Washington
LLC
Website link to register:
https://ccfs.sos.wa.gov/
Naming conventions
Cannot use restricted words without state approval; PLLC names must reflect the service offered. Must include “Limited Liability Company,” “LLC,” or “L.L.C.” PLLC required for medical practices.
Licensing Requirements
All members must hold valid licenses from the Washington Medical Commission. Proof of malpractice insurance required. Comply with Washington State Department of Health facility standards.
Required documentation for medical practices
Articles of Organization, Wisconsin Health Services Compliance, Professional Licenses, Malpractice Insurance
Filing Fee: $200
Annual/Biennial Fee: $60
Additional Notes: Annual report due on LLC anniversary date.
Medicaid
Program Name: Washington Apple Health
Official Website: http://hca.wa.gov/health-care-services-supports/apple-health-medicaid-coverage
Legislation: Washington passed SB 5322 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
Washington Medicaid, known as Apple Health, provides health coverage to eligible low-income residents.
Notification Requirements
Notification required if Medicaid patients are not accepted for services.
Provider Enrollment Requirements
Providers must enroll with Apple Health 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 documented consent.
CMS Guidance
CMS supports innovative primary care models through managed care frameworks.
Opportunities for Collaboration
Opportunities may exist to collaborate with Medicaid Managed Care Organizations (MCOs) or state healthcare programs aimed at innovative care delivery.
State-Specific Notes
Collaboration opportunities exist with Washington Medicaid Managed Care Organizations for primary care innovation.
Dispensing Medication
Board of Pharmacy Official Link:
https://doh.wa.gov/licenses-permits-and-certificates/professions-new-renew-or-update/pharmacy-commission
State Licensing
Physicians must register with the Washington State Department of Health for controlled substances dispensing.
Scope of Practice
Dispensing medications is allowed under state law; controlled substances require DEA registration.
Inventory Management
Maintain secure storage and detailed inventory logs for all dispensed medications.
Record-Keeping
Records must comply with Washington state laws and federal HIPAA standards.
Dispensing Standards
Labels must meet Washington State Board of Pharmacy standards, including patient name, prescriber details, and dosage.
Controlled Substances
DEA registration and reporting to Washington’s PMP are mandatory for controlled substances.
Billing and Reimbursement
Billing practices must comply with Washington-specific regulations and federal anti-kickback laws.
Federal Compliance
Adherence to FDA, DEA, and OSHA standards is required for dispensing medications.
State Pharmacy Laws
Physicians must comply with Washington Board of Pharmacy regulations for dispensing controlled substances.
Patient Consent
Informed patient consent is required prior to dispensing medications.
Insurance and Liability
Physicians must ensure malpractice insurance includes coverage for dispensing risks.
Training Requirements
Continuing education is encouraged for compliance with Washington’s controlled substances regulations.
Audits and Inspections
Inspections by the Washington State Department of Health ensure compliance, with penalties for violations.