reglab/housing_qa huggingface dataset:
DC Code § 31-3106 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31 - Drug Abuse, Alcohol Abuse, and Mental Illness Insurance Coverage|§ 31-3106. Certification of nonhospital residential facilities and outpatient treatment facilities

(a) The Mayor shall certify qualifying nonhospital residential facilities and outpatient treatment facilities in the District in accordance with rules issued pursuant to § 31-3111. (b) Each certification issued by the Mayor shall state whether the facility is certified as a provider of treatment for drug abuse, alcohol abuse, mental illness, or a combination of these that shall be specified. (c) To qualify for certification, a nonhospital residential facility or outpatient treatment facility shall demonstrate that: (1) It offers an organized program for the treatment of drug abuse, alcohol abuse, mental illness, or any combination of these; (2) It operates under the day-to-day supervision of an individual with demonstrable training and experience in the treatment of drug abuse, alcohol abuse, or mental illness; (3) It employs sufficient numbers of professional staff members to deliver adequately the services offered to its patient caseload; and (4) It offers and has the capacity to provide services for the durations specified in §§ 31-3103 and 31-3104. (d) Nothing in this section shall be construed as superseding the requirements of chapter 5 of Title 44. (e) Any certification issued pursuant to this section shall be issued as a Public Health: Human Services Facility endorsement to a basic business license under the basic business license system as set forth in subchapter I-A of Chapter 28 of Title 47.  (Feb. 28, 1987, D.C. Law 6-195, § 7, 34 DCR 491; Apr. 20, 1999, D.C. Law 12-261, § 2003(kk), 46 DCR 3142; Oct. 28, 2003, D.C. Law 15-38, § 3(y), 50 DCR 6913.)  Prior Codifications 1981 Ed., § 35-2306. Section References This section is referenced in § 44-1204. Effect of Amendments D.C. Law 15-38, in subsec. (e), substituted “Public Health: Human Services Facility endorsement to a basic business license under the basic” for “Class A Public Health: Human Services Facility endorsement to a master business license under the master”. Cross References Substance abuse treatment certification requirements, see § 44-1204. Emergency Legislation For temporary (90 day) amendment of section, see § 3(y) of Streamlining Regulation Emergency Act of 2003 (D.C. Act 15-145, August 11, 2003, 50 DCR 6896). Delegation of Authority Delegation of authority pursuant to D.C. Law 6-195, “Drug Abuse, Alcohol Abuse, and Mental Illness Insurance Act of 1986.”, see Mayor’s Order 88-50, February 25, 1988.
DC Code § 31-3107 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31 - Drug Abuse, Alcohol Abuse, and Mental Illness Insurance Coverage|§ 31-3107. Preservation of certain benefits

Nothing in this chapter shall serve to diminish the benefits of any insured person or prevent the offering or acceptance of benefits that exceed the minimum benefits required by this chapter.  (Feb. 28, 1987, D.C. Law 6-195, § 8, 34 DCR 491.)  Prior Codifications 1981 Ed., § 35-2307.
DC Code § 31-3108 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31 - Drug Abuse, Alcohol Abuse, and Mental Illness Insurance Coverage|§ 31-3108. Notification of coverage and benefits

All individual and group health benefit plans shall contain statements, in easily readable type and in easily understandable language, approved by the Commissioner, to inform policyholders and beneficiaries of the coverage and benefits provided or offered pursuant to this chapter.  (Feb. 28, 1987, D.C. Law 6-195, § 9, 34 DCR 491; May 21, 1997, D.C. Law 11-268, § 10(w), 44 DCR 1730; Mar. 8, 2007, D.C. Law 16-242, § 2(f), 54 DCR 601.)  Prior Codifications 1981 Ed., § 35-2308. Section References This section is referenced in § 31-3110. Effect of Amendments D.C. Law 16-242 substituted “health benefit plans” for “health insurance policies”.
DC Code § 31-3110 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31 - Drug Abuse, Alcohol Abuse, and Mental Illness Insurance Coverage|§ 31-3110. Health maintenance organizations

