Wisconsin
LLC
Website link to register:
https://www.wdfi.org/corporations
Naming conventions
Must not mislead the public about the LLC’s purpose.
Must include “Limited Liability Company,” “LLC,” or “L.L.C.” PLLCs required for professional services.
Licensing Requirements
Medical licenses must be approved by the Wisconsin Medical Examining Board.
Proof of malpractice insurance required. Compliance with Wisconsin Department of Health Services standards is mandatory.
Required documentation for medical practices
Articles of Organization, Professional Licenses, Malpractice Insurance, Facility Permits
Filing Fee: $130
Annual/Biennial Fee: $25
Additional Notes: Annual report due on LLC anniversary date.
Medicaid
Program Name: Wisconsin Medicaid
Official Website: http://dhs.wisconsin.gov/medicaid
Legislation: Wisconsin does not have specific DPC legislation; practices operate under general healthcare and insurance laws.
Private Contracting
Permitted; DPC practices should ensure compliance with state insurance regulations to avoid being classified as insurers.
Restrictions
No explicit restrictions for DPC providers; compliance with federal and state regulations is required.
Medicaid Program
Wisconsin Medicaid provides health coverage to eligible low-income residents through BadgerCare and other programs.
Notification Requirements
Notification strongly recommended for Medicaid patient clarity.
Provider Enrollment Requirements
Providers must enroll with Wisconsin 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 unless explicitly outlined.
CMS Guidance
CMS supports innovative approaches to Medicaid delivery.
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 Wisconsin Medicaid Managed Care Organizations for primary care innovation.
Dispensing Medication
Board of Pharmacy Official Link: https://dsps.wi.gov/Pages/Professions/Pharmacy/default.aspx
State Licensing
Physicians must register with the Wisconsin Department of Safety and Professional Services for controlled substances.
Scope of Practice
Dispensing medications is allowed for both non-controlled and controlled substances under Wisconsin law.
Inventory Management
Secure storage and accurate inventory tracking are required for all medications.
Record-Keeping
Records must comply with Wisconsin state laws and federal HIPAA regulations.
Dispensing Standards
Labels must meet Wisconsin Board of Pharmacy standards, including patient and prescriber details.
Controlled Substances
DEA registration and reporting to Wisconsin’s PMP are mandatory for controlled substances.
Billing and Reimbursement
Physicians must comply with Wisconsin-specific billing regulations and federal anti-kickback statutes.
Federal Compliance
Adherence to FDA, DEA, and OSHA standards is required for dispensing medications.
State Pharmacy Laws
Physicians must comply with Wisconsin Board of Pharmacy laws for dispensing controlled substances.
Patient Consent
Informed consent must be obtained prior to dispensing medications.
Insurance and Liability
Physicians must ensure malpractice insurance explicitly covers medication dispensing risks.
Training Requirements
Continuing education is encouraged for compliance with Wisconsin controlled substances laws.
Audits and Inspections
Inspections are conducted by the Wisconsin Department of Safety and Professional Services to ensure compliance, with penalties for violations.