Source: https://development.code.dccouncil.us/dc/council/code/sections/1-307.02.html
Timestamp: 2019-04-20 02:47:12+00:00

Document:
D.C. Law Library - § 1–307.02. District of Columbia medical assistance program.
↪ § 1–307.02. District of Columbia medical assistance program.
§ 1–307.01. District of Columbia student loan insurance program.
§ 1–307.02a. Minimum maintenance needs allowance for an institutionalize Medicaid beneficiary with a community spouse.
§ 1–307.02. District of Columbia medical assistance program.
(a)(1) The Mayor may submit, under title XIX of the Social Security Act (Title XIX) to the Secretary of the United States Department of Health and Human Services, a plan for medical assistance (and any modifications of the plan) to enable the District to receive federal financial assistance under Title XIX for a medical assistance program established by the Mayor under such plan.
(I) Reduce disallowances for public provider agencies.
(4) Review and approval by the Council of the fiscal year 2011 budget and financial plan shall constitute the Council review and approval required by paragraph (2) of this subsection of any waiver, modification to the state plan, or modification to a waiver required during fiscal year 2011 for purposes of implementing federal health care reform initiatives as set forth in the Patient Protection and Affordable Care Act, approved March 23, 2010 (124 Stat. 119; Pub. L. No. 111-148); provided, that the Department of Health Care Finance publishes a copy of any waiver, modification to the state plan, or modification to a waiver available on its website for at least 5 business days prior to submission to the Secretary of the United States Department of Health and Human Services.
(B) Any modification or waiver to the state plan required to change in whole or in part the level of personal-care services offered as a state plan benefit.
(D) Transition beneficiaries to the replenishing pharmacy network for antiretroviral medications.
(D) Implement an annual inflation rate adjustment for nursing facilities.
(G) Update transplantation coverage standards and provide coverage for lung transplantation and autologous bone marrow transplantation.
(G) Establish a supplemental payment to District Medicaid hospitals for outpatient services.
(B) Increase the number of participants in the Home and Community-Based Services Waiver for Persons with Intellectual and Developmental Disabilities program.
(F) Make changes to mental health rehabilitation services.
(B) Prescribe criteria which would permit an individual or family to be eligible for such assistance if such individual or family would be ineligible, solely by reason of his or its resources, for medical assistance both under the plan of the State of Maryland approved under Title XIX of the Social Security Act and under the plan of the State of Virginia approved under such title.
(C) During any of the first 4 calendar quarters in which medical assistance is provided under such plan there shall be deemed to be no Title XIX maximum income levels in effect if the Title XIX maximum income levels in effect during such quarter are higher than the Mayor’s maximum income levels for the local medical assistance program.
(3) A pregnant woman or a child during a presumptive eligibility period as authorized by § 1902(a) of the Social Security Act, approved July 30, 1965 (79 Stat. 343; 42 U.S.C. § 1396a(a)).
(A) “TANF-related Medicaid recipient” means a family that has dependent children under 21 years of age in the home and whose income is not low enough to qualify for financial assistance, but is low enough to qualify for medical assistance.
(B) “Health maintenance organization” means a public or private organization, operating in the District of Columbia, which contracts with the District government to provide comprehensive health maintenance, preventive and treatment services emphasizing access to primary care for enrolled members of the plan through its own network of physicians and hospitals for a fixed prepaid premium.
(C) “Managed care provider” means either a primary care provider or a health maintenance organization.
(D) “Primary care provider” means a physician, clinic, hospital, or neighborhood health center that is responsible for providing primary care and coordinating referrals, when necessary, to other health care providers.
(E) “Restricted recipient” means a person who has been restricted to one designated primary care provider for a minimum of one year after a finding of abuse or misuse of Medicaid services by the Commission on Health Care Financing.
(C) The Mayor shall assign any TANF and TANF-related Medicaid recipient who does not choose a provider within a reasonable time to a health maintenance organization described in subparagraph (A) of this paragraph.
(E) TANF and TANF-related Medicaid recipients enrolled in a managed care program shall be exempted from any additional co-payment requirements other than those imposed by the Medicaid program.
