Pennsylvania
LLC
Website link to register:
https://www.dos.pa.gov/BusinessCharities/Business/Pages/default.aspx
Naming conventions
PLLC names must reflect the professional service being offered. Must include “Limited Liability Company,” “LLC,” or “L.L.C.” PLLCs required for medical practices.
Licensing Requirements
Medical licenses must be verified by the Pennsylvania State Board of Medicine. Malpractice insurance mandatory. Additional certifications for outpatient surgery centers may apply.
Required documentation for medical practices
Articles of Organization, General Facility Permits, Professional Licenses, Malpractice Insurance
Filing Fee: $125
Annual/Biennial Fee: $70 (Decennial)
Additional Notes: Decennial report required every 10 years.
Medicaid
Program Name: Pennsylvania Medicaid
Official Website: http://dhs.pa.gov/Services/Assistance/Pages/Medical-Assistance.aspx
Legislation: Pennsylvania 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
Pennsylvania Medicaid, known as Medical Assistance, provides health coverage to eligible low-income residents.
Notification Requirements
Notification strongly recommended for Medicaid patient clarity.
Provider Enrollment Requirements
Providers must enroll with Medical Assistance 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 improving primary care access.
State-Specific Notes
Collaboration opportunities exist with Pennsylvania Medicaid Managed Care Organizations for primary care expansion.
Dispensing Medication
Board of Pharmacy Official Link:
https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Pharmacy/
State Licensing
Physicians must register with the Pennsylvania Department of Health and Board of Pharmacy for controlled substances dispensing.
Scope of Practice
Direct dispensing is allowed for non-controlled and controlled substances within a physician’s scope of practice.
Inventory Management
Maintain detailed inventory logs and secure storage for all dispensed medications.
Record-Keeping
Records must comply with Pennsylvania state laws and federal HIPAA regulations.
Dispensing Standards
Labels must include patient name, prescribing physician, and detailed usage instructions.
Controlled Substances
DEA registration and reporting to Pennsylvania’s PMP are mandatory for controlled substances.
Billing and Reimbursement
Billing practices must follow Pennsylvania-specific regulations and federal anti-kickback laws.
Federal Compliance
Adherence to federal FDA, DEA, and OSHA standards is required for dispensing.
State Pharmacy Laws
Physicians must comply with Pennsylvania Board of Pharmacy laws for dispensing controlled substances.
Patient Consent
Informed patient consent is required prior to dispensing medications.
Insurance and Liability
Physicians must ensure liability insurance covers dispensing-related risks.
Training Requirements
Continuing education for controlled substances dispensing is recommended under Pennsylvania law.
Audits and Inspections
Regular inspections are conducted by the Pennsylvania Board of Pharmacy to ensure compliance, with penalties for violations.