reglab/housing_qa huggingface dataset:
DC Code § 31-3175.05 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31E - Health Benefits Plans Behavioral Health Parity|§ 31-3175.05. Medicaid coverage for medication-assisted treatment

Medicaid shall provide coverage for medication-assisted treatment prescribed for the treatment of substance use disorders; provided, that medication assisted treatment covered in accordance with this section shall not be subject to: (1) Utilization control, other than those processes specified by the American Society of Addiction Medicine; (2) Prior authorization; (3) Step therapy; or (4) Lifetime restriction limits.  (Mar. 13, 2019, D.C. Law 22-242, § 6, 66 DCR 930.)
DC Code § 31-3175.06 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31E - Health Benefits Plans Behavioral Health Parity|§ 31-3175.06. Rules

The Mayor, pursuant to subchapter I of Chapter 5 of Title 2, may issue rules to implement the provisions of this chapter.  (Mar. 13, 2019, D.C. Law 22-242, § 7, 66 DCR 930.)
DC Code § 31-3272 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 32A - Health Insurance Coverage for Habilitative Services for Children|§ 31-3272. Coverage, notice, applicability, and regulations

(a) A health insurer shall: (1) Provide coverage of habilitative services for children under the age of 21 years and may do so through a managed care system; (2) Not be required to provide reimbursement for habilitative services actually delivered through early intervention or school services; and (3) Provide notice to its insureds and enrollees about the coverage required under this chapter. (b) The coverage shall not be more restrictive than coverage provided for any other illness, condition, or disorder for purposes of determining deductibles, benefit year or lifetime durational limits, benefit year or lifetime dollar limits, lifetime episodes or treatment limits, copayment and coinsuance factors, and benefit year maximum for deductibles and copayments and coinsurance factors. (c) The Commissioner may issue rules and regulations necessary to implement the provisions of this chapter. (d) This chapter shall apply to all individual and group health benefit plans issued or renewed on the first day of the month beginning on or after 90 days following March 2, 2007.  (Mar. 2, 2007, D.C. Law 16-198, § 3, 53 DCR 8829.)
DC Code § 31-3311.03 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 33A - Health Insurance Ratemaking|§ 31-3311.03. Loss ratio disclosure

Policies, certificates, and marketing materials shall prominently display medical loss ratio disclosure, as defined by rule.  (Apr. 8, 2011, D.C. Law 18-360, § 104, 58 DCR 896.)
DC Code § 31-3311.03a (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 33A - Health Insurance Ratemaking|§ 31-3311.03a. Essential health benefits

(a) Consistent with federal law, the Commissioner, with the approval of the Executive Board of the Health Benefit Exchange Authority, shall, by rule, select the benchmark plan for the individual and small group market for purposes of establishing the essential health benefits in the District pursuant to section 1302 of the Affordable Care Act. (b) If the essential health benefits benchmark plan for the individual and small group market does not include all of the benefit categories specified by section 1302 of the Affordable Care Act, or a need exists to add additional benefits, the Commissioner, with the approval of the Executive Board of the Health Benefit Exchange Authority, may, by rule, supplement the benchmark plan benefits as needed so long as the benchmark plan meets the minimum requirements of section 1302 of the Affordable Care Act. (c)(1) A health plan offering the required essential health benefits for the individual and small group markets, other than a health plan offered through the federal basic health program or Medicaid, may not be offered in the District unless the Commissioner determines that it is substantially equal to the benchmark plan. (2) When making this determination, the Commissioner shall: (A) Ensure that the plan covers the essential health benefits categories specified in section 1302 of the Affordable Care Act; and (B) Consider whether the health plan has a benefit design that would create a risk of biased selection based on health status and whether the health plan contains meaningful scope and level of benefits in each of the 10 essential health benefit categories specified by section 1302 of Affordable Care Act. (d)(1) Except as provided in paragraph (2) of this subsection, notwithstanding any other provision of benefits mandated by District law, the benchmark plan adopted by the Commissioner shall be the benefits required in all health benefit plans offered in the individual and small group markets. (2) Grandfathered health plans, as defined in section 1251 of the Affordable Care Act, shall be exempt from complying with the requirements of the benchmark plan.  (April 8, 2011, D.C. Law 18-360, § 104a; as added May 2, 2015, D.C. Law 20-265, § 104(b), 62 DCR 1529.)
DC Code § 31-3311.03b (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 33A - Health Insurance Ratemaking|§ 31-3311.03b. Underwriting ratemaking criteria

