Illinois
LLC
Website link to register:
https://www.ilsos.gov/departments/business_services/home.html
Naming conventions
Cannot include “Corporation” or “Corp.” unless misleading or inaccurate. Must include “Limited Liability Company,” “LLC,” or “L.L.C.” Medical practices must use “PLLC.”
Licensing Requirements
Medical licenses for PLLC members must be certified by the Illinois Department of Financial and Professional Regulation (IDFPR). Malpractice insurance required. Comply with Illinois Department of Public Health’s standards for medical offices.
Required documentation for medical practices
Articles of Organization, Malpractice Insurance, Illinois Health Department Permits, Professional Licenses
Filing Fee: $150
Annual/Biennial Fee: $75
Additional Notes: Annual report due before the 1st day of anniversary month.
Medicaid
Program Name: Illinois Medicaid
Official Website: http://hfs.illinois.gov/medicalprograms/medicaid
Legislation:No 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
Illinois Medicaid provides coverage through the Illinois Department of Healthcare and Family Services (HFS).
Notification Requirements
Notification strongly recommended to avoid confusion.
Provider Enrollment Requirements
Providers must enroll with HFS to serve Medicaid 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 act as Medicaid-designated 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 unless explicitly outlined.
CMS Guidance
CMS informational bulletins recommend clarity on private contracting rules.
Opportunities for Collaboration
Potential collaboration with Medicaid Managed Care Organizations (MCOs) or participation in state healthcare programs.
State-Specific Notes
Collaboration possible with Illinois Medicaid Managed Care Organizations for primary care expansion.
Dispensing Medication
Board of Pharmacy Official Link: https://www.idfpr.com/profs/pharmacy.asp
State Licensing
Physicians must register with the Illinois Department of Financial and Professional Regulation for dispensing medications.
Scope of Practice
Direct dispensing of medications is allowed; controlled substances require DEA registration.
Inventory Management
Maintain detailed inventory logs for all medications; secure storage for controlled substances is required.
Record-Keeping
Records must comply with state laws and federal HIPAA regulations; available for audits.
Dispensing Standards
Labels must include patient name, prescribing physician, dosage, and usage instructions.
Controlled Substances
DEA registration and reporting to Illinois’s PMP are mandatory for controlled substances.
Billing and Reimbursement
Adhere to state billing regulations and federal anti-kickback statutes.
Federal Compliance
Compliance with FDA, DEA, and OSHA guidelines is required for dispensing.
State Pharmacy Laws
Physicians must comply with Illinois state pharmacy laws for dispensing controlled substances.
Patient Consent
Informed consent must be obtained prior to dispensing any medication.
Insurance and Liability
Malpractice insurance must cover risks associated with dispensing medications.
Training Requirements
Illinois mandates continuing education for controlled substances dispensing.
Audits and Inspections
Inspections by the Illinois Department of Financial and Professional Regulation are routine and penalties for violations are enforced.