Texas
LLC
Website link to register:
https://www.sos.state.tx.us/corp
Naming conventions
Restricted words require state licensing; PLLC names must identify the professional service. Must include “Limited Liability Company,” “LLC,” or “L.L.C.” Medical professionals must use “PLLC.”
Licensing Requirements
Submit proof of licensure from the Texas Medical Board. Malpractice insurance required. Must meet Texas Health and Human Services Commission’s facility standards.
Required documentation for medical practices
Articles of Organization, Vermont Health Codes Compliance, Professional Licenses, Malpractice Insurance
Filing Fee: $300
Annual/Biennial Fee: None
Additional Notes: No annual report fee, but a public information report (PIR) must be filed annually.
Medicaid
Program Name: Texas Medicaid
Official Website: http://hhs.texas.gov/services/health/medicaid-chip
Legislation: Texas passed SB 417 in 2015, 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
Texas Medicaid provides health coverage to eligible low-income residents, including children.
Notification Requirements
Notification required if Medicaid patients are not accepted for services.
Provider Enrollment Requirements
Providers must enroll with Texas 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 serve as Medicaid PCPs.
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 unless explicitly outlined.
CMS Guidance
CMS supports streamlined enrollments for non-billing providers.
Opportunities for Collaboration
Opportunities may exist to collaborate with Medicaid Managed Care Organizations (MCOs) or state healthcare initiatives focused on primary care access.
State-Specific Notes
Collaboration opportunities exist with Texas Medicaid Managed Care Organizations for primary care innovation.
Dispensing Medication
Board of Pharmacy Official Link: https://www.pharmacy.texas.gov/
State Licensing
Physicians must register with the Texas Medical Board for dispensing controlled substances.
Scope of Practice
Dispensing medications is allowed within a physician’s scope of practice under Texas law.
Inventory Management
Accurate inventory tracking and secure storage are mandatory for all medications.
Record-Keeping
Records must comply with Texas state and federal laws, including HIPAA compliance.
Dispensing Standards
Labels must include patient name, prescribing physician, dosage, and detailed usage instructions.
Controlled Substances
DEA registration and reporting to Texas’s PMP (PMP AWARxE) are mandatory for controlled substances.
Billing and Reimbursement
Billing practices must comply with Texas-specific and federal anti-kickback statutes.
Federal Compliance
Compliance with FDA, DEA, and OSHA standards is required for dispensing medications.
State Pharmacy Laws
Physicians must comply with Texas Medical Board regulations for controlled substances dispensing.
Patient Consent
Patient consent is required before dispensing medications.
Insurance and Liability
Physicians must ensure malpractice insurance includes coverage for medication dispensing.
Training Requirements
Continuing education for compliance with Texas’s controlled substances regulations is required.
Audits and Inspections
Regular inspections are conducted by the Texas Medical Board and penalties for violations include fines and suspension.