(a) To implement section 1201 of the Affordable Care Act, the Commissioner, with the approval of the Executive Board of the Health Benefit Exchange Authority, shall have the authority to establish by rule: (1) The geographic rating area for the District; (2) The age rating or curve; and (3) The rating for tobacco uses. (b) The Commissioner’s authority to implement subsection (a) of this section shall be accomplished in a manner that is not inconsistent with, or would prevent the application of, the Affordable Care Act and its implementing regulations. In exercising the authority under subsection (a) of this section, the Commissioner may provide consumer protections and benefits that exceed those provided in the Affordable Care Act. (c) Health insurers are required to merge their experience in the individual and group markets for purposes of setting health insurance rates.  (April 8, 2011, D.C. Law 18-360, § 104b; as added May 2, 2015, D.C. Law 20-265, § 104(b), 62 DCR 1529.)
DC Code § 31-3311.04 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 33A - Health Insurance Ratemaking|§ 31-3311.04. Annual rate filing requirement

All insurers subject to this chapter shall file annually its rates, rating schedule, and supporting documentation, including ratios of incurred losses to earned premiums by policy form or certificate form, for approval by the Commissioner. The supporting documentation shall demonstrate, in accordance with actuarial principles and standards, using reasonable assumptions, that the appropriate medical loss ratio standards can be expected to be met over the entire period for which rates are computed and that insurer is in compliance with the ratemaking principles of this chapter. If the data submitted does not confirm that the insurer has satisfied the requirements of this chapter, the Commissioner shall notify the insurer in writing of the deficiency within 30 business days of the date that the data is submitted. The insurer shall have 30 days after the date of the Commissioner’s notice to file amended rates that comply with this chapter. If the insurer fails to file amended rates within the 30-day period, the Commissioner shall order that the insurer’s filed rates for the nonconforming policies and certificates be reduced to an amount that would bring the rates into compliance with this chapter. Upon request of the insurer and before any order or notice issued pursuant to this section becomes final, the Commissioner shall hold a hearing upon not less than 10 business days’ written notice to the insurer specifying the matters to be considered at the hearing. The insurer’s failure to file amended rates within the specified time or the issuance of the Commissioner’s order amending the rates shall not preclude the insurer from filing an amendment of its rates at a later time.  (Apr. 8, 2011, D.C. Law 18-360, § 105, 58 DCR 896.)
DC Code § 31-3311.05 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 33A - Health Insurance Ratemaking|§ 31-3311.05. Commissioner’s authority to rescind approved rates

(a) The Commissioner may, at any time, require any insurer subject to this chapter to demonstrate that its rates and method for setting rates are in compliance with this chapter, notwithstanding that the filings then in effect had previously been approved. Any rates previously approved by the Commissioner, but subsequently disapproved under this chapter, shall be considered disapproved on a prospective basis only from the date of the notice of disapproval, unless the insurer made a material misrepresentation in its contract form or rate filings, in which case the rates shall be deemed disapproved on a retroactive basis. (b) If, at any time subsequent to the approval of rates, the Commissioner finds that a filing does not meet the requirements of this chapter, the Commissioner shall issue an order to the insurer specifying why the filing fails to meet the requirements of this chapter, and, stating when, within a reasonable period thereafter, the filing shall be no longer effective. The order shall not affect any subscriber contract, group certificate, or other contract made or issued prior to the expiration of the period set forth in the order. The Commissioner may, prior to issuing the order and if requested by the insurer, hold a hearing upon not less than 10 business days’ written notice to the insurer specifying the matters to be considered at the hearing. (c) For violations of this chapter, the Commissioner may order any relief which is appropriate, including disapproving a rate and awarding interest.  (Apr. 8, 2011, D.C. Law 18-360, § 106, 58 DCR 896; Sept. 26, 2012, D.C. Law 19-171, § 85(b), 59 DCR 6190.)  Effect of Amendments The 2012 amendment by D.C. Law 19-171 substituted “this title” for “this act” [translated as “this chapter”] in (b). References in Text This act, referred to in subsec. (b), is D.C. Law 18-360, the Reasonable Health Insurance Ratemaking and Health Care Reform Act of 2010.
DC Code § 31-3311.06 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 33A - Health Insurance Ratemaking|§ 31-3311.06. Post-claims underwriting and prior approval for rescission, cancellation, or limitation

