Iowa
LLC
Website link to register:
https://sos.iowa.gov/business
Naming conventions
PLLC names must reflect the professional service offered (e.g., “Healthcare PLLC”). Must include “Limited Liability Company,” “LLC,” or “L.L.C.” Professional practices must include “PLLC.”
Licensing Requirements
Proof of licensure is required from the Iowa Board of Medicine. Proof of malpractice insurance required. Comply with Iowa Department of Public Health facility standards.
Required documentation for medical practices
Articles of Organization, Facility Standards Compliance, Professional Licenses, Malpractice Insurance
Filing Fee: $50
Annual/Biennial Fee: $30(Biennial)
Additional Notes: Biennial report due April 1 on odd-numbered years.
Medicaid
Program Name: Iowa Medicaid
Official Website: https://hhs.iowa.gov/programs/welcome-iowa-medicaid
Legislation:Iowa does not have specific DPC legislation; practices operate under general healthcare and insurance laws.
Private Contracting
Permitted; DPC practices should ensure compliance with state insurance regulations to avoid classification as insurers.
Restrictions
No explicit restrictions for DPC providers; compliance with federal and state regulations is necessary.
Medicaid Program
Iowa Medicaid provides coverage through the Iowa Department of Human Services (DHS).
Notification Requirements
Notification required if Medicaid patients are not accepted under the program.
Provider Enrollment Requirements
Providers must enroll with Iowa 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 serve as Medicaid PCPs.
Billing and Reimbursement
DPC practices typically do not bill Medicaid for services covered under private agreements.
Managed Care Plan Exemptions
Exemptions may apply for managed care beneficiaries.
Billing Clarity
Cannot bill Medicaid patients for covered services unless clearly agreed upon.
CMS Guidance
CMS encourages states to adopt streamlined enrollment processes for non-billing providers.
Opportunities for Collaboration
Potential collaboration with Medicaid Managed Care Organizations (MCOs) or participation in state healthcare programs.
State-Specific Notes
Collaboration opportunities exist with Iowa Medicaid Managed Care Organizations for DPC integration.
Dispensing Medication
Board of Pharmacy Official Link: https://pharmacy.iowa.gov/
State Licensing
Physicians must register with the Iowa Board of Pharmacy for dispensing controlled substances.
Scope of Practice
Physicians may dispense medications directly within their scope of practice.
Inventory Management
Detailed inventory tracking and secure storage are mandatory for all medications.
Record-Keeping
Records must adhere to state and federal standards; compliance with HIPAA is required.
Dispensing Standards
Medication labels must comply with Iowa pharmacy rules, including dosage, patient name, and prescribing details.
Controlled Substances
DEA registration and reporting to the Iowa PDMP are required for controlled substances.
Billing and Reimbursement
Physicians must adhere to Iowa state billing regulations and federal anti-kickback laws.
Federal Compliance
Compliance with federal FDA, DEA, and OSHA guidelines is required for dispensing.
State Pharmacy Laws
Registration with the Iowa Board of Pharmacy is required for controlled substances dispensing.
Patient Consent
Patients must provide informed consent prior to receiving medications.
Insurance and Liability
Liability insurance must cover risks related to dispensing activities.
Training Requirements
Continuing education is encouraged for physicians dispensing controlled substances in Iowa.
Audits and Inspections
Inspections are conducted by the Iowa Board of Pharmacy, with penalties for non-compliance.