§ 7–1405. Authorization to contract for comprehensive health care services.

(a) The Mayor is authorized to provide by contract or by other means comprehensive community-centered health care and medical services for residents of the District of Columbia.

(b) A contract entered into by the Mayor pursuant to subsection (a) of this section shall be exempt from the requirements of Unit A [repealed] of Chapter 3 of Title 2, except that the contract shall be subject to § 2-301.05a [repealed].

(c)(1) Notwithstanding any other provision of the District’s health insurance laws and subject to paragraph (2) of this subsection, a health maintenance organization that has a contractual obligation to provide health care services to persons enrolled in the D.C. HealthCare Alliance (“Alliance”) shall be required to provide to persons enrolled in the Alliance only those health benefits specified in its contract with the District of Columbia.

(2) A contract between the District and a health maintenance organization or a managed care organization that provides health-care services to persons enrolled in the DC HealthCare Alliance shall include coverage for all services, including hospital-based services, being provided to DC HealthCare Alliance enrollees as of January 1, 2013; provided, that the Department of Health Care Finance shall have the authority to exclude coverage for those hospital-based emergency services that are eligible for Medicaid reimbursement under section 401(b)(1)(A) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, approved August 21, 1996 (110 Stat. 502; 8 U.S.C. § 1611(b)(1)(A)), 42 U.S.C. § 1396b(v)(3), and 42 C.F.R. § 440.255(c).

(d) A health maintenance organization or health insurer under contract to the District to deliver services to persons enrolled in the Alliance is not required to reimburse non-participating hospitals for services provided to Alliance enrollees.

(e) A health maintenance organization or health insurer under contract to the District to deliver services to persons enrolled in the Alliance (“Contractor”), which shall include safety net clinics, shall have the option of paying the safety net clinics on a fee-for-service basis or a capitated basis. If the Contractor elects to pay on a fee-for-service basis, the Contractor shall pay the safety net clinics no less that $95 per visit. If the Contractor elects to pay the safety net clinics on a capitated basis, the Contractor shall pay the safety net clinics on the same terms and condition as other clinics.

(July 12, 2001, D.C. Law 14-18, § 7, 48 DCR 4047; Mar. 2, 2007, D.C. Law 16-192, § 5052, 53 DCR 6899; Aug. 16, 2008, D.C. Law 17-219, § 5035, 55 DCR 7598; Sept. 20, 2012, D.C. Law 19-168, § 5112, 59 DCR 8025; Dec. 24, 2013, D.C. Law 20-61, § 5002, 60 DCR 12472.)

Section References

This section is referenced in § 7-1401 and § 44-407.

Effect of Amendments

D.C. Law 16-192 added subsecs. (c) and (d).

D.C. Law 17-219 added subsec. (e).

The 2012 amendment by D.C. Law 19-168 added the (c)(1) designation; added “and subject to paragraph (2) of this subsection” in (c)(1); and added (c)(2).

The 2013 amendment by D.C. Law 20-61 rewrote (c)(2).

Emergency Legislation

For temporary (90 day) amendment of section, see § 2 of Health Care Privatization Benefit and Reimbursement Exemption Emergency Amendment Act of 2006 (D.C. Act 16-374, May 19, 2006, 53 DCR 4388).

For temporary (90 day) amendment of section, see § 5052 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) amendment of section, see § 5052 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) amendment of section, see § 5052 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 § 5112 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 § 5112 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 § 5002 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 § 5002 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).

Temporary Legislation

For temporary (225 day) amendment of section, see § 2 of Health Care Privatization Benefit and Reimbursement Exemption Temporary Amendment of Act of 2006 (D.C. Law 16-155, September 19, 2006, law notification 53 DCR 7927).

Short Title

Short title: Section 5051 of D.C. Law 16-192 provided that subtitle E of title V of the act may be cited as the “Health Care Privatization Benefit Amendment Act of 2006”.

Short title: Section 5034 of D.C. Law 17-219 provided that subtitle O of title V of the act may be cited as the “Safety Net Clinics Fee Amendment Act of 2008”.

Section 5001 of D.C. Law 20-61 provided that Subtitle A of Title V of the act may be cited as the “DC HealthCare Alliance Preservation Amendment Act of 2013”.

Editor's Notes

Applicability of D.C. Law 20-61: Section 11001 of D.C. Law 20-61 provided that, except as otherwise provided, the act shall apply as of October 1, 2013.