Massachusetts
LLC
Website link to register:
https://www.sec.state.ma.us/cor
Naming conventions
PLLC names must clearly describe the professional service provided. Must include “Limited Liability Company,” “LLC,” or “L.L.C.” PLLC applies to medical professionals.
Licensing Requirements
Members must have licenses from the Massachusetts Board of Registration in Medicine. Malpractice insurance required. Additional permits for lab facilities may apply.
Required documentation for medical practices
Articles of Organization, Lab Facility Permits, Professional Licenses, Malpractice Insurance
Filing Fee: $500
Annual/Biennial Fee: $500
Additional Notes: Annual report due on LLC anniversary date.
Medicaid
Program Name: MassHealth
Official Website: http://mass.gov/topics/masshealth
Legislation: Massachusetts does not have 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 being classified as insurers.
Restrictions
No explicit restrictions for DPC providers; compliance with federal and state regulations is necessary.
Medicaid Program
MassHealth provides Medicaid and CHIP coverage to eligible low-income residents, including children.
Notification Requirements
Notification strongly recommended for Medicaid patient clarity.
Provider Enrollment Requirements
Providers must enroll with MassHealth 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 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 encourages streamlined enrollment for non-billing providers.
Opportunities for Collaboration
Potential collaboration with Medicaid Managed Care Organizations (MCOs) or state programs aimed at increasing primary care access.
State-Specific Notes
Collaboration opportunities exist with MassHealth for expanding access to primary care.
Dispensing Medication
Board of Pharmacy Official Link: https://www.mass.gov/orgs/board-of-registration-in-pharmacy
State Licensing
Physicians must register with the Massachusetts Board of Registration in Medicine and the Board of Pharmacy.
Scope of Practice
Dispensing is allowed within a physician’s scope; controlled substances require additional registration.
Inventory Management
Detailed inventory logs and secure storage are required, especially for controlled substances.
Record-Keeping
Records must comply with Massachusetts and federal HIPAA regulations.
Dispensing Standards
Labels must meet state standards, including patient, prescriber, and usage details.
Controlled Substances
DEA registration and reporting to Massachusetts’s PMP are required for controlled substances.
Billing and Reimbursement
Billing practices must follow state-specific regulations and federal anti-kickback laws.
Federal Compliance
Adherence to federal FDA, DEA, and OSHA standards is mandatory.
State Pharmacy Laws
Physicians must comply with Massachusetts Board of Pharmacy regulations for dispensing controlled substances.
Patient Consent
Informed consent is required for all medications dispensed.
Insurance and Liability
Liability insurance must cover risks associated with dispensing.
Training Requirements
Continuing education for dispensing controlled substances is encouraged in Massachusetts.
Audits and Inspections
Inspections by the Massachusetts Board of Pharmacy ensure compliance; non-compliance leads to penalties.