Chapter 7D. Department of Health Care Finance.
§ 7–771.01. Definitions.
For the purposes of this chapter, the term:
(1) “Attorney General” means the Attorney General for the District of Columbia.
(2) “CMPA” means Chapter 6 of Title 1, [§ 1-601.01 et seq.].
(3) “Department” means the Department of Health Care Finance established by § 7-771.02.
(4) “Department CFO” means the Chief Financial Officer for the Department of Health Care Finance.
(4A) "Director" means the Director of the Department of Health Care Finance.
(5) “District CFO” means the Chief Financial Officer of the District of Columbia.
(6) “DOH” means the Department of Health.
(7) “MAA” means the Medical Assistance Administration.
(8) “PPA” means Unit A of Chapter 3 of Title 2, [§ 2-301.01 et seq.].
§ 7–771.02. Establishment of the Department of Health Care Finance.
Pursuant to § 1-204.04(b), there is established a Department of Health Care Finance as a separate, cabinet-level agency, subordinate to the Mayor, within the executive branch of the government of the District of Columbia.
§ 7–771.03. Purpose of the Department.
The Department shall:
(1) Maximize the well-being and quality of life for eligible low-income individuals and other populations through the provision of leadership and direction in administering responsive, effective, and efficient health-care benefits;
(2) Develop a comprehensive, efficient, and cost-effective health-care system for the District’s uninsured, under-insured, and low-income residents;
(3) Develop eligibility, service coverage, and service delivery and reimbursement policies for the District’s health-care-financing programs that ensure improved access and efficient delivery of service;
(4) Ensure that District health-care programs maximize available federal financial assistance; and
(5) Support the health-care policy, delivery, and access initiatives of the Department of Health and other District agencies through sound health-care financing.
§ 7–771.04. Appointment of Director.
The Department shall be headed by a Director, who shall:
(1) Be appointed by the Mayor with the advice and consent of the Council, pursuant to § 1-523.01(a);
(2) Be qualified by experience and training to carry out the purposes of the Department as set forth in § 7-771.03; and
(3) Serve at the pleasure of the Mayor.
§ 7–771.05. Duties of Director.
In addition to other duties as may be lawfully imposed, the Director shall:
(1) Supervise and direct the Department, organizing the Department for its efficient operation, including creating offices within the Department, as necessary, and exercising any other powers necessary and appropriate to implement the provisions of this chapter;
(2) Receive, manage, and disburse all local and federal funds for operations and medical-assistance purposes of the Department;
(3) Exercise personnel authority as appropriate to perform the functions of the Department consistent with Chapter 6 of Title 1 [§ 1-601.01 et seq.];
(4) Execute grants, contracts, memoranda of agreement and understanding, or other agreements with governmental bodies, public and private agencies, institutions, and organizations on behalf of the Department;
(5) Collaborate with other District agencies to ensure the coordination of Department initiatives that may affect or involve programs within other District agencies; and
(6) Promulgate and implement rules and regulations necessary and appropriate to accomplish his or her duties and the Department’s functions in accordance with subchapter I of Chapter 5 of Title 2.
§ 7–771.05a. Assessment Fund.
(a) There is established as a special fund the Assessment Fund (“Fund”), which shall be administered by the Department of Health Care Finance in accordance with subsection (c) of this section.
(b) The Fund shall consist of revenue from the following sources:
(1) User fees; and
(2) Enrollment fees.
(c) The Fund shall be used for the following purposes:
(1) Administration and maintenance of the Department’s provider operations;
(2) Enrollment activities; and
(3) Health information exchange activities.
(d)(1) The money deposited into the Fund, and interest earned, shall not revert to the unrestricted fund balance of the General Fund of the District of Columbia at the end of a fiscal year, or at any other time.
(2) Subject to authorization by Congress, any funds appropriated in the Fund shall be continually available without regard to fiscal year limitation.
§ 7–771.06. Department organization.