(F) The Mayor shall develop an education program to fully inform TANF and TANF-related Medicaid recipients about the various managed care programs to ensure better care for recipients while avoiding unnecessary and inappropriate use of hospital based services for preventive and primary care.
(B) Have a written contract with the District government which provides detailed information regarding the responsibilities of the managed care provider and the District government for providing or arranging for the provision of, and making payment for all services to which the TANF and TANF-related Medicaid recipient is entitled under the District state Medicaid plan.
(4) The Mayor shall maintain a grievance and appeal process for TANF and TANF-related Medicaid recipients enrolled in a managed care program.
(5) The Mayor shall require that managed care providers, which receive a capitated method of payment, submit adequate assurances to protect the District government against risk in case a provider becomes insolvent.
(B) Seek and obtain all necessary waivers of federal Medicaid statutes, rules and regulations.
(7) The Mayor shall submit to the Council on an annual basis an assessment of the cost effectiveness of the managed care plan and its impact on the TANF and TANF-related Medicaid recipient’s access to care of adequate quality.
(e)(1) The District state plan required under Title XIX of the Social Security Act, approved July 30, 1965 (79 Stat. 343; 42 U.S.C. § 1396 et seq.), may provide for reimbursement of chiropractic services.
(2) The Mayor may develop and implement a reimbursement methodology for chiropractic services.
This section is referenced in § 4-204.12, § 4-204.52, § 4-204.61, § 4-801, § 7-761.02, § 7-1131.02, § 7-1811.03, § 44-631, § 44-651, § 47-1261, and § 47-1270.
Section 2204 of D.C. Law 13-38 provided that the Mayor shall issue rules to implement the provisions of the act.
“Sec. 3902. The Medical Assistance Administration (‘MAA’) shall work closely with all District agencies and the Budget Director of the Council of the District of Columbia, in establishing Medicaid rates and Medicaid waiver programs to maximize Federal dollars as a means of reimbursement for services provided by District of Columbia agencies.
D.C. Law 16-305, in subsec. (d)(2)(B)(i), substituted “persons with mental retardation” for “the mentally retarded”.
D.C. Law 18-111 added subsec. (a)(3).
D.C. Law 18-223 added subsec. (a)(4).
D.C. Law 19-21 added subsec. (a)(5).
The 2012 amendment by D.C. Law 19-168 added (a)(6).
The 2012 amendment by D.C. Law 19-169 substituted “intellectual or developmental disabilities” for “mental retardation” in (d)(2)(B)(i).
The 2013 amendment by D.C. Law 20-61 added (a)(7).
The 2015 amendment by D.C. Law 20-155 added (a)(8) and (e).
The 2015 amendment by D.C. Law 20-225 would have added (f).
The 2015 amendment by D.C. Law 21-36 added (a)(9).
Medicaid provider fraud prevention, “Medicaid program” defined, see § 4-801.
For temporary (90 days) amendment of this section, see § 5042 of Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017 (D.C. Act 22-167, Oct. 24, 2017, 64 DCR 10802).
For temporary (90 days) amendment of this section, see § 5042 of Fiscal Year 2018 Budget Support Emergency Act of 2017 (D.C. Act 22-104, July 20, 2017, 64 DCR 7032).
For temporary amendment of section, see § 5 of the Public Assistance Emergency Amendment Act of 1997 (D.C. Act 12-25, February 27, 1997, 44 DCR 1778), § 5 of the Public Assistance Legislative Review Emergency Amendment Act of 1997 (D.C. Act 12-77, May 27, 1997, 44 DCR 3181), and § 5 of the Public Assistance Emergency Amendment Act of 1998 (D.C. Act 12-306, March 20, 1998, 45 DCR 1900).
For temporary amendment of section, see § 2 of the TANF and TANF-Related Medicaid Managed Care Program Emergency Amendment Act of 1997 (D.C. Act 12-197, December 2, 1997, 44 DCR 7484), § 2 of the TANF-Related Medicaid Managed Care Program Technical Clarification Emergency Amendment Act of 1998 (D.C. Act 12-605, January 20, 1999, 46 DCR 1287), § 2 of the TANF and TANF-Related Medicaid Managed Care Program Legislative Review Emergency Amendment Act of 1998 (D.C. Act 12-501, November 10, 1998, 45 DCR 8123) and § 2 of the TANF and TANF-Related Medicaid Managed Care Program Congressional Review Emergency Amendment Act of 1999 (D.C. Act 13-5, February 8, 1999, 46 DCR 2294).