(a) An insurer shall not rescind an enrollee’s plan or coverage once the enrollee is covered under the plan or coverage involved; provided, that this section shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage. The plan or coverage shall not be cancelled without prior notice to the Commissioner as required by subsection (b) of this section and prior notice to the consumer and an opportunity to appeal as required by the Patient Protection and Affordable Care Act, approved March 23, 2010 (124 Stat. 109; scattered sections of the United States Code). (b) A health carrier shall provide at least 30 days advance written notice to each plan enrollee, or for individual health insurance coverage, primary subscriber, who would be affected by the proposed rescission of coverage before coverage under the plan may be rescinded in accordance with subsection (a) of this section regardless of, in the case of group or only to an individual within the group. The notice shall explain the reason for the rescission, procedures of appealing, and how to contact the Health Care Ombudsman and the Department of Insurance, Securities, and Banking for further information. (c) Prior to rescinding the enrollee’s plan or coverage, the insurer shall provide to the Commissioner documentation to support the rescission and the Commissioner shall have 5 business days following receipt of the proposed rescission and supporting documentation to review the documentation to determine if the insurer is complying with the requirements of subsection (a) of this section. The insurer may rescind the plan or coverage after the end of the 5-day period of review unless the Commissioner objects or disapproves the proposed rescission within the 5-day period.  (Apr. 8, 2011, D.C. Law 18-360, § 107, 58 DCR 896.)
DC Code § 31-3311.07 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 33A - Health Insurance Ratemaking|§ 31-3311.07. Public records

The Commissioner shall, as soon as practicable, make all rate filings, including all supporting documentation, amended filings, and reports filed pursuant to this chapter, available for public inspection either at the Department of Insurance, Securities, and Banking or on its website.  (Apr. 8, 2011, D.C. Law 18-360, § 108, 58 DCR 896.)
DC Code § 31-3311.08 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 33A - Health Insurance Ratemaking|§ 31-3311.08. Annual report and recommendations

On June 1, 2011, and every year thereafter, the Commissioner shall report to the Council any significant National Association of Insurance Commissioners adoptions related to health care reform, including medical loss ratios and loss ratio disclosure, and any recommendations if the District law differs.  (Apr. 8, 2011, D.C. Law 18-360, § 109, 58 DCR 896.)
DC Code § 31-3311.09 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 33A - Health Insurance Ratemaking|§ 31-3311.09. Rules

The Mayor, pursuant to subchapter I of Chapter 5 of Title 2 [§ 2-501 et seq.], shall issue rules to implement the provisions of this chapter.  (Apr. 8, 2011, D.C. Law 18-360, § 110, 58 DCR 896.)
DC Code § 31-3311.10 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 33A - Health Insurance Ratemaking|§ 31-3311.10. Application

