Virginia
LLC
Website link to register:
https://cis.scc.virginia.gov/
Naming conventions
PLLC names must include the professional designation, such as “Medical PLLC.” Must include “Limited Liability Company,” “LLC,” or “L.L.C.” PLLCs required for licensed professionals.
Licensing Requirements
Licenses must be validated by the Virginia Board of Medicine. Malpractice insurance required. Specialized permits for surgical or diagnostic facilities may be necessary.
Required documentation for medical practices
Articles of Organization, Advanced Diagnostic Permits, Professional Licenses, Malpractice Insurance
Filing Fee: $100
Annual/Biennial Fee: $50
Additional Notes: Annual report due on LLC anniversary date.
Medicaid
Program Name: Virginia Medicaid
Official Website: http://coverva.org
Legislation: Virginia passed HB 2053 in 2017, 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
Virginia 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 Virginia 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 without documented consent.
CMS Guidance
CMS supports enrollment pathways for "Ordering and Referring Only" providers.
Opportunities for Collaboration
Opportunities may exist to collaborate with Medicaid Managed Care Organizations (MCOs) or state healthcare initiatives aimed at increasing access to primary care.
State-Specific Notes
Collaboration opportunities exist with Virginia Medicaid Managed Care Organizations for primary care expansion.
Dispensing Medication
Board of Pharmacy Official Link: https://www.dhp.virginia.gov/pharmacy/
State Licensing
Physicians must register with the Virginia Board of Pharmacy to dispense controlled substances.
Scope of Practice
Physicians may dispense medications directly under Virginia law; additional DEA registration is required for controlled substances.
Inventory Management
Maintain detailed inventory logs and secure storage for all medications.
Record-Keeping
Records must adhere to Virginia state laws and federal HIPAA regulations.
Dispensing Standards
Labels must meet Virginia Board of Pharmacy standards, including patient and prescriber details.
Controlled Substances
DEA registration and reporting to Virginia’s PMP are mandatory for controlled substances.
Billing and Reimbursement
Physicians must comply with Virginia-specific billing regulations and federal anti-kickback statutes.
Federal Compliance
Compliance with FDA, DEA, and OSHA standards is mandatory for dispensing medications.
State Pharmacy Laws
Physicians must adhere to Virginia Board of Pharmacy laws for dispensing controlled substances.
Patient Consent
Patient consent is required before dispensing medications.
Insurance and Liability
Physicians must ensure liability insurance covers risks associated with medication dispensing.
Training Requirements
Continuing education for compliance with Virginia controlled substances laws is encouraged.
Audits and Inspections
Regular inspections are conducted by the Virginia Board of Pharmacy, with penalties for non-compliance.