State by State Guidance
Find DPC Pediatricians by State:
Alabama
Website link to register: https://www.sos.alabama.gov/index.php/business-entities/llcs
Naming conventions
Must be unique; cannot imply a purpose not allowed by state law. Must include “Limited Liability Company,” “LLC,” or “L.L.C.”; for PLLC, include “Professional Limited Liability Company” or “PLLC.”
Licensing Requirements
Obtain a certificate of good standing from the Alabama State Board of Medical Examiners.
Malpractice insurance is mandatory. Must meet Alabama Board of Medical Examiners’ facility standards.
Required documentation for medical practices
Articles of Organization, Operating Agreement, Professional Licenses, Malpractice Insurance, Facility Permits
Filing Fee: $200
Annual/BIennial Fee: $100
Additional Notes: Plus $25 name reservation fee. Annual report due 2.5 months after beginning of LLC’s tax year.
Program Name: Alabama Medicaid
Official Website: http://medicaid.alabama.gov/
Legislation: Alabama Physicians and Dentists Direct Pay Act: Allows DPC agreements for physicians and dentists.
Private Contracting: Permitted under the Direct Pay Act. Medicaid-related private contracting is not explicitly addressed.
Medicaid Program: Alabama Coordinated Health Network (ACHN): Coordinates care for Medicaid recipients across seven regions.
Provider Enrollment Requirements: Providers must enroll with Medicaid and may need to contract with ACHN for Medicaid reimbursement.
Ordering, Referrals, and Testing: Non-Medicaid-enrolled providers may face limitations with Medicaid recognition of orders and referrals.
Billing and Reimbursement: Direct billing to Medicaid is typically not applicable for DPC providers under private contracts.
Billing Clarity: Cannot bill Medicaid patients for covered services.
Opportunities for Collaboration: Collaboration with ACHN entities may provide opportunities to work with Medicaid recipients.
Restrictions: State regulations do not explicitly prohibit DPC providers from serving Medicaid families but may limit certain activities.
Notification Requirements: Not explicitly required but recommended for clarity.
Enrollment Options: No “Ordering and Referring Only” status available.
Designated PCP Restrictions: DPC physicians cannot be designated PCPs for Medicaid patients.
Managed Care Plan Exemptions: Not specified.
CMS Guidance: Refer to 42 CFR § 455.410(b) for federal guidance.
State-Specific Notes: ACHN program manages Medicaid; collaboration possible for DPC providers.
Board of Pharmacy Official Link: https://albop.com/
State Licensing: Physicians can dispense non-controlled substances under their medical license. Dispensing controlled substances requires registration with the Alabama Board of Medical Examiners.
Scope of Practice: Physicians may dispense medications directly. Controlled substances require compliance with state laws.
Inventory Management: Maintain logs for all medications. Secure storage and adherence to state labeling standards are required.
Record-Keeping: Mandatory logs for all dispensed medications. Records must be HIPAA-compliant and available for audits.
Dispensing Standards: Labels must include patient name, medication name, dosage, and prescribing physician details. Written prescriptions must accompany dispensed medications.
Controlled Substances: Registration with the Alabama Board of Medical Examiners is required for controlled substances. PDMP reporting is mandatory. Dispensed quantities are limited.
Billing and Reimbursement: Ensure compliance with state and federal billing regulations. Avoid anti-kickback statute violations.
Federal Compliance: Adhere to FDA, DEA, and OSHA guidelines for dispensing medications and handling hazardous substances.
State Pharmacy Laws: Special registration with the Alabama Board of Medical Examiners is required for controlled substances dispensing.
Patient Consent: Patient consent must be obtained prior to dispensing medications.
Insurance and Liability: Liability insurance must include coverage for in-office dispensing. Additional malpractice insurance may be needed.
Training Requirements: Physicians must undergo state-mandated training for controlled substances and participate in continuing education.
Audits and Inspections: Audits are conducted periodically by the Alabama Board of Medical Examiners. Non-compliance can result in fines of up to $10,000 per violation.