The Department shall:
(1) Have a Chief Financial Officer separate from any financial cluster, who shall:
(A) Be appointed by the Chief Financial Officer of the District of Columbia after consultation with the Director;
(B) Be qualified by experience and training to carry out accounting, budgeting, and financial management functions;
(C) Report directly to, be ultimately responsible to, and be under the supervisory direction of the District CFO, through the Director;
(D) Engage in the accounting, budgeting, and financial management functions as authorized by the District CFO;
(E) Serve as a member of the Department management team;
(F) Advocate for and advance the policy objectives of the Director, to the extent consistent with the ultimate responsibility of the Department CFO to, and supervisory control by, the District CFO; and
(G) Be subject to evaluation, discipline, and transfer by the District CFO, in consultation with the Director;
(2) Have a general counsel or the equivalent, who shall:
(A) Be appointed by the Attorney General for the District of Columbia as an employee of the Office of the Attorney General, after consultation with the Director;
(B) Be an attorney admitted to the practice of law in the District of Columbia;
(C) Be qualified by experience and training to advise the Department with respect to legal issues related to its powers and duties;
(D) Be in the Senior Executive Attorney Service as an at-will employee under the direction and control of the Attorney General;
(E) Be subject to all applicable provisions of subchapter VIII-B of Chapter 6 of Title 1 [§ 1-608.51 et seq.];
(F) Have an attorney-client relationship with the Department;
(G) Advocate vigorously for the positions of the Department on legal issues, and if that advocacy poses a conflict with a legal position of the Attorney General, seek exemption from the supervision of the Attorney General as to that position, in accordance with § 1-608.55(b); and
(H) Be subject to evaluation, discipline, and transfer by the Attorney General, after consultation with the Director; and
(3) Have sufficient staff, supervisory personnel, and resources, and be organized to carry out the functions and duties set forth in this chapter.
§ 7–771.07. Powers and duties of the Department.
Notwithstanding any other provision of law, the Department shall:
(1) Be the single state agency, successor to the Medical Assistance Administration, for the administration of the Medicaid Program under section 1902(a)(5) of the Social Security Act, approved July 30, 1965 (79 Stat. 344; 42 U.S.C. § 1396a(a)(5));
(2) Administer the D.C. HealthCare Alliance program and any other publicly funded health-care insurance program;
(3) Coordinate with the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services on all waivers, State Plan amendments, demonstration grants, and other opportunities to maximize federal assistance and fulfill the purposes of the Department as set forth in § 7-771.03;
(4) Coordinate with other District government agencies to ensure effective and efficient use of Medicaid dollars, including providing training and technical assistance to ensure proper and timely billing and claims processing;
(5) Cooperate with other District agencies to ensure coordinated health-care access and delivery for publicly funded health-care services;
(6) Collaborate with the District agency responsible for eligibility determination in monitoring enrollment and beneficiary-outreach efforts;
(7) Engage providers and clients in eligibility, access, quality-of-care, and reimbursement issues;
(8) Develop and maintain a comprehensive information-technology infrastructure that accurately and efficiently processes claims, interfaces with other necessary public, private, and nonprofit information-technology systems, and collects information for data analysis of trending, cost measurement, performance management, policy development, and strategic planning;
(9) Develop a long-term-care-finance infrastructure, in cooperation with other District agencies, including the Department of Disability Services, Department of Aging and Community Living, Long-Term Care Ombudsman, and DOH;
(10) Promote cost-containment initiatives through policy development, best-practice implementation, grant development, innovative strategies to leverage funding sources, and strategic planning;
(11) Develop an annual budget for the Department to be submitted to the Council by the Mayor, in accordance with § 1-204.42; and
(12) Exercise any other power or duty necessary to fulfill the purposes of the Department as set forth in § 7-771.03.
(13) Repealed.
§ 7–771.07a. Grant authority.
(a)(1) For Fiscal Year 2018, the Director shall:
(A) Award 4 grants of at least $50,000 to facilitate the development and application of telehealth services to:
(i) Health care providers located in Wards 7 and 8; and
(ii) Residents located in Wards 7 and 8;
(B) Award 2 grants of at least $75,000 to facilitate the development and application of telehealth services to homeless shelters or public housing projects; and
(C) Award a grant of $250,000 to a college of pharmacy located in the District to create and maintain a medication-assisted treatment genomic registry.
(2) In awarding grants pursuant to paragraph (1)(A) of this subsection, the Director shall consider the following:
(A) Promoting telehealth in specialty areas of medicine, including ophthalmology, obstetrics, and endocrinology; and
(B) Expanding the application of telehealth to public schools, patient homes, and skilled nursing facilities.
