Indiana
LLC
Website link to register:
https://inbiz.in.gov
Naming conventions
Name must not imply affiliation with government or unlawful activity. Must include “LLC,” “L.L.C.,” or “Limited Liability Company.” PLLC applies to medical professionals.
Licensing Requirements
Medical practitioners must have licenses from the Indiana Medical Licensing Board. Malpractice insurance required. Specific certifications for labs or diagnostic facilities may be needed.
Required documentation for medical practices
Articles of Organization, Lab Facility Permits, Professional Licenses, Malpractice Insurance
Filing Fee: $100
Annual/Biennial Fee: $50 (Biennial)
Additional Notes: Biennial report due end of anniversary month every other year.
Medicaid
Program Name: Indiana Health Coverage Programs (IHCP)
Official Website: in.gov/medicaid
Legislation: Indiana passed SB 101 in 2021, recognizing DPC agreements as not being insurance and exempting them from state insurance laws.
Private Contracting
Explicitly permitted; DPC agreements are allowed and not subject to state insurance laws.
Restrictions
No explicit restrictions for DPC providers; compliance with federal and state regulations is necessary.
Medicaid Program
Indiana Medicaid provides health coverage to eligible low-income residents, including children.
Notification Requirements
Notification strongly recommended to avoid confusion for Medicaid patients.
Provider Enrollment Requirements
Providers must enroll with Indiana Medicaid to serve beneficiaries directly or offer reimbursable services.
Enrollment Options
No "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 Medicaid-designated PCPs.
Billing and Reimbursement
DPC practices typically do not bill Medicaid for services covered under private agreements.
Managed Care Plan Exemptions
Not specified.
Billing Clarity
Cannot bill Medicaid patients for covered services unless pre-agreed terms exist.
CMS Guidance
CMS recommends streamlined enrollment for limited Medicaid interaction.
Opportunities for Collaboration
Opportunities may exist to collaborate with Medicaid Managed Care Organizations (MCOs) or state programs.
State-Specific Notes
Opportunities exist to collaborate with Indiana Medicaid Managed Care Programs.
Dispensing Medication
Board of Pharmacy Official Link: https://www.in.gov/pla/professions/indiana-board-of-pharmacy/
State Licensing
Physicians must register with the Indiana Board of Pharmacy for controlled substances dispensing.
Scope of Practice
Direct dispensing is allowed; additional rules apply to controlled substances.
Inventory Management
Secure storage and accurate inventory records are required for all dispensed medications.
Record-Keeping
Detailed records must comply with state and federal regulations; HIPAA compliance is required.
Dispensing Standards
Medication labels must include patient name, dosage, prescribing details, and proper instructions.
Controlled Substances
DEA registration and mandatory reporting to the Indiana PDMP for controlled substances.
Billing and Reimbursement
Billing practices must follow state-specific and federal anti-kickback laws.
Federal Compliance
Physicians must adhere to federal and Indiana state compliance regulations, including DEA standards.
State Pharmacy Laws
Indiana Board of Pharmacy oversees controlled substances compliance for physicians.
Patient Consent
Patients must give informed consent before receiving dispensed medications.
Insurance and Liability
Liability insurance must explicitly cover dispensing practices.
Training Requirements
Continuing education is required for compliance with Indiana’s controlled substances laws.
Audits and Inspections
Inspections are conducted regularly by the Indiana Board of Pharmacy; non-compliance can lead to penalties.