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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 29. PUBLIC WELFARE |
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Chapter 29-53. STANDARDS FOR MANAGED CARE PROVIDERS THAT ARE PAID ON A FIXED, PREPAID, CAPITATED BASIS FOR SERVICES RENDERED TO AFDC AND AFDC-RELATED MEDICAID RECIPIENTS |
Section 29-5301. PREPAID CAPITATED PROVIDER QUALIFICATIONS - GENERAL
Latest version.
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5301.1Each prepaid, capitated provider shall execute a Medicaid managed care provider agreement with the Department.
5301.2Each prepaid, capitated provider shall admit or refer all AFDC and AFDC-related Medicaid recipients requiring hospital care only to a hospital located in the District unless:
(a)Emergency care is required and a non-District hospital is the closest emergency facility to the recipient at the time of the emergency; or
(b)The enrollee requires a specialized service not available in a hospital located in the District.
5301.3Each prepaid, capitated provider shall maintain a staffed business office in the District.
source
Final Rulemaking published at 42 DCR 1566, 1567 (March 