(a) This chapter shall apply to policies and certificates of insurance that are health benefit plans as defined under § 31-3271(4) that are issued 90 days after April 8, 2011. This chapter shall not apply to short-term limited duration health benefit plans. (b) Small group market requirements under this chapter shall apply to a health benefit plan offered by a multiple employer welfare arrangement, including an association or any other entity, if the plan covers an employee of a small employer, as that term is defined in§ 31-3301.01(42), in the District. (c) Individual market requirements under this chapter shall apply to a health benefit plan offered by a multiple employer welfare arrangement, including an association or any other entity, if the plan covers an individual in the District who is not an employee or dependent of a participating employer.  (Apr. 8, 2011, D.C. Law 18-360, § 111, 58 DCR 896; Mar. 22, 2019, D.C. Law 22-266, § 3(a), 66 DCR 1423.)  Emergency Legislation  For temporary (90 days) amendment of this section, see § 3(a) of Health Insurance Marketplace Improvement Emergency Amendment Act of 2018 (D.C. Act 22-526, Dec. 10, 2018, 65 DCR 13424).  Temporary Legislation  For temporary (225 days) amendment of this section, see § 3(a) of Health Insurance Marketplace Improvement Temporary Amendment Act of 2018 (D.C. Law 22-251, Mar. 15, 2019, 66 DCR 975).
DC Code § 31-3311.11 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 33A - Health Insurance Ratemaking|§ 31-3311.11. Definitions

For the purposes of this chapter, the term: (1) “Affordable Care Act” means the Patient Protection and Affordable Care Act approved March 23, 2010 (124 Stat. 111; 42 U.S.C. § 18001, note), as the law and its implementing regulations were in effect on December 15, 2017. (2) “Commissioner” means the Commissioner of the Department of Insurance, Securities, and Banking established by Chapter 1 of this title [§ 31-101 et seq.].  (April 8, 2011. D.C. Law 18-360, § 112; as added May 2, 2015, D.C. Law 20-265, § 104(c), 62 DCR 1529; Mar. 22, 2019, D.C. Law 22-266, § 3(b), 66 DCR 1423.)  Emergency Legislation  For temporary (90 days) amendment of this section, see § 3(b) of Health Insurance Marketplace Improvement Emergency Amendment Act of 2018 (D.C. Act 22-526, Dec. 10, 2018, 65 DCR 13424).  Temporary Legislation  For temporary (225 days) amendment of this section, see § 3(b) of Health Insurance Marketplace Improvement Temporary Amendment Act of 2018 (D.C. Law 22-251, Mar. 15, 2019, 66 DCR 975).
DC Code § 31-3404 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3404. Powers of health maintenance organizations

(a) The powers of a health maintenance organization include, but are not limited to, the following: (1) The purchase, lease, construction, renovation, operation, or maintenance of hospitals, medical facilities, or both, and their ancillary equipment, and such property and equipment as may reasonably be required for its principal office or for such purposes as may be necessary in the transaction of the business of the organization; (2) Transactions between affiliated entities, including loans and the transfer of responsibility under all contracts (provider, enrollee, etc.) between affiliates or between the health maintenance organization and its parent; (3) The furnishing of health care services through providers, provider associations, or agents for providers which are under contract with or employed by the health maintenance organization; (4) The contracting with any person for the performance on its behalf of certain functions, such as marketing, enrollment, and administration; (5) The contracting with an insurance company, including Group Hospitalization and Medical Service, Inc., licensed in the District for the provision of insurance, indemnity, or reimbursement against the cost of covered services provided by the health maintenance organization or with optometry services, podiatry services, dental services, pharmaceutical service plans, and other entities authorized to do business in the District for the provision of supplemental health services; (6) The joint marketing of products with an insurance company authorized to do business in the District as long as the company that is offering each product is clearly identified; and (7) Entering into administrative service provider contracts with contracting providers whereby covered services are rendered to enrollees by external providers who have entered into contracts with the contracting provider. (b) A health maintenance organization shall file notice, with adequate supporting information, with the Commissioner prior to the exercise of any power granted in subsection (a)(1), (2), or (4) of this section which may affect the financial soundness of the health maintenance organization. The Commissioner shall disapprove such exercise of power only if the Commissioner determines it would substantially and adversely affect the financial soundness of the health maintenance organization and endanger its ability to meet its obligations. If the Commissioner does not disapprove within 30 days of the filing of the notice, the exercise of power shall be deemed approved. (c) The Commissioner may issue rules and regulations exempting those activities having a de minimis effect from the filing requirement of this subsection.  (Apr. 9, 1997, D.C. Law 11-235, § 5, 44 DCR 818; Mar. 24, 1998, D.C. Law 12-81, § 46(b), 45 DCR 745.)  Prior Codifications 1981 Ed., § 35-4504. Section References This section is referenced in § 31-3411.
DC Code § 31-3405 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3405. Fiduciary responsibilities

