West Virginia
LLC
Website link to register:
https://business4.wv.gov/startmybusiness/Pages/Register-Your-Business.aspx
Naming conventions
PLLC names must include the professional service designation. Must include “Limited Liability Company,” “LLC,” or “L.L.C.” PLLCs must use “Professional LLC.”
Licensing Requirements
Submit proof of licensure from the West Virginia Board of Medicine. Malpractice insurance mandatory. Certification for diagnostic equipment, such as CT scanners, may be required.
Required documentation for medical practices
Articles of Organization, Telemedicine Permits, Professional Licenses, Malpractice Insurance
Filing Fee: $100
Annual/Biennial Fee: $25
Additional Notes: Annual report due by June 30.
Medicaid
Program Name: West Virginia Medicaid
Official Website: http://dhhr.wv.gov/bms
Legislation: West Virginia passed HB 2301 in 2019, 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
West 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 West 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 serve 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 pre-agreed terms.
CMS Guidance
CMS supports enrollment pathways for non-billing providers.
Opportunities for Collaboration
Opportunities may exist to collaborate with Medicaid Managed Care Organizations (MCOs) or state programs aimed at expanding access to primary care.
State-Specific Notes
Collaboration opportunities exist with West Virginia Medicaid Managed Care Organizations for primary care integration.
Dispensing Medication
Board of Pharmacy Official Link: https://www.wvbop.com/
State Licensing
Physicians must register with the West Virginia Board of Pharmacy for dispensing controlled substances.
Scope of Practice
Direct dispensing is allowed for non-controlled and controlled substances within the scope of practice.
Inventory Management
Maintain secure storage and detailed inventory tracking for all medications dispensed.
Record-Keeping
Records must comply with West Virginia state and federal laws, including HIPAA compliance.
Dispensing Standards
Labels must include prescribing physician, patient name, dosage, and usage instructions.
Controlled Substances
DEA registration and reporting to West Virginia’s PMP are mandatory for controlled substances.
Billing and Reimbursement
Physicians must comply with West Virginia-specific billing practices and federal Stark Law regulations.
Federal Compliance
Compliance with FDA, DEA, and OSHA standards is mandatory for dispensing medications.
State Pharmacy Laws
Physicians must adhere to West Virginia Board of Pharmacy regulations for controlled substances dispensing.
Patient Consent
Patient consent must be obtained prior to dispensing medications.
Insurance and Liability
Liability insurance must include coverage for risks associated with dispensing activities.
Training Requirements
Continuing education is encouraged for compliance with West Virginia’s controlled substances laws.
Audits and Inspections
Regular inspections are conducted by the West Virginia Board of Pharmacy, with penalties for violations.