For temporary (90-day) amendment of section, see §§ 2204 and 2205 of the Service Improvement and Fiscal Year 2000 Budget Support Emergency Act of 1999 (D.C. Act 13-110, July 28, 1999, 46 DCR 6320).
For temporary (90-day) directive to Medical Assistance Administration to work with District agencies and the Council Budget Director to establish rates and programs to maximize Federal reimbursement dollars and to report to the Council on new agency programs participating in Medicaid, see §§ 3902 and 3903 of the Fiscal Year 2001 Budget Support Emergency Act of 2000 (D.C. Act 13-376, July 24, 2000, 47 DCR 6574).
For temporary (90 day) amendment of section, see §§ 3902 and 3903 of the Fiscal Year 2001 Budget Support Congressional Review Emergency Act of 2000 (D.C. Act 13-438, October 20, 2000, 47 DCR 8740).
For temporary (90 day) enactments, see §§ 5092, 5102 to 5104 of Fiscal Year 2007 Budget Support Emergency Act of 2006 (D.C. Act 16-477, August 8, 2006, 53 DCR 7068).
For temporary (90 day) enactments, see §§ 5092, 5102 to 5104 of Fiscal Year 2007 Budget Support Congressional Review Emergency Act of 2006 (D.C. Act 16-499, October 23, 2006, 53 DCR 8845).
For temporary (90 day) enactments, see §§ 5092, 5102 to 5104 of Fiscal Year 2007 Budget Support Congressional Review Emergency Act of 2007 (D.C. Act 17-1, January 16, 2007, 54 DCR 1165).
For temporary (90 day) amendment of section, see § 5002 of Fiscal Year 2010 Budget Support Emergency Act of 2009 (D.C. Act 18-187, August 26, 2009, 56 DCR 7374).
For temporary (90 day) amendment of section, see § 5031 of Fiscal Year 2010 Budget Support Second Emergency Act of 2009 (D.C. Act 18-207, October 15, 2009, 56 DCR 8234).
For temporary (90 day) amendment of section, see § 5031 of Fiscal Year Budget Support Congressional Review Emergency Amendment Act of 2009 (D.C. Act 18-260, January 4, 2010, 57 DCR 345).
For temporary (90 day) amendment of section, see § 5002 of Fiscal Year 2011 Budget Support Emergency Act of 2010 (D.C. Act 18-463, July 2, 2010, 57 DCR 6542).
For temporary (90 day) amendment of section, see § 5012 of Fiscal Year 2012 Budget Support Emergency Act of 2011 (D.C. Act 19-93, June 29, 2011, 58 DCR 5599).
For temporary (90 day) amendment of section, see § 5152 of Fiscal Year 2013 Budget Support Emergency Act of 2012 (D.C. Act 19-383, June 19, 2012, 59 DCR 7764).
For temporary (90 day) amendment of section, see § 5152 of Fiscal Year 2013 Budget Support Congressional Review Emergency Act of 2012 (D.C. Act 19-413, July 25, 2012, 59 DCR 9290).
For temporary (90 days) amendment of this section, see § 5042 of the Fiscal Year 2014 Budget Support Emergency Act of 2013 (D.C. Act 20-130, July 30, 2013, 60 DCR 11384, 20 DCSTAT 1827).
For temporary (90 days) amendment of this section, see § 5042 of the Fiscal Year 2014 Budget Support Congressional Review Emergency Act of 2013 (D.C. Act 20-204, October 17, 2013, 60 DCR 15341, 20 DCSTAT 2311).
For temporary (90 days) amendment of this section, see § 5022 of the Fiscal Year 2015 Budget Support Emergency Act of 2014 (D.C. Act 20-377, July 14, 2014, 61 DCR 7598, 20 STAT 3696).
For temporary (90 days) amendment of this section, see § 5022 of the Fiscal Year 2015 Budget Support Congressional Review Emergency Act of 2014 (D.C. Act 20-449, October 10, 2014, 61 DCR 10915, 20 STAT 4188).
