storage for all medications, especially controlled substances.
Record-Keeping
Records must comply with HIPAA and state laws and be available for audits and inspections.
Dispensing Standards
Labels must meet Idaho’s Board of Pharmacy standards, including dosage, patient, and prescriber details.
Controlled Substances
Controlled substances require compliance with DEA registration and reporting to Idaho’s PDMP.
Billing and Reimbursement
Physicians must comply with Idaho and federal regulations for billing to avoid anti-kickback violations.
Federal Compliance
Adherence to FDA, DEA, and OSHA standards is required for dispensing.
State Pharmacy Laws
Physicians must follow Idaho Board of Pharmacy laws for dispensing controlled substances.
Patient Consent
Informed patient consent must be obtained prior to dispensing medications.
Insurance and Liability
Liability insurance should cover risks associated with dispensing activities.
Training Requirements
Idaho encourages continuing education for compliance with controlled substances regulations.
Audits and Inspections
Inspections are periodically conducted by the Idaho Board of Pharmacy, with penalties for non-compliance.