Colorado
LLC
Website link to register:
https://www.coloradosos.gov/pubs/business/businessHome.html
Naming conventions
Must not falsely suggest an unlawful purpose.
Must include “Limited Liability Company,” “LLC,” or “L.L.C.”; PLLC is required for medical practices.
Licensing Requirements
Requires certification of professional licenses for all members from the Colorado Medical Board.
Must obtain permits for facility operations from the Colorado Department of Public Health & Environment.
Required documentation for medical practices
Articles of Organization, Operating Agreement, Facility Permits, Malpractice Insurance, Professional Licenses
Filing Fee: $50
Annual/Biennial Fee: $10
Additional Notes: Annual report due end of anniversary month.
Medicaid
Program Name: Health First Colorado
Official Website: http://healthfirstcolorado.com/
Legislation: House Bill 20-1140 (2020) allows Medicaid recipients to purchase DPC services or enter into DPC agreements.
Private Contracting
Explicitly permitted; Medicaid recipients can enter into DPC agreements.
Restrictions
No explicit restrictions for DPC providers; compliance with federal regulations is required.
Medicaid Program
Health First Colorado provides health coverage to eligible low-income residents, including children.
Notification Requirements
Written notification required for clarity on non-Medicaid acceptance.
Provider Enrollment Requirements
Providers must enroll with Health First Colorado to serve Medicaid 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 may not act as PCPs without full enrollment.
Billing and Reimbursement
DPC practices typically do not bill Health First Colorado for services covered under private agreements.
Managed Care Plan Exemptions
Exemptions may apply under managed care frameworks.
Billing Clarity
Cannot bill Medicaid patients for covered services unless clearly defined.
CMS Guidance
CMS supports streamlined provider enrollments for DPC integration.
Opportunities for Collaboration
Opportunities exist to collaborate with Medicaid Managed Care Organizations (MCOs) or participate in state healthcare initiatives.
State-Specific Notes
Medicaid Managed Care Organizations in Colorado promote innovation in primary care delivery.
Dispensing Medication
Board of Pharmacy Official Link: https://dpo.colorado.gov/Pharmacy
State Licensing
Physicians may dispense medications with proper state licensure; controlled substances require DEA registration.
Scope of Practice
Allowed for non-controlled and controlled substances under strict compliance with state laws.
Inventory Management
Secure storage and accurate inventory tracking for all medications are mandatory.
Record-Keeping
Maintain comprehensive records that comply with state and federal regulations, including HIPAA.
Dispensing Standards
Labels must include patient, prescriber, and medication details as per state pharmacy board standards.
Controlled Substances
Controlled substances require DEA registration and reporting to the Colorado PDMP.
Billing and Reimbursement
Adhere to federal and state anti-kickback statutes and billing practices.
Federal Compliance
FDA, DEA, and OSHA compliance is required for in-office dispensing.
State Pharmacy Laws
Registration with the Colorado State Board of Pharmacy is required for dispensing controlled substances.
Patient Consent
Obtain informed consent from patients prior to dispensing medications.
Insurance and Liability
Liability insurance must provide coverage for risks associated with dispensing.
Training Requirements
Continuing education for controlled substances dispensing is recommended.
Audits and Inspections
Colorado’s medical board conducts periodic audits; violations may result in penalties or loss of dispensing privileges.