District of Columbia § 31-3875.07 Continuity of care for enrollees.

District of Columbia Statutes

§ 31-3875.07 — Continuity of care for enrollees.

District of Columbia § 31-3875.07

Title 31Insurance and Securities.

Ch. 38FPrior Authorization by a Utilization Review Entity.

This text of District of Columbia § 31-3875.07 (Continuity of care for enrollees.) is published on Counsel Stack Legal Research, covering District of Columbia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

D.C. Code § 31-3875.07 (2026).

Text

(1)A utilization review entity shall honor an approval granted by a previous utilization review entity for at least the initial 60 days of an enrollee's coverage under the new health benefits plan; provided, that the utilization review entity may condition honoring the approval on receipt of information documenting the approval.

(2)During the 60-day period described in subsection (a) of this section, a utilization review entity may perform its own prior authorization review; provided, that if the utilization review entity issues an adverse determination following review, the adverse determination shall not take effect before the end of the 60-day period described in subsection (a) of this section.

(b)If a health insurer changes coverage of, or approval criteria for, a health care

Free access — add to your briefcase to read the full text and ask questions with AI

(1) A utilization review entity shall honor an approval granted by a previous utilization review entity for at least the initial 60 days of an enrollee's coverage under the new health benefits plan; provided, that the utilization review entity may condition honoring the approval on receipt of information documenting the approval.

(2) During the 60-day period described in subsection (a) of this section, a utilization review entity may perform its own prior authorization review; provided, that if the utilization review entity issues an adverse determination following review, the adverse determination shall not take effect before the end of the 60-day period described in subsection (a) of this section.

(b) If a health insurer changes coverage of, or approval criteria for, a health care service for which an enrollee previously received approval, the change in coverage or approval criteria shall not apply to an enrollee who received approval prior to the effective date of the change for the duration of the approval.

(c) A utilization review entity shall honor a prior grant of approval to an enrollee who changes health benefit plans offered by the same health insurer.