(a) The requirements of this chapter shall apply to health maintenance organizations 5 years from February 28, 1987, unless the Mayor requests the Council to extend the exemption to a time certain and the Council, by resolution, approves the extension. (b) Upon becoming subject to the requirements of this chapter, each health maintenance organization shall: (1) Provide to its members the coverage and benefits required by §§ 31-3102, 31-3103, and 31-3104; (2) Ensure that deductible or copayment plans, durational limits, and methods of determination adopted with respect to coverage of the benefits required by §§ 31-3102, 31-3103, and 31-3104 result in coverage that is determined by the Commissioner to be at least equivalent in actuarial value to the average actuarial value of the plans provided by the health insurer with the largest number of enrollees in the District; and (3) Provide the notification of coverage and benefits required by § 31-3108. (c) Each health maintenance organization may provide the treatment required by §§ 31-3103 and 31-3104 directly by its staff or by referring its members to a hospital or other treatment facility that provides those services under a contract or agreement with the health maintenance organization. Nothing in this chapter shall require the alteration of any terms and conditions of the health maintenance organization membership contract relating to prior approval by the health maintenance organization for treatment provided to its members by other treatment facilities. (d)(1) Each health maintenance organization, within 120 days after becoming subject to the requirements of this chapter, shall file with the Commissioner the membership contracts it proposes to use, identifying its charges for all services and the portion of charges attributable to the services required by this chapter. (2) The provisions of § 31-3109, except for subsection (b)(2) of this section, shall apply thereafter to the membership contracts and charges filed and implemented by health maintenance organizations. Rates and charges for the coverage required by this chapter shall not be excessive and shall be reasonably related to the cost of providing the coverage.  (Feb. 28, 1987, D.C. Law 6-195, § 11, 34 DCR 491; May 21, 1997, D.C. Law 11-268, § 10(w), 44 DCR 1730; Mar. 8, 2007, D.C. Law 16-242, § 2(h), 54 DCR 601.)  Prior Codifications 1981 Ed., § 35-2310. Section References This section is referenced in § 31-3101, § 31-3109, and § 31-3111. Effect of Amendments D.C. Law 16-242, in subsec. (b)(2), substituted “health insurer” for “insurer”.
DC Code § 31-3111 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31 - Drug Abuse, Alcohol Abuse, and Mental Illness Insurance Coverage|§ 31-3111. Duties of Mayor

(a) The Mayor shall, within 120 days from February 28, 1987, issue rules to implement all sections of this chapter except § 31-3110. The Mayor shall issue rules to implement § 31-3110 no later than 5 years from February 28, 1987. (b) The Mayor shall provide the coverage and benefits set forth in this chapter to employees of the District and their dependents who are insured through the District of Columbia Employees’ Health Benefits Program. For District employees and their dependents who are insured through the Federal Employees’ Health Benefits Program, the Mayor shall provide supplemental coverage and benefits that comply with the requirements of this chapter no later than February 28, 1994.  (Feb. 28, 1987, D.C. Law 6-195, § 12, 34 DCR 491; Mar. 16, 1993, D.C. Law 9-192, § 2(d), 39 DCR 9007.)  Prior Codifications 1981 Ed., § 35-2311. Section References This section is referenced in § 31-3106 and § 31-3109. Delegation of Authority Delegation of authority pursuant to D.C. Law 6-195, “Drug Abuse, Alcohol Abuse, and Mental Illness Insurance Act of 1986.”, see Mayor’s Order 88-50, February 25, 1988.
DC Code § 31-3112 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31 - Drug Abuse, Alcohol Abuse, and Mental Illness Insurance Coverage|§ 31-3112. Excluded programs

This chapter shall not be applicable to the District of Columbia Alliance Program, Medicaid Program, and Post-1987 District of Columbia Employees’ Health Insurance Benefits Plan.  (Feb. 28, 1987, D.C. Law 6-195, § 12a; as added Mar. 8, 2007, D.C. Law 16-242, § 2(i), 54 DCR 601.)  Editor's Notes Section 3 of D.C. Law 16-242 provided: “Section 2 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 after the effective date of this act.”
DC Code § 31-3133 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31A - Health Benefits Plans Prompt Payment|§ 31-3133. Retroactive denial of reimbursement

(a) A health insurer may only retroactively deny reimbursement to a health care provider: (1) For services subject to coordination of benefits with another health insurer during the 18-month period after the date that the health insurer paid the health care provider; or (2) Except as provided in paragraph (1) of this subsection, during the 6-month period after the date that the health insurer paid the health care provider. (b)(1) A health insurer that retroactively denies reimbursement to a health care provider under subsection (a)(1) of this section shall provide the health care provider with a written statement specifying the basis for the retroactive denial. If the retroactive denial of reimbursement results from coordination of benefits, the written statement shall provide the name and address of the entity acknowledging responsibility for payment of the denied claim. (2) This subsection shall not apply if a health insurer retroactively denies reimbursement to a health care provider because: (A) The information submitted to the health insurer was fraudulent; (B) The information submitted to the health insurer was improperly coded and the health insurer has provided to the health care provider sufficient information regarding the coding guidelines used by the health insurer at least 30 days prior to the date the services subject to the retroactive denial were rendered; or (C) The claim submitted to the health insurer was a duplicate claim. (3) Information submitted to the health insurer may be considered to be improperly coded under paragraph (1) of this subsection if the information submitted to the health insurer by the health care provider: (A) Uses codes that do not conform with the coding guidelines used by the health insurer applicable as of the date that services were rendered; or (B) Does not otherwise conform with the contractual obligations of the health care provider to the health insurer applicable as of the date that services were rendered. (c) If a health insurer retroactively denies reimbursement for services as a result of coordination of benefits, the health care provider shall have 180 days after the date of denial, unless the health insurer permits a longer time period, to submit a claim for reimbursement for the service to the health insurer responsible for payment. (d) A health insurer that retroactively denies reimbursement to a health care provider under this section shall provide the health care provider with a written statement specifying the basis for the retroactive denial. (e) This section shall not apply to an adjustment to reimbursement made as part of an annual contracted reconciliation of a risk-sharing arrangement.  (July 23, 2002, D.C. Law 14-176, § 4, 49 DCR 5086.)  Section References This section is referenced in § 31-3138.
DC Code § 31-3134 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31A - Health Benefits Plans Prompt Payment|§ 31-3134. Provider panels

