California
LLC
Website link to register:
https://www.sos.ca.gov/business-programs
Naming conventions
LLCs cannot be used for professional services like medical practices.
Medical professionals are prohibited from forming LLCs; must form a Professional Corporation (PC).
Licensing Requirements
Medical practices must form Professional Corporations (PCs) and obtain approval from the Medical Board of California.
Malpractice insurance required. Additional permits for medical waste management and X-ray equipment may be needed.
Required documentation for medical practices
Professional Corporation: Articles of Incorporation, Malpractice Insurance, Medical Waste Permits, Professional Licenses
Filing Fee: $70
Annual/BIennial Fee: $800
Additional Notes: $800 Franchise Tax (LLCs formed between Jan 2021 and Jan 2024 are exempt for first year). $20 Statement of Information fee.
Medicaid
Program Name: Medi-Cal
Official Website: https://www.dhcs.ca.gov/Pages/myMedi-Cal.aspx
Legislation: No specific DPC legislation; previous attempts like Senate Bill 1320 in 2012 did not pass.
Private Contracting
Permitted; DPC practices operate within existing legal frameworks, ensuring compliance with the Knox-Keene Act to avoid being classified as health plans.
Restrictions
No specific restrictions on DPC practices, but compliance with state regulations like the Knox-Keene Act is essential.
Medicaid Program
Medi-Cal provides health coverage to low-income residents, including children.
Notification Requirements
Notification recommended but not mandated.
Provider Enrollment Requirements
Providers must enroll with Medi-Cal 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 Medi-Cal recognition for orders and referrals.
Designated PCP Restrictions
DPC physicians cannot serve as Medicaid PCPs.
Billing and Reimbursement
DPC practices typically do not bill Medi-Cal for services covered under private agreements.
Managed Care Plan Exemptions
Not specified.
Billing Clarity
Cannot bill Medicaid patients for covered services without documented notice.
CMS Guidance
CMS highlights streamlined processes in state Medicaid manuals.
Opportunities for Collaboration
The California Direct Primary Care Coalition supports DPC practices and advocates for favorable legislation.
State-Specific Notes
Collaboration possible with Medi-Cal managed care plans for expanding primary care options.
Dispensing Medication
Board of Pharmacy Official Link: https://www.pharmacy.ca.gov/
State Licensing
Physicians must register with the California Board of Pharmacy for dispensing medications. Controlled substances require additional DEA registration.
Scope of Practice
Physicians may dispense medications within their scope of practice; dispensing controlled substances has stricter regulations.
Inventory Management
Maintain detailed inventory logs; controlled substances must have additional documentation.
Record-Keeping
Records must be retained as per California law and meet HIPAA standards.
Dispensing Standards
Labels must comply with California Board of Pharmacy rules, including dosage, patient, and prescriber details.
Controlled Substances
Controlled substances require reporting to the CURES PDMP. DEA and state compliance are mandatory.
Billing and Reimbursement
Follow federal Stark Law and California-specific billing requirements for dispensing.
Federal Compliance
Compliance with FDA, DEA, and OSHA standards is required.
State Pharmacy Laws
Physicians dispensing controlled substances must adhere to California’s stricter pharmacy board regulations.
Patient Consent
Informed patient consent is required before dispensing any medication.
Insurance and Liability
Liability insurance must cover risks associated with medication dispensing.
Training Requirements
California encourages continuing education specific to controlled substances and dispensing laws.
Audits and Inspections
Inspections by California medical and pharmacy boards are routine; penalties for non-compliance can include fines or revocation of dispensing privileges.