New York
LLC
Website link to register:
https://www.dos.ny.gov/corps
Naming conventions
Cannot include “College,” “Academy,” or “School” without approval from the State Education Department. Must include “Limited Liability Company,” “LLC,” or “L.L.C.” PLLCs must include “Professional Limited Liability Company.”
Licensing Requirements
Proof of professional licensure must be submitted to the New York State Education Department (NYSED). Malpractice insurance required. Comply with New York State Department of Health’s facility regulations.
Required documentation for medical practices
Articles of Organization, Diagnostic Equipment Permits, Professional Licenses, Malpractice Insurance
Filing Fee: $200
Annual/Biennial Fee: $9-$450 (Publication)
Additional Notes: Publication requirement for LLCs costs $900–$1,200 in NYC and ~$50–$200 elsewhere. Biennial fee is $9.
Medicaid
Program Name: New York Medicaid
Official Website: http://health.ny.gov/health_care/medicaid
Legislation: New York 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 York Medicaid provides health coverage to eligible low-income residents through multiple managed care plans.
Notification Requirements
Notification strongly recommended for Medicaid patient clarity.
Provider Enrollment Requirements
Providers must enroll with New York 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 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 innovative healthcare delivery.
State-Specific Notes
Collaboration opportunities exist with New York Medicaid Managed Care Organizations for primary care expansion.
Dispensing Medication
Board of Pharmacy Official Link: http://www.op.nysed.gov/prof/pharm/
State Licensing
Physicians must register with the New York State Department of Health and Board of Pharmacy to dispense controlled substances.
Scope of Practice
Physicians may dispense medications directly; strict rules apply to controlled substances.
Inventory Management
Secure storage and detailed inventory tracking are required for controlled substances.
Record-Keeping
Records must meet New York state and federal standards, including HIPAA compliance.
Dispensing Standards
Labels must comply with New York Board of Pharmacy standards, including patient name, prescriber details, and dosage.
Controlled Substances
DEA registration and reporting to New York’s I-STOP PMP are mandatory for controlled substances.
Billing and Reimbursement
Billing practices must adhere to New York-specific and federal regulations.
Federal Compliance
Adherence to FDA, DEA, and OSHA standards is required for dispensing.
State Pharmacy Laws
Physicians must comply with New York Board of Pharmacy laws for dispensing controlled substances.
Patient Consent
Informed patient consent is required prior to dispensing medications.
Insurance and Liability
Liability insurance must cover risks related to medication dispensing.
Training Requirements
Continuing education specific to controlled substances dispensing is recommended in New York.
Audits and Inspections
Inspections are conducted by the New York Department of Health and Board of Pharmacy, with penalties for non-compliance.