(a-1) For Fiscal Year 2019, the Director shall:
(1) Award a competitive grant in an amount not to exceed $75,000 to develop a pilot program to strengthen the ability of faith-based organizations to:
(A) Deliver health screening, assessments, and health care services through telehealth; and
(B) Reduce low-acuity, non-emergency room visitation, avoidable hospitalizations, and hospital readmission for persons who live in Wards 5, 7, and 8;
(2) Award 2 competitive grants in an amount not to exceed $50,000 to health care providers with expertise and staff capacity in medical oncology, particularly prostate and gynecologic cancers, that focus on patient screening, treatment planning, and care coordination, to defray the capital and equipment costs associated with the provision of additional oncological services in Wards 7 and 8;
(3) Award a competitive grant in an amount not to exceed $30,000 to a health care provider to establish a program to provide free medical services to teen parents attending a District of Columbia public school or public charter high school located in Ward 7 or 8;
(4) Award a competitive grant in an amount not to exceed $500,000 to an organization to design and develop a community resource inventory that is accessible to health and social support organizations and that has the capacity to communicate and track referrals; and
(5)(A) Award a competitive grant in an amount not to exceed $200,000 to an entity to provide multi-disciplinary, patient-centered preventative health and perinatal educational services to high-risk expectant mothers residing in Wards 7 and 8 and who receive Medicaid or are Medicaid-eligible.
(B) No more than 50% of the selected entity's direct services delivery staff shall possess higher than a bachelor's degree.
(C) At a minimum, the selected entity shall demonstrate an ability to:
(i) Implement a peer-support model of care for expectant mothers;
(ii) Identify a consistent source of referrals for expectant mothers;
(iii) Refer expectant mothers to WIC, health insurance coverage options, and other community resources;
(iv) Provide the following services to expectant mothers:
(I) Regular office and in-home visits;
(II) Mental health supports;
(III) Access to classes and support groups on perinatal fitness, childbirth education, nutritional education, newborn care, and parenting skills;
(IV) Expanded maternity services from the end of pregnancy to 6 months postpartum; and
(v) Initiate delivery of services to expectant mothers as follows:
(I) Prior to 4 weeks postpartum for non-neonatal intensive care unit births; and
(II) Up to 12 weeks postpartum for neonatal intensive care unit births; and
(vi) Increase breastfeeding rates.
(D)(i) The Director shall collect the following data from the selected entity regarding expectant mothers that receive services pursuant to paragraph (5)(A) of this subsection:
(I) Maternal morbidity and mortality rates;
(II) Number of low birth-weight newborns;
(III) Rate of premature births;
(IV) Infant morbidity and mortality rates;
(V) Tobacco and nicotine use during pregnancy and pediatric exposure to second hand smoke; and
(VI) Other data as determined by the Director.
(ii) The Director shall compare the data in sub-subparagraph (i) with outcomes among the general Medicaid and Medicaid-eligible population and report his findings to the Council's Committee on Health.
(a-2) For Fiscal Year 2020, the Director shall:
(1)(A) Award a competitive grant in an amount not to exceed $150,000 to fund operating expenses associated with the provision of medical respite care services to individuals who are homeless; provided, that if such a grant is awarded to a Federally Qualified Health Center ("FQHC"), the amount of the grant shall not be offset against the FQHC's expenses for the purpose of determining its allowable costs in accordance with section 4511.2 of Title 29 of the District of Columbia Municipal Regulations (29 DCMR § 4511.2).
(B) At a minimum, the selected entity shall possess:
(i) The staff capacity and expertise necessary to provide medical respite care, with a particular emphasis on care for women who are homeless; and
(ii) The ability to provide case management services, including assistance in accessing permanent housing services.
(C) By September 30, 2020, the Director shall submit a report to the Council that sets forth:
(i) Recommendations for the establishment of medical respite care services for homeless individuals, through either:
(I) An amendment to the District of Columbia Medicaid State Plan; or
(II) A waiver pursuant to section 1115 of the Social Security Act, approved July 25, 1962 (76 Stat. 192; 42 U.S.C. § 1315), for home and community-based services;
(ii) The types of services that may be offered to homeless individuals through a medical respite care program; and
(iii) An identification of any potential restrictions on the provision of services identified pursuant to sub-subparagraph (ii) of this subparagraph, including the use of prior authorization.