Alabama
Website link to register: https://www.sos.alabama.gov/index.php/business-entities/llcs
Naming conventions
Must be unique; cannot imply a purpose not allowed by state law. Must include “Limited Liability Company,” “LLC,” or “L.L.C.”; for PLLC, include “Professional Limited Liability Company” or “PLLC.”
Licensing Requirements
Obtain a certificate of good standing from the Alabama State Board of Medical Examiners.
Malpractice insurance is mandatory. Must meet Alabama Board of Medical Examiners’ facility standards.
Required documentation for medical practices
Articles of Organization, Operating Agreement, Professional Licenses, Malpractice Insurance, Facility Permits
Filing Fee: $200
Annual/BIennial Fee: $100
Additional Notes: Plus $25 name reservation fee. Annual report due 2.5 months after beginning of LLC’s tax year.
Program Name: Alabama Medicaid
Official Website: http://medicaid.alabama.gov/
Legislation: Alabama Physicians and Dentists Direct Pay Act: Allows DPC agreements for physicians and dentists.
Private Contracting: Permitted under the Direct Pay Act. Medicaid-related private contracting is not explicitly addressed.
Medicaid Program: Alabama Coordinated Health Network (ACHN): Coordinates care for Medicaid recipients across seven regions.
Provider Enrollment Requirements: Providers must enroll with Medicaid and may need to contract with ACHN for Medicaid reimbursement.
Ordering, Referrals, and Testing: Non-Medicaid-enrolled providers may face limitations with Medicaid recognition of orders and referrals.
Billing and Reimbursement: Direct billing to Medicaid is typically not applicable for DPC providers under private contracts.
Billing Clarity: Cannot bill Medicaid patients for covered services.
Opportunities for Collaboration: Collaboration with ACHN entities may provide opportunities to work with Medicaid recipients.
Restrictions: State regulations do not explicitly prohibit DPC providers from serving Medicaid families but may limit certain activities.
Notification Requirements: Not explicitly required but recommended for clarity.
Enrollment Options: No “Ordering and Referring Only” status available.
Designated PCP Restrictions: DPC physicians cannot be designated PCPs for Medicaid patients.
Managed Care Plan Exemptions: Not specified.
CMS Guidance: Refer to 42 CFR § 455.410(b) for federal guidance.
State-Specific Notes: ACHN program manages Medicaid; collaboration possible for DPC providers.
Board of Pharmacy Official Link: https://albop.com/
State Licensing: Physicians can dispense non-controlled substances under their medical license. Dispensing controlled substances requires registration with the Alabama Board of Medical Examiners.
Scope of Practice: Physicians may dispense medications directly. Controlled substances require compliance with state laws.
Inventory Management: Maintain logs for all medications. Secure storage and adherence to state labeling standards are required.
Record-Keeping: Mandatory logs for all dispensed medications. Records must be HIPAA-compliant and available for audits.
Dispensing Standards: Labels must include patient name, medication name, dosage, and prescribing physician details. Written prescriptions must accompany dispensed medications.
Controlled Substances: Registration with the Alabama Board of Medical Examiners is required for controlled substances. PDMP reporting is mandatory. Dispensed quantities are limited.
Billing and Reimbursement: Ensure compliance with state and federal billing regulations. Avoid anti-kickback statute violations.
Federal Compliance: Adhere to FDA, DEA, and OSHA guidelines for dispensing medications and handling hazardous substances.
State Pharmacy Laws: Special registration with the Alabama Board of Medical Examiners is required for controlled substances dispensing.
Patient Consent: Patient consent must be obtained prior to dispensing medications.
Insurance and Liability: Liability insurance must include coverage for in-office dispensing. Additional malpractice insurance may be needed.
Training Requirements: Physicians must undergo state-mandated training for controlled substances and participate in continuing education.
Audits and Inspections: Audits are conducted periodically by the Alabama Board of Medical Examiners. Non-compliance can result in fines of up to $10,000 per violation.