(a) Except for Medicaid and Medicare provider panels, if a provider panel contract between a provider and a health insurer, or other entity that provides hospital, physician, or other health care services to a health insurer, require a provider, as a condition of participating in one of the health insurer’s or other entity’s provider panels, to participate in any other provider panel owned or operated by the health insurer or other entity, the contract shall contain a provision permitting the provider to refuse participation in one or more of the other provider panels at the time the contract is executed or renewed. The status of a physician as a member of, or as being eligible for, other existing or new provider panels shall not be adversely affected by the exercise of the right to refuse participation. (b) If a provider elects to terminate participation on a provider panel of a health insurer or entity that provides hospital, physicians, or health services to a health insurer, the provider shall: (1) Notify the health insurer at least 90 days before termination; and (2) For at least 90 days after the date of notice of termination, continue to furnish health care services to an enrollee of a health insurer for whom the provider was responsible for the delivery of health care services prior to the notice of termination.  (July 23, 2002, D.C. Law 14-176, § 5, 49 DCR 5086.)  Section References This section is referenced in § 31-3138.
DC Code § 31-3135 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31A - Health Benefits Plans Prompt Payment|§ 31-3135. Claims payment report

A health insurer shall include with its annual report filed with the Commissioner a claims payment report to include the: (1) Number of claims received in the previous calendar year; (2) Number of claims denied in the previous calendar year; (3) Number of claims paid: (A) In the previous calendar year; (B) In 30 days; (C) In 60 days; (D) In 120 days; and (E) In more than 120 days; and (4) Average number of days to pay a claim submitted in the previous calendar year.  (July 23, 2002, D.C. Law 14-176, § 6, 49 DCR 5086.)  Section References This section is referenced in § 31-3138.
DC Code § 31-3136 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31A - Health Benefits Plans Prompt Payment|§ 31-3136. Penalties

An action by a health insurer that establishes a pattern or practice of repeated violation of this chapter, as determined by the Commissioner, shall constitute a violation as provided in Chapter 22A of this title.  (July 23, 2002, D.C. Law 14-176, § 7, 49 DCR 5086.)
DC Code § 31-3137 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31A - Health Benefits Plans Prompt Payment|§ 31-3137. Rules and regulations

The Commissioner may adopt rules and regulations as necessary to implement this chapter.  (July 23, 2002, D.C. Law 14-176, § 8, 49 DCR 5086.)
DC Code § 31-3138 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31A - Health Benefits Plans Prompt Payment|§ 31-3138. Applicability

(a) This chapter shall apply to any individual and group health benefits plan issued or renewed in the District of Columbia. Health insurers shall comply with this chapter on the earlier of October 16, 2002, or the effective date of the claims payment standards in section 1173 of the Social Security Act, approved August 14, 1935 (110 Stat. 2024; 42 U.S.C. § 1320d-2). (b) Section 31-3132 shall apply to claims received on or after October 16, 2002. (c) Section 31-3133 shall apply to retroactive denials made on or after October 16, 2002. (d) Section 31-3134 shall apply to any contract issued or renewed on or after October 16, 2002. (e) Section 31-3135 shall apply to claims data collected beginning with the first full calendar year following July 23, 2002. A health insurer shall include this data in the annual report filed with the Commissioner beginning on March 15, 2004.  (July 23, 2002, D.C. Law 14-176, § 9, 49 DCR 5086.)
DC Code § 31-3151 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31B - Health Benefit Plans Withdrawal from Market|§ 31-3151. Definitions

