New Jersey
LLC
Website link to register:
https://www.nj.gov/treasury/revenue
Naming conventions
Names must be distinguishable and cannot mislead the public.
Must include “Limited Liability Company,” “LLC,” or “L.L.C.” Medical professionals must use “PLLC.”
Licensing Requirements
Members must have valid licenses from the New Jersey State Board of Medical Examiners. Proof of malpractice insurance required. Specialized certifications for outpatient surgery centers may be needed.
Required documentation for medical practices
Articles of Organization, Telemedicine Permits, Professional Licenses, Malpractice Insurance
Filing Fee: $125
Annual/Biennial Fee: $75
Additional Notes: Annual report due on LLC anniversary date.
Medicaid
Program Name: NJ FamilyCare
Official Website: http://njfamilycare.org/
Legislation: New Jersey 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
New Jersey Medicaid, also known as NJ FamilyCare, provides health coverage to eligible low-income residents.
Notification Requirements
Notification strongly recommended for Medicaid patient clarity.
Provider Enrollment Requirements
Providers must enroll with NJ FamilyCare 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
Opportunities may exist to collaborate with Medicaid Managed Care Organizations (MCOs) or state programs aimed at increasing access to primary care.
State-Specific Notes
Collaboration opportunities exist with New Jersey Medicaid Managed Care Organizations for primary care expansion.
Dispensing Medication
Board of Pharmacy Official Link: https://www.njconsumeraffairs.gov/pharm
State Licensing
Physicians must register with the New Jersey State Board of Medical Examiners for dispensing controlled substances.
Scope of Practice
Direct dispensing is allowed for non-controlled and controlled substances within a physician’s scope of practice.
Inventory Management
Secure storage and detailed inventory tracking are required for all medications.
Record-Keeping
Records must comply with New Jersey state and federal HIPAA regulations.
Dispensing Standards
Labels must meet New Jersey Board of Pharmacy standards, including patient name, dosage, and prescribing physician.
Controlled Substances
DEA registration and reporting to New Jersey’s PMP are mandatory for controlled substances.
Billing and Reimbursement
Billing practices must follow federal Stark Law and New Jersey-specific regulations.
Federal Compliance
Adherence to federal FDA, DEA, and OSHA regulations is required for dispensing.
State Pharmacy Laws
Physicians must comply with New Jersey Board of Pharmacy regulations for dispensing controlled substances.
Patient Consent
Informed consent must be obtained prior to dispensing medications.
Insurance and Liability
Liability insurance must explicitly cover risks associated with dispensing activities.
Training Requirements
Continuing education is recommended for compliance with controlled substances regulations.
Audits and Inspections
Inspections are conducted by the New Jersey Board of Pharmacy, with penalties for non-compliance.