(a) Any director, officer, employee, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of such organization shall be responsible for such funds in a fiduciary relationship to the organization. (b) A health maintenance organization shall maintain in force a fidelity bond or fidelity insurance on such employees and officers, directors, and partners in an amount not less than $250,000 and not more than $5,000,000.  (Apr. 9, 1997, D.C. Law 11-235, § 6, 44 DCR 818.)  Prior Codifications 1981 Ed., § 35-4505.
DC Code § 31-3408 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3408. Annual report. [Repealed]

Repealed.  (Apr. 9, 1997, D.C. Law 11-235, § 9, 44 DCR 818; Apr. 27, 1999, D.C. Law 12-274, § 501(a)(3), 46 DCR 1294; Mar. 27, 2003, D.C. Law 14-252, § 2(d), 50 DCR 225.)  Prior Codifications 1981 Ed., § 35-4508. Editor's Notes Application of D.C. Law 12-274: Section 501(b) of D.C. Law 12-274 provided that this section shall apply upon the promulgation of regulations pursuant to § 32-574.1 § 44-304.01, (2001 Ed.).
DC Code § 31-3408.01 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3408.01. Compliance with other laws

Health maintenance organizations shall comply with the following laws: (1) Chapter 3 of this title; (2) Chapter 19 of this title; (3) Chapter 14 of this title; (4) Subchapter I of Chapter 7 of this title; (5) Chapter 21 of this title; and (6) The Reasonable Health Insurance Ratemaking Reform Act of 2010 [Chapters 30A, 31C, and 33A of this title].  (Apr. 9, 1997, D.C. Law 11-235, § 9a; as added Mar. 27, 2003, D.C. Law 14-252, § 2(d), 50 DCR 225; Apr. 8, 2011, D.C. Law 18-360, § 502(a), 58 DCR 896.)  Effect of Amendments D.C. Law 18-360 deleted “and” from the end of par. (4), substituted “; and” for a period the end of par. (5), and added par. (6). Editor's Notes Application of Law 14-252: Section 3 of D.C. Law 14-252 provided: “This act shall not apply until the Commissioner gives written notice that all necessary rules and administrative procedures are in place to effect the provisions of this act.”
DC Code § 31-3409 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3409. Information to enrollees

(a) A health maintenance organization shall provide to its enrollees a list of providers, upon enrollment and re-enrollment. (b) Every health maintenance organization shall provide to its enrollees within 30 days notice of any material change in the operation of the organization that will affect them directly. (c) An enrollee must be notified in writing by a health maintenance organization of the termination of the primary care provider who provided health care services to that enrollee. A health maintenance organization shall provide assistance to the enrollee in transferring to another participating primary care provider. (d) A health maintenance organization shall provide to enrollees information on how services may be obtained, where additional information on access to services can be obtained, and a number where the enrollee can contact the HMO at no cost to the enrollee.  (Apr. 9, 1997, D.C. Law 11-235, § 10, 44 DCR 818.)  Prior Codifications 1981 Ed., § 35-4509.
DC Code § 31-3410 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3410. Grievance procedures [Repealed]

Repealed.  (Apr. 9, 1997, D.C. Law 11-235, § 11, 44 DCR 818; Apr. 27, 1999, D.C. Law 12-274, § 501(a)(4), 46 DCR 1294.)  Prior Codifications 1981 Ed., § 35-4510. Section References This section is referenced in § 31-3419. Editor's Notes Application of Law 12-274: Section 501(b) of D.C. Law 12-274 provided that this section shall apply upon the promulgation of regulations pursuant to § 32-574.1 § 44-304.01, 2001 Ed. .