Ohio
LLC
Website link to register:
https://www.ohiosos.gov/businesses/
Naming conventions
Restricted words require approval from the relevant authority. Must include “Limited Liability Company,” “LLC,” or “L.L.C.” PLLC designation applies to professional services.
Licensing Requirements
Members must be licensed by the State Medical Board of Ohio. Malpractice insurance required. Facility permits for diagnostic imaging or lab services may apply.
Required documentation for medical practices
Articles of Organization, Surgical Practice Permits, Professional Licenses, Malpractice Insurance
Filing Fee: $99
Annual/Biennial Fee: None
Additional Notes: No annual report requirement for LLCs.
Medicaid
Program Name: Ohio Medicaid
Official Website: http://medicaid.ohio.gov/
Legislation: Ohio passed HB 166 in 2019, defining 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
Ohio Medicaid provides health coverage to eligible low-income residents, including children.
Notification Requirements
Notification strongly recommended to avoid confusion.
Provider Enrollment Requirements
Providers must enroll with Ohio 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 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 processes for non-billing providers.
Opportunities for Collaboration
Opportunities may exist to collaborate with Medicaid Managed Care Organizations (MCOs) or state healthcare programs aimed at innovative care delivery.
State-Specific Notes
Collaboration opportunities exist with Ohio Medicaid Managed Care Organizations for primary care expansion.
Dispensing Medication
Board of Pharmacy Official Link: https://www.pharmacy.ohio.gov/
State Licensing
Physicians must register with the State of Ohio Board of Pharmacy for dispensing controlled substances.
Scope of Practice
Direct dispensing is allowed for non-controlled and controlled substances within the physician’s scope of practice.
Inventory Management
Secure storage and detailed inventory tracking are mandatory for all medications.
Record-Keeping
Records must comply with Ohio state and federal HIPAA regulations.
Dispensing Standards
Labels must meet Ohio Board of Pharmacy standards, including prescribing details, patient name, and dosage.
Controlled Substances
DEA registration and reporting to Ohio’s PMP (OARRS) are mandatory for controlled substances.
Billing and Reimbursement
Physicians must comply with Ohio billing practices and federal anti-kickback regulations.
Federal Compliance
Compliance with federal FDA, DEA, and OSHA standards is required for dispensing.
State Pharmacy Laws
Physicians must adhere to Ohio Board of Pharmacy regulations for dispensing controlled substances.
Patient Consent
Patients must provide informed consent before receiving medications.
Insurance and Liability
Liability insurance must include coverage for dispensing-related risks.
Training Requirements
Continuing education for controlled substances dispensing is encouraged under Ohio law.
Audits and Inspections
Regular inspections are conducted by the Ohio Board of Pharmacy to ensure compliance, with penalties for violations.