Delaware
LLC
Website link to register:
https://corp.delaware.gov/
Naming conventions
Name cannot contain “Bank” or “Trust” unless authorized.
Must include “Limited Liability Company,” “LLC,” or “L.L.C.” No specific rules for medical offices.
Licensing Requirements
Obtain a professional license through the Delaware Division of Professional Regulation.
Malpractice insurance required. Additional certifications for specialized practices may apply.
Required documentation for medical practices
Articles of Organization, Operating Agreement, Certificates for Specialized Services, Professional Licenses
Filing Fee: $110
Annual/Biennial Fee: $300
Additional Notes: Annual report due June 1.
Medicaid
Program Name: Delaware Medicaid
Official Website: https://dhss.delaware.gov/dmma/
Legislation: No specific DPC legislation; practices operate under general healthcare and insurance laws.
Private Contracting
Permitted; DPC practices should ensure they are not inadvertently operating as unlicensed insurers.
Restrictions
No explicit restrictions for DPC providers; compliance with federal and state regulations is necessary.
Medicaid Program
Delaware Medicaid provides health coverage to eligible low-income residents, including children.
Notification Requirements
Written notification advised for clarity on non-Medicaid services.
Provider Enrollment Requirements
Providers must enroll with Delaware 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 serve as Medicaid 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 without written consent.
CMS Guidance
CMS guidelines emphasize streamlined enrollments for ordering/referring providers.
Opportunities for Collaboration
Opportunities may exist to collaborate with Medicaid Managed Care Organizations (MCOs) or participate in state healthcare programs.
State-Specific Notes
Collaboration possible with Medicaid Managed Care Organizations for primary care expansion.
Dispensing Medication
Board of Pharmacy Official Link: https://dpr.delaware.gov/boards/pharmacy/
State Licensing
Physicians must register with the Delaware Division of Professional Regulation to dispense medications.
Scope of Practice
Physicians may dispense medications under strict compliance with state rules; controlled substances have additional requirements.
Inventory Management
Maintain secure storage and complete inventory logs, especially for controlled substances.
Record-Keeping
Records must adhere to Delaware Board of Pharmacy requirements and be HIPAA-compliant.
Dispensing Standards
Labels must include all necessary patient and prescribing details as required by the state.
Controlled Substances
DEA registration and reporting to the Delaware PMP are mandatory for controlled substances.
Billing and Reimbursement
Follow federal and state regulations for billing to ensure compliance.
Federal Compliance
Physicians must comply with FDA, DEA, and OSHA regulations for dispensing medications.
State Pharmacy Laws
Special registration with the Delaware Division of Professional Regulation is required for controlled substances.
Patient Consent
Obtain informed consent from patients before dispensing medications.
Insurance and Liability
Liability insurance should explicitly cover risks associated with dispensing medications.
Training Requirements
Physicians must complete any state-mandated training for controlled substances dispensing.
Audits and Inspections
The Delaware Board of Pharmacy conducts inspections regularly, with penalties for non-compliance.