Kentucky
LLC
Website link to register:
https://www.sos.ky.gov/bus/business-filings/Pages/default.aspx
Naming conventions
PLLC names must include the professional designation, such as “MD,” or the service type, e.g., “Dental PLLC.”
Must include “Limited Liability Company,” “LLC,” or “L.L.C.” PLLC applies to licensed professionals.
Licensing Requirements
Submit proof of licensure from the Kentucky Board of Medical Licensure. Malpractice insurance required. Certifications for dispensing medication may be needed.
Required documentation for medical practices
Articles of Organization, Rural Facility Certifications, Malpractice Insurance, Professional Licenses
Filing Fee: $40
Annual/Biennial Fee: $15
Additional Notes: Annual report due June 30.
Medicaid
Program Name: Kentucky Medicaid
Official Website: https://www.chfs.ky.gov/agencies/dms
Legislation: Kentucky does not have specific DPC legislation, but general healthcare and insurance laws apply.
Private Contracting
Private contracting is restricted; prior executive orders have prohibited private contracting with Medicaid beneficiaries for services covered by Medicaid.
Restrictions
State executive orders have prohibited DPC practices from privately contracting with Medicaid beneficiaries.
Medicaid Program
Kentucky Medicaid provides health coverage to eligible low-income residents, including children.
Notification Requirements
Notification required, and private contracting is generally restricted.
Provider Enrollment Requirements
Providers must enroll with Kentucky 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 cannot have their orders or referrals recognized by Medicaid.
Designated PCP Restrictions
DPC physicians cannot serve as Medicaid PCPs.
Billing and Reimbursement
DPC practices typically cannot privately bill Medicaid-covered services due to state restrictions.
Managed Care Plan Exemptions
Not specified.
Billing Clarity
Cannot bill Medicaid patients for covered services under most circumstances.
CMS Guidance
CMS recommends engaging with state Medicaid programs for guidance on private contracting.
Opportunities for Collaboration
Limited collaboration opportunities due to restrictions on private contracting with Medicaid patients.
State-Specific Notes
Kentucky has restrictive Medicaid rules; DPC providers should seek legal counsel for compliance.
Dispensing Medication
Board of Pharmacy Official Link: https://pharmacy.ky.gov/
State Licensing
Physicians must register with the Kentucky Board of Pharmacy and the Cabinet for Health and Family Services for dispensing controlled substances.
Scope of Practice
Physicians may dispense medications directly under state law; controlled substances require additional licensing.
Inventory Management
Inventory tracking and secure storage are required for all medications.
Record-Keeping
Record-keeping must comply with state and federal laws, including HIPAA.
Dispensing Standards
Labels must meet Kentucky Board of Pharmacy standards, including patient and prescriber details.
Controlled Substances
Controlled substances require DEA registration and reporting to Kentucky’s KASPER system.
Billing and Reimbursement
Billing practices must comply with federal and state anti-kickback laws.
Federal Compliance
Physicians must adhere to federal FDA, DEA, and Kentucky-specific guidelines for compliance.
State Pharmacy Laws
Registration with the Kentucky Board of Pharmacy is required for controlled substances.
Patient Consent
Obtain patient consent prior to dispensing medications.
Insurance and Liability
Liability insurance must explicitly cover dispensing activities.
Training Requirements
Continuing education for controlled substances dispensing is mandated in Kentucky.
Audits and Inspections
The Kentucky Board of Pharmacy conducts regular inspections, and non-compliance results in strict penalties.