For the purposes of this chapter, the term: (1) “Application” means a carrier’s application pursuant to this chapter for approval to voluntarily withdraw from the District of Columbia health insurance market. (2) “Carrier” means any person or organization subject to the authority of the Commissioner that provides one or more health benefit plans in the District of Columbia, and includes an insurer, a hospital and medical services corporation, a fraternal benefit society, a health maintenance organization, or multiple employer welfare arrangement. (3) “Commissioner” means the Commissioner of the Department of Insurance, Securities, and Banking. (4) “Health benefit plan” means any accident and health insurance policy or certificate, hospital and medical services corporation contract, health maintenance organization subscriber contract, a plan provided by a multiple employer welfare arrangement, or a plan provided by another benefit arrangement. The term “health benefit plan” does not mean accident only, credit, or disability insurance; coverage of Medicare services or federal employee health plans, pursuant to contracts with the United States government; Medicare supplement or long-term care insurance; dental only or vision only insurance; specified disease insurance; hospital confinement indemnity coverage; limited benefit health coverage; coverage issued as a supplement to liability insurance; insurance arising out of a workers’ compensation or similar law; automobile medical payment insurance; medical expense and loss of income benefits; or insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance. (5) “HIPAA” means the Health Insurance Portability and Accountability Act of 1996, approved August 21, 1996 (110 Stat. 1936; scattered sections of the United States Code). (6) “Medicare” means the health insurance program established pursuant to the Health Insurance for the Aged Act, approved July 30, 1965 (79 Stat. 290; 42 U.S.C. § 401 et seq.). (7) “Withdraw” means the full cessation of underwriting insurance policies, including the nonrenewal of existing insurance policies, relative to any line of business or any subgroup thereof, including individual accounts.  (Apr. 12, 2005, D.C. Law 15-328, § 2, 52 DCR 1459.)
DC Code § 31-3152 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31B - Health Benefit Plans Withdrawal from Market|§ 31-3152. Procedures for voluntary withdrawal by carriers

(a) A carrier shall give the Commissioner written notice, prior to notifying the members of the health benefit plan, of its intent to discontinue the offering of all health benefit plans in the District of Columbia and shall submit to the Commissioner an application with the following information: (1) The name of the carrier; (2) The name, address, telephone number, and facsimile number of the carrier’s representative responsible for the activities pertaining to withdrawing from the District of Columbia health insurance market; (3) A specific description of the reasons the carrier is withdrawing its health benefit plans from the District of Columbia health insurance market; (4) A statement of the number of in-force policies affected by the withdrawal; (5) A copy of the nonrenewal notice, which complies with HIPAA, that the carrier will send to its enrollees and dependents once its application is approved; and (6) Any other information or documentation that the Commissioner considers relevant and appropriate in connection with the carrier ceasing to offer a health benefit plan in the District of Columbia. (b) The carrier shall obtain prior approval of its application from the Commissioner before it commences to voluntarily withdraw from the District of Columbia health insurance market. (c) The Commissioner shall complete his or her review of the application submitted by the carrier to withdraw from the District of Columbia health insurance market within 60 days after receipt of all requested documentation. (d) To ensure that health care services will be available and accessible to all group and nongroup policyholders of a withdrawing carrier, the Commissioner may allocate the group and nongroup contracts among other carriers in a similar manner as provided in § 31-3414. (e) The Commissioner may condition his or her approval of the carrier’s application upon the terms and conditions as are necessary for the protection of the carrier’s policyholders, its creditors, or the public interest.  (Apr. 12, 2005, D.C. Law 15-328, § 3, 52 DCR 1459.)
DC Code § 31-3153 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31B - Health Benefit Plans Withdrawal from Market|§ 31-3153. Judicial review; mandamus

(a) Any carrier aggrieved by any act, determination, rule, regulation, or order or any other action of the Commissioner pursuant to this chapter, and which was the subject of a contested case, may appeal to the District of Columbia Court of Appeals, in accordance with § 2-510. (b) The filing of an appeal pursuant to this section shall not stay the application of any rule, regulation, order, or other action of the Commissioner to the appealing party unless the court, after giving the appealing party notice and an opportunity to be heard, determines that failure to grant the stay would be detrimental to the interest of policyholders, shareholders, creditors, or the public. (c) Any carrier aggrieved by any failure of the Commissioner to act or make a determination required by this chapter may petition the Superior Court of the District of Columbia for a writ in the nature of a mandamus or a peremptory mandamus directing the Commissioner to act or make the determination forthwith.  (Apr. 12, 2005, D.C. Law 15-328, § 4, 52 DCR 1459.)
DC Code § 31-3154 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 31B - Health Benefit Plans Withdrawal from Market|§ 31-3154. Regulations

The Commissioner may promulgate rules and regulations necessary to implement the provisions of this chapter, including provisions for the disposal of books of business.  (Apr. 12, 2005, D.C. Law 15-328, § 5, 52 DCR 1459.)