(2)(A)(i) Award competitive grants in an amount not to exceed $100,000 to community-based initiatives focused on addressing the social determinants of health in Wards 7 and 8.
(ii) In establishing criteria for the award of grants pursuant to sub-subparagraph (i) of this subparagraph, the Department shall prioritize community-based initiatives that utilize a cohort-based curriculum that incorporates design-thinking.
(B) By November 1, 2019, the Department shall publish criteria in the District of Columbia Register governing the process for applying for and administering grants issued pursuant to subparagraph (A)(i) of this paragraph; provided, that the Department shall require grant applications to be submitted by January 15, 2020.
(C) By March 1, 2020, the Department shall dispense final awards for all grants issued pursuant to subparagraph (A)(i) of this paragraph.
(a-3) For Fiscal Year 2021, the Director may issue grants pursuant to [§7-771.07b(b)(4)(B)(ii) and (iii) [§ 7-771.07b repealed]] .
(a-4) For Fiscal Year 2021, the Director may:
(1)(A) Award a competitive grant in an amount not to exceed $150,000 to fund operating expenses associated with the provision of medical respite care services to individuals who are homeless; provided, that if such a grant is awarded to a Federally Qualified Health Center ("FQHC"), the amount of the grant shall not be offset against the FQHC's expenses for the purpose of determining its allowable cost in accordance with section 4511.2 of Title 29 of the District of Columbia Municipal Regulations (29 DCMR § 4511.2).
(B) At a minimum, the selected entity shall possess:
(i) The staff capacity and expertise necessary to provide medical respite care, with a particular emphasis on care for women who are homeless; and
(ii) The ability to provide case management services, including assistance in accessing permanent housing services.
(2) If a grant is awarded, then by September 30, 2021, the Director shall submit a report to the Council that sets forth:
(A) Recommendations for the establishment of medical respite care services for homeless individuals, through either:
(i) An amendment to the District of Columbia Medicaid State Plan; or
(ii) A waiver pursuant to section 1115 of the Social Security Act, approved July 25, 1962 (76 Stat. 192; 42 U.S.C. § 1315), for home and community-based services;
(B) The types of services that may be offered to homeless individuals through a medical care respite program; and
(C) An identification of any potential restrictions on the provision of services identified pursuant to sub-subparagraph (ii) of this subparagraph, including the use of prior authorization.
(a-5) For Fiscal Year 2022, subject to the availability of funds, the Director may:
(1)(A) Award a competitive grant in an amount not to exceed $150,000 to fund operating expenses associated with the provision of medical respite care services to individuals who are homeless; provided, that if such a grant is awarded to a Federally Qualified Health Center ("FQHC"), the amount of the grant shall not be offset against the FQHC's expenses for the purpose of determining its allowable cost in accordance with section 4511.2 of Title 29 of the District of Columbia Municipal Regulations (29 DCMR § 4511.2).
(B) At a minimum, the selected entity shall possess:
(i) The staff capacity and expertise necessary to provide medical respite care, with a particular emphasis on care for women who are homeless; and
(ii) The ability to provide case management services, including assistance in accessing permanent housing services.
(2)(A) Award competitive grants in an amount not to exceed $200,000 to community-based initiatives focused on addressing the social determinants of health in Wards 7 and 8.
(B) In establishing criteria for the award of grants pursuant to this paragraph, the Department shall prioritize community-based initiatives that utilize a cohort-based curriculum that incorporates design-thinking.
(3)(A) Award competitive grants in an amount not to exceed $200,000 to study the barriers to telehealth services for clients of the Department of Behavioral Health and the Department of Disability Services, utilizing a design-thinking approach, and to propose a set of recommendations for addressing those barriers.
(B) In establishing criteria for the award of grants pursuant to this paragraph, the Department shall prioritize providers that have an established program dedicated to design-thinking.
(4) Award competitive grants in an amount not to exceed $250,000 to assist FQHCs in educating their patients in Wards 7 and 8 on how to properly access telehealth services; provided, that the amount of the grant shall not be offset against the FQHC's expenses for the purpose of determining its allowable costs in accordance with section 4511.2 of Title 29 of the District of Columbia Municipal Regulations (29 DCMR § 4511.2).
