Alabama
LLC
Website link to register:
https://www.sos.alabama.gov/index.php/business-entities/llcs
Naming conventions
Must be unique; cannot imply a purpose not allowed by state law. Must include “Limited Liability Company,” “LLC,” or “L.L.C.”; for PLLC, include “Professional Limited Liability Company” or “PLLC.”
Licensing Requirements
Obtain a certificate of good standing from the Alabama State Board of Medical Examiners.
Malpractice insurance is mandatory. Must meet Alabama Board of Medical Examiners’ facility standards.
Required documentation for medical practices
Articles of Organization, Operating Agreement, Professional Licenses, Malpractice Insurance, Facility Permits
Filing Fee: $200
Annual/BIennial Fee: $100
Additional Notes: Plus $25 name reservation fee. Annual report due 2.5 months after beginning of LLC’s tax year.
Medicaid
Program Name: Alabama Medicaid
Official Website: http://medicaid.alabama.gov/
Legislation: Alabama Physicians and Dentists Direct Pay Act: Allows DPC agreements for physicians and dentists.
Private Contracting
Permitted under the Direct Pay Act. Medicaid-related private contracting is not explicitly addressed.
Restrictions
State regulations do not explicitly prohibit DPC providers from serving Medicaid families but may limit certain activities.
Medicaid Program
Alabama Coordinated Health Network (ACHN): Coordinates care for Medicaid recipients across seven regions.
Notification Requirements
Not explicitly required but recommended for clarity.
Provider Enrollment Requirements
Providers must enroll with Medicaid and may need to contract with ACHN for Medicaid reimbursement.
Enrollment Options
No “Ordering and Referring Only” status available.
Ordering, Referrals, and Testing
Non-Medicaid-enrolled providers may face limitations with Medicaid recognition of orders and referrals.
Designated PCP Restrictions
DPC physicians cannot be designated PCPs for Medicaid patients.
Billing and Reimbursement
Direct billing to Medicaid is typically not applicable for DPC providers under private contracts.
Managed Care Plan Exemptions
Not specified.
Billing Clarity
Cannot bill Medicaid patients for covered services.
CMS Guidance
Refer to 42 CFR § 455.410(b) for federal guidance.
Opportunities for Collaboration
Collaboration with ACHN entities may provide opportunities to work with Medicaid recipients.
State-Specific Notes
ACHN program manages Medicaid; collaboration possible for DPC providers.
Dispensing Medication
Board of Pharmacy Official Link: https://albop.com/
State Licensing
Physicians can dispense non-controlled substances under their medical license. Dispensing controlled substances requires registration with the Alabama Board of Medical Examiners.
Scope of Practice
Physicians may dispense medications directly. Controlled substances require compliance with state laws.
Inventory Management
Maintain logs for all medications. Secure storage and adherence to state labeling standards are required.
Record-Keeping
Mandatory logs for all dispensed medications. Records must be HIPAA-compliant and available for audits.
Dispensing Standards
Labels must include patient name, medication name, dosage, and prescribing physician details. Written prescriptions must accompany dispensed medications.
Controlled Substances
Registration with the Alabama Board of Medical Examiners is required for controlled substances. PDMP reporting is mandatory. Dispensed quantities are limited.
Billing and Reimbursement
Ensure compliance with state and federal billing regulations. Avoid anti-kickback statute violations.
Federal Compliance
Adhere to FDA, DEA, and OSHA guidelines for dispensing medications and handling hazardous substances.
State Pharmacy Laws
Special registration with the Alabama Board of Medical Examiners is required for controlled substances dispensing.
Patient Consent
Patient consent must be obtained prior to dispensing medications.
Insurance and Liability
Liability insurance must include coverage for in-office dispensing. Additional malpractice insurance may be needed.
Training Requirements
Physicians must undergo state-mandated training for controlled substances and participate in continuing education.
Audits and Inspections
Audits are conducted periodically by the Alabama Board of Medical Examiners. Non-compliance can result in fines of up to $10,000 per violation.