Utah
LLC
Website link to register:
https://corporations.utah.gov/
Naming conventions
Cannot imply unlawful activities or government affiliations. Must include “Limited Liability Company,” “LLC,” or “L.L.C.” PLLC designation applies to medical offices.
Licensing Requirements
Medical licenses must be issued by the Utah Division of Occupational and Professional Licensing (DOPL). Proof of malpractice insurance required. Certification for telemedicine practices may apply.
Required documentation for medical practices
Articles of Organization, Diagnostic & Surgical Permits, Professional Licenses, Malpractice Insurance
Filing Fee: $70
Annual/Biennial Fee: $20
Additional Notes: Annual renewal fee due on LLC anniversary date.
Medicaid
Program Name: Utah Medicaid
Official Website: http://medicaid.utah.gov
Legislation: Utah passed SB 0084 in 2020, 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
Utah Medicaid provides health coverage to eligible low-income residents through Medicaid and CHIP programs.
Notification Requirements
Notification required for Medicaid patients under private contracts.
Provider Enrollment Requirements
Providers must enroll with Utah 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 serve 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 pre-agreed terms.
CMS Guidance
CMS guidance highlights enrollment pathways for non-billing providers.
Opportunities for Collaboration
Opportunities may exist to collaborate with Medicaid Managed Care Organizations (MCOs) or state healthcare programs aimed at improving care delivery.
State-Specific Notes
Collaboration opportunities exist with Utah Medicaid Managed Care Organizations for primary care expansion.
Dispensing Medication
Board of Pharmacy Official Link: https://dopl.utah.gov/pharmacy/
State Licensing
Physicians must register with the Utah Department of Commerce’s Division of Occupational and Professional Licensing (DOPL).
Scope of Practice
Physicians may dispense medications directly; controlled substances require additional registration and compliance.
Inventory Management
Maintain accurate inventory logs and secure storage for all dispensed medications.
Record-Keeping
Records must comply with Utah state and federal HIPAA standards.
Dispensing Standards
Labels must meet Utah Board of Pharmacy standards, including prescribing details, patient name, and dosage.
Controlled Substances
DEA registration and reporting to Utah’s Controlled Substances Database (CSD) are mandatory for controlled substances.
Billing and Reimbursement
Billing practices must comply with Utah-specific regulations and federal anti-kickback statutes.
Federal Compliance
Adherence to FDA, DEA, and OSHA standards is mandatory for dispensing medications.
State Pharmacy Laws
Physicians must comply with Utah Board of Pharmacy regulations for dispensing controlled substances.
Patient Consent
Informed consent is required prior to dispensing any medications.
Insurance and Liability
Physicians must ensure liability insurance explicitly covers dispensing activities.
Training Requirements
Continuing education is encouraged for compliance with Utah’s controlled substances regulations.
Audits and Inspections
Inspections by the Utah Division of Occupational and Professional Licensing ensure compliance, with penalties for non-compliance.