(5) Award a competitive grant in an amount not to exceed $100,000 to a District-based organization to deploy non-physician healthcare practitioners, such as social workers, to facilitate and improve care coordination for pregnant mothers receiving health benefits through Medicaid or the DC HealthCare Alliance; provided, that the Department shall select an awardee with experience providing prenatal and postpartum maternal care to Medicaid beneficiaries by way of digital health or telehealth with a focus on early detection of pregnancy-related illnesses, such as gestational hypertension or preeclampsia.
(b) By April 1, 2019, the Director shall submit a report to the Secretary to the Council on all grants issued pursuant to this section.
(c) All grants issued pursuant to this section shall be administered pursuant to the requirements set forth in part B of subchapter XII-A of Chapter 3 of Title 1.
(d) The Director may set forth health outcome measures for all grants issued pursuant to this section.
(d-1) Funds appropriated for grants issued pursuant to subsection (a-2) of this section shall not be reprogrammed, unless the Council approves the reprogramming request by resolution.
(e) For the purposes of this section, the term:
(1) "Design-thinking" means a structured, human-centered creative process that synthesizes multi-disciplinary ideas to address the social determinants of health.
(1A) "Health-care provider" shall have the same meaning as provided in § 21-2202(4).
(2) "Medication-assisted treatment genomic registry" means a central location for the submission of genetic test information that health care providers can use in the provision of medication assisted treatment, clinical decision support for induction, stabilization, and maintenance treatment, and genomic-guided medication therapy management for opioid addiction.
(2A) "Social determinants of health" means the conditions in the environment in which people are born, live, work, and age that have a significant impact on health outcomes, including socioeconomic status, education, physical environment, employment, social support networks, and access to health-care services.
(3) "Telehealth" shall have the same meaning as provided in § 31-3861(18).
(4) "WIC" means the Special Supplemental Nutrition Program for Women, Infants, and Children, as provided in section 17 of the Child Nutrition Act of 1966, approved September 26, 1972 (86 Stat. 729; 42 U.S.C. § 1786).
§ 7–771.07b. Medicaid reserve. [Repealed]
Repealed.
§ 7–771.07c. DC HealthCare Alliance Reform Fund. [Repealed]
Repealed.
§ 7–771.07d. Home and Community-Based Services Enhancement Fund.
(a) There is established as a special fund the Medicaid Home and Community-Based Services Enhancement Fund ("Fund"), which shall be administered by the Department in accordance with subsections (c) and (d) of this section.
(b)(1) On or before October 1, 2022, the Chief Financial Officer shall deposit into the Fund an amount of local funds equal to the amount of federal funds received by the District attributable to the increase in the federal medical assistance percentage authorized by section 9817 of the American Rescue Plan Act of 2021, approved March 11, 2021 (Pub. L. No. 117-2; 135 Stat. 216) ("Section 9817 Enhancement Amount"), minus the amount of the Section 9817 Enhancement Amount expended by the District before the date the Chief Financial Officer makes the deposit required by this paragraph.
(2) There shall be deposited into the Fund after the date the Chief Financial Officer makes the deposit required by paragraph (1) of this subsection an amount of local funds equal to the amount of any additional federal funds received by the District attributable to the increase in the federal medical assistance percentage authorized by section 9817 of the American Rescue Plan Act of 2021, approved March 11, 2021 (Pub. L. No. 117-2; 135 Stat. 216) ("Section 9817").
(c) Money in the Fund shall be used only to fund the implementation of activities that enhance, expand, or strengthen Medicaid home and community-based services, as described in the Initial Spending Plan and Narrative for Enhanced Funding for Medicaid Home and Community-Based Services under Section 9817, as such plan may be updated from time to time, or as otherwise authorized by the Centers for Medicare and Medicaid Services.
(d)(1) The money deposited into the Fund but not expended in a fiscal year shall not revert to the unassigned fund balance of the General Fund of the District of Columbia at the end of a fiscal year, or at any other time.
(2) Subject to authorization in an approved budget and financial plan, any funds appropriated in the Fund shall be continually available without regard to fiscal year limitation.
§ 7–771.08. Temporary personnel and procurement authority.
Effective until October 1, 2009, the Department shall exercise:
(1) Personnel authority to hire, retain, and terminate personnel as appropriate to perform the functions of the Department consistent with Chapter 6 of Title 1, including establishing compensation and reimbursement consistent with the District’s wage grade and non-wage grade schedules and the Congressionally approved budget; and
(2) Procurement authority independent of the Office of Contracting and Procurement, consistent with Chapter 3A of Title 2; except that § 2-352.01a shall not apply.
§ 7–771.09. Transition process.
(a) No later than March 1, 2008, the Mayor shall submit a proposed transition plan, which has been approved by the Chief Financial Officer and which is accompanied by a proposed resolution, to the Council for a 45-day period of review, excluding Saturdays, Sundays, legal holidays, and days of Council recess, that identifies:
(1) All the powers, duties, functions, operations, real and personal property, positions, assets, records, and obligations, and all unexpended balances of appropriations, allocations, and other funds available, or to be made available, including those from the MAA and the Health Care Safety Net Administration, that are used to accomplish the purposes of the Department as set forth in § 7-771.03;
(2) The powers, duties, functions, operations, real and personal property, positions, assets, records, and obligations, and all unexpended balances of appropriations, allocations, and other funds available, or to be made available, that will be transferred to the Department;
(3) The impact of the proposed transfers on the budget of DOH and on the budgets of each affected District agency;
(4) The personnel who shall form the transition team and who shall be accountable for the monitoring and allocation of functions and assets to be transferred to the Department; and
(5) The procedure by which other District government agencies shall pre-approve claims and allow providers to submit bills directly to the Department, enabling the Department to satisfy valid claims from all available funding sources.
(b) If the Council does not approve or disapprove the proposed transition plan, in whole or in part, by resolution within the 45-day review period, the proposed transition plan shall be deemed approved;
(c) Nothing in this section shall affect any requirements imposed upon the Mayor by subchapter I of Unit A of Chapter 3 of Title 2, [§ 2-301.01 et seq.].
§ 7–771.10. Date of transfer of assets and authority.
No later than October 1, 2008, the transition plan required by § 7-771.09, as approved, shall be implemented.
§ 7–771.10a. Unspent local funds. [Repealed]
Repealed.
§ 7–771.10b. Nutrition services. [Not Funded]
Not Funded.
§ 7–771.10c. Department of Health Care Finance reporting requirements.
(a) By January 1, 2024, the Director shall submit the following reports to the Council:
(1) A report on medical respite care for homeless individuals, including:
(A) Recommendations for the establishment of medical respite care services for homeless individuals, through either an amendment to the District of Columbia Medicaid State Plan or a waiver pursuant to section 1115 of the Social Security Act, approved July 25, 1962 (76 Stat. 192; 42 U.S.C. § 1315);
(B) The types of services that may be offered to homeless individuals through a medical respite care program; and
(C) An identification of any potential restrictions on the provision of services identified pursuant to subparagraph (B) of this paragraph, including the use of prior authorization; and
(2) A report on the status of value-based payment methods within the District's public and locally funded health benefit programs operated by managed care organizations ("MCOs"), which shall include:
(A) Specific efforts undertaken by each of the District's public and locally funded health benefit programs operated by MCOs to incorporate value-based payment initiatives with their network providers, along with qualitative and quantitative outcomes associated with those efforts;
(B) A description of how each public and locally funded health benefit program operated by MCOs aligns financial incentives and accountability with the total costs of care and overall health outcomes;
(C) A description of how each public and locally funded health benefit program operated by MCOs aligns payments directly with quality and efficiency of care; and
(D) An analysis of the percentage of total medical expenditures by public and locally funded health benefit programs operated by MCOs that are linked to alternative payment methods.
(b)(1) Beginning January 1, 2024, and every 3 months thereafter, each of the District's public and locally funded health benefit programs operated by MCOs shall report to the Department the following data on a de-identified basis:
(A) The total number of beneficiaries in its plan, including those enrolled in a value-based payment model;
(B) The number of its beneficiaries who do not have an assigned primary care physician;
(C) The number of its beneficiaries who have not had a primary care visit in the previous 12 months; and
(D) The number of its beneficiaries who have had more than 5 emergency room visits in the previous 90 days.
(2) Within 30 days of receiving the information required under paragraph (1) of this subsection, the Director shall report such information to the Council and post it publicly on the Department's website.
§ 7–771.11. Continuation of rules and regulations.
All rulemaking and regulations for the administration of the District Medicaid Program and D.C. Health Care Alliance Program, issued under appropriate authority, shall continue in full force and effect.
