North Carolina
LLC
Website link to register:
https://www.sosnc.gov/divisions/business_registration
Naming conventions
Names for PLLCs must indicate the professional service provided. Must include “Limited Liability Company,” “LLC,” or “L.L.C.” PLLCs required for medical professionals.
Licensing Requirements
Members must hold valid licenses from the North Carolina Medical Board. Proof of malpractice insurance required. Certifications for specialized equipment, such as MRIs, may be necessary.
Required documentation for medical practices
Articles of Organization, Facility Compliance, North Dakota Health Standards, Professional Licenses
Filing Fee: $125
Annual/Biennial Fee: $200
Additional Notes: Annual report due April 15.
Medicaid
Program Name: NC Medicaid
Official Website: http://medicaid.ncdhhs.gov/
Legislation: North Carolina passed SB 628 in 2019, recognizing DPC agreements as not being insurance and exempting them from state insurance laws.
Private Contracting
Explicitly permitted; DPC agreements are recognized and not subject to state insurance laws.
Restrictions
No explicit restrictions for DPC providers; compliance with federal and state regulations is required.
Medicaid Program
North Carolina Medicaid provides health coverage to eligible low-income residents, including children.
Notification Requirements
Notification strongly recommended for Medicaid patient clarity.
Provider Enrollment Requirements
Providers must enroll with NC Medicaid to serve beneficiaries directly or offer reimbursable services.
Enrollment Options
"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 PCPs unless fully enrolled.
Billing and Reimbursement
DPC practices typically do not bill Medicaid for services covered under private agreements.
Managed Care Plan Exemptions
Exemptions may apply under managed care frameworks.
Billing Clarity
Cannot bill Medicaid patients for covered services without prior notice.
CMS Guidance
CMS supports streamlined enrollments for "Ordering and Referring Only" providers.
Opportunities for Collaboration
Opportunities may exist to collaborate with Medicaid Managed Care Organizations (MCOs) or state healthcare programs.
State-Specific Notes
Collaboration opportunities exist with Medicaid Managed Care Organizations in NC for innovative primary care models.
Dispensing Medication
Board of Pharmacy Official Link: https://www.ncbop.org/
State Licensing
Physicians must register with the North Carolina Board of Pharmacy and Medical Board for dispensing controlled substances.
Scope of Practice
Dispensing medications is allowed within the physician’s scope of practice.
Inventory Management
Secure storage and accurate inventory logs are mandatory for controlled substances.
Record-Keeping
Records must comply with North Carolina state and federal HIPAA standards.
Dispensing Standards
Labels must include patient, prescriber, and medication details as per North Carolina regulations.
Controlled Substances
DEA registration and reporting to North Carolina’s Controlled Substances Reporting System (CSRS) are mandatory.
Billing and Reimbursement
Physicians must comply with North Carolina-specific billing regulations and federal anti-kickback laws.
Federal Compliance
Physicians must adhere to federal FDA, DEA, and OSHA standards for compliance.
State Pharmacy Laws
Registration with the North Carolina Board of Pharmacy is required for controlled substances.
Patient Consent
Informed consent is required for all dispensed medications.
Insurance and Liability
Liability insurance must explicitly cover risks associated with medication dispensing.
Training Requirements
Continuing education for compliance with North Carolina controlled substances laws is encouraged.
Audits and Inspections
Inspections are conducted by the North Carolina Board of Pharmacy and Medical Board, with penalties for non-compliance.