For temporary (90 days) amendment of this section, see § 5022 of the Fiscal Year 2015 Budget Support Second Congressional Review Emergency Act of 2014 (D.C. Act 20-566, January 9, 2015, 62 DCR 884, 21 STAT 541).
For temporary (90 days) amendment of this section, see § 5022 of the Fiscal Year 2016 Budget Support Emergency Act of 2015 (D.C. Act 21-127, July 27, 2015, 62 DCR 10201).
For temporary (225 day) amendment of section, see § 501 of Multiyear Budget Spending Reduction and Support Temporary Act of 1995 (D.C. Law 10-253, March 23, 1995, law notification 42 DCR 1652).
For temporary (225 day) amendment of section, see § 5 of Public Assistance Temporary Amendment Act of 1997 (D.C. Law 12-7, August 1, 1997, law notification 44 DCR 4639).
For temporary (225 day) amendment of section, see § 2 of TANF and TANF-Related Medicaid Managed Care Program Temporary Amendment Act of 1997 (D.C. Law 12-70, April 29, 1998, law notification 45 DCR 2105).
For temporary (225 day) amendment of section, see § 5 of Public Assistance Temporary Amendment Act of 1998 (D.C. Law 12-130, July 24, 1998, law notification 45 DCR 6501).
For temporary (225 day) amendment of section, see § 2 of TANF-Related Medicaid Managed Care Program Technical Clarification Temporary Amendment Act of 1997 (D.C. Law 12-277, April 27, 1999, law notification 46 DCR 4283).
Short title: Section 5091 of D.C. Law 16-192 provided that subtitle I of title V of the act may be cited as the “Medicaid Enrollment and Expansion Act of 2006”.
Short title: Section 5101 of D.C. Law 16-192 provided that subtitle I of title V of the act may be cited as the “Medical Assistance Administration Reporting Requirements Act of 2006”.
Short title: Section 5030 of D.C. Law 18-111 provided that subtitle D of title V of the act may be cited as the “Medical Assistance Program Amendment Act of 2009”.
Short title: Section 5001 of D.C. Law 18-223 provided that subtitle A of title IV of the act may be cited as the “Medical Assistance Program Amendment Act of 2010”.
Short title: Section 5041 of D.C. Law 19-21 provided that subtitle E of title V of the act may be cited as “Medical Assistance Program Amendment Act of 2011”.
Section 5041 of D.C. Law 20-61 provided that Subtitle E of Title V of the act may be cited as the “Medical Assistance Program Amendment Act of 2013”.
“Title XIX of the Social Security Act,” referred to in this section, is codified as 42 U.S.C. § 1396 et seq.
Mayor authorized to issue rules: Section 3 of D.C. Law 9-247 provided that the Mayor shall issue rules necessary to implement subsection (d) of this section pursuant to subchapter I of Chapter 15 of Title 1.
“Sec. 5102. Non-Emergency Transportation Reform Report.
“(2) Quantify the potential savings from the measures described in paragraph (1) of this section.
“Sec. 5103. Out-of-state reimbursement report.
“(a) This act shall apply upon the date of inclusion of its fiscal effect in an approved budget and financial plan.
Delegation of authority under D.C. Law 9-247, the “Medicaid Managed Care Amendment Act of 1992”, see Mayor’s Order 93-218, December 1, 1993.
Resolution 14-520, the “Modification to the Medicaid Home and Community-Based Waiver for Individuals with Mental Retardation and Developmental Disabilities Emergency Approval Resolution of 2002”, was approved effective July 19, 2002.
Resolution 14-558, the “Medicaid State Plan Amendment for the Breast and Cervical Cancer Treatment Program Emergency Approval Resolution of 2002”, was approved effective September 27, 2002.
Resolution 15-295, the “Modification to the Medicaid Home and Community-based Waiver for Individuals with Mental Retardation and Developmental Disabilities Disapproval Resolution of 2003”, was approved effective November 4, 2003.
Resolution 15-784, the “Renewal of the Home and Community-based Services Waiver Governing Water Filters for Persons with HIV/AIDS Emergency Approval Resolution of 2004”, was approved effective December 7, 2004.
Resolution 16-108, the “Medicaid Home and Community-based Waiver for Persons with Mental Retardation and Developmental Disabilities Modification Governing Physical Therapy, Occupational Therapy, Speech Therapy and Skilled Nursing Services Approval Resolution of 2005”, was approved effective April 1, 2005.
Resolution 16-154, the “Use of less Restrictive Income and Resource Criteria for Selected Medicaid Populations Approval Resolution of 2005”, was approved effective May 6, 2005.
Resolution 16-205, the “Medicaid Preferred Drug List (PDL) Program for Pharmacy Services Approval Resolution of 2005”, was approved effective June 17, 2005.
Resolution 16-273, the “Medicaid State Plan Amendment to Raise the Federal Poverty Levels of Qualified Medicare Beneficiaries and Specified Low Income Medicare Beneficiaries Emergency Approval Resolution of 2005”, was approved effective July 6, 2005.
Resolution 16-281, the “Medicaid Case Mix Prescription Drugs Approval Resolution of 2005”, was approved effective July 8, 2005.
Resolution 16-282, the “Medicaid State Plan Amendment to Implement a Case Mix Nursing Facility Reimbursement System with a Ventilator Services Add-on Rate Approval Resolution of 2005”, was approved effective July 8, 2005.
Resolution 16-283, the “Medicaid State Plan Amendment and Waiver Instituting a Non-emergency Transportation Broker Delivery System Approval Resolution of 2005”, was approved effective July 22, 2005.
Resolution 16-284, the “Medicaid Acute Involuntary Admissions Payment State Plan Amendment Approval Resolution of 2005”, was approved effective July 22, 2005.
Resolution 16-285, the “Medicaid D.C. Coverage Initiative Health Insurance Flexibility and Accountability Waiver Approval Resolution of 2005”, was approved effective July 22, 2005.
Resolution 16-286, the “Medicaid State Plan Amendment Governing Liens and Adjustments or Recoveries Approval Resolution of 2005”, was approved effective August 6, 2005.
Resolution 16-296, the “Medicaid State Plan Amendment Ensuring Compliance with the Low Income Subsidy Provisions of the Medicare Modernization Act Emergency Approval Resolution of 2005”, was approved effective September 20, 2005.
Resolution 16-354, the “Demonstration Waiver for Medicaid and State Children’s Health Insurance Program Coverage for Evacuees of Hurricane Katrina Residing in the District of Columbia Emergency Approval Resolution of 2005”, was approved effective November 1, 2005.
Resolution 16-478, the “Medicaid School-Based Health Services Approval Resolution of 2006”, was approved effective January 20, 2006.
Resolution 16-580, the “Medicaid State Plan Amendment for Managed Care Compliance with the Medicare Modernization Act Emergency Approval Resolution of 2006”, was approved effective March 7, 2006.
Resolution 16-785, the “Medicaid Reserved Bed Days Payment Modification Approval Resolution of 2006”, was approved effective August 11, 2006.
Resolution 16-786, the “Medicaid Maximum Allowable Cost State Plan Amendment Approval Resolution of 2006”, was approved effective August 11, 2006.
Resolution 16-787, the “Modification to the Medicaid Disproportionate Share Hospital Payment Methodology State Plan Amendment Approval Resolution of 2006”, was approved effective August 11, 2006.
Resolution 16-875, the “Expansion of Adult Dental Services Emergency Approval Resolution of 2006”, was approved effective November 14, 2006.
Resolution 16-877, the “Determination of Eligibility for Qualified Medicare Beneficiaries Emergency Approval Resolution of 2006”, was approved effective November 14, 2006.
Resolution 16-879, the “Expansion of Allowable Income for Determination of State Child Health Insurance Program Eligibility Emergency Approval Resolution of 2006”, was approved effective November 14, 2006.
Resolution 16-958, the “Disqualification for Medicaid Long-Term Care Assistance for Individuals with Substantial Home Equity Interest Approval Resolution of 2006”, was approved effective December 15, 2006.
Resolution 16-959, the “Medicaid Elderly and Persons with Physical Disabilities Waiver Renewal Application Approval Resolution of 2006”, was approved effective December 15, 2006.

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