(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.
(a-1) Effective October 1, 2025, the Mayor may, notwithstanding any other law:
(1)Limit the services provided by the DC Healthcare Alliance program to enrollees who are age 21 or older to such primary care services, inpatient and outpatient acute-care hospital services, emergency medical transportation services, prescription drugs, and durable medical equipment as may be designated by the Mayor; and
(2)For enrollees under age 21:
(A)Exclude home health services, nursing facility services, and services provided by an inpatient psychiatric hospital from coverage under the program; and
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(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.
(a-1) Effective October 1, 2025, the Mayor may, notwithstanding any other law:
(1) Limit the services provided by the DC Healthcare Alliance program to enrollees who are age 21 or older to such primary care services, inpatient and outpatient acute-care hospital services, emergency medical transportation services, prescription drugs, and durable medical equipment as may be designated by the Mayor; and
(2) For enrollees under age 21:
(A) Exclude home health services, nursing facility services, and services provided by an inpatient psychiatric hospital from coverage under the program; and
(B) Limit coverage by the program to such primary care, dental, durable medical equipment, and behavioral health services as may be designated by the Mayor.
(b) A contract entered into by the Mayor pursuant to subsection (a) or (a-1) of this section shall be exempt from the requirements of subchapter I of Chapter 3A of Title 2 ; except, that the contract shall be subject to § 2-352.02 .
(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.
(f) The Mayor may establish by rule, pursuant to § 7-1406 , a limit on the number of District residents who may be served by a contract entered into, or program established under, this section; provided, that the rules shall provide DC HealthCare Alliance program enrollees with a 90-day grace period beyond the end of the enrollee's certification period to complete any renewal requirements and, if deemed eligible, retroactive coverage to the end of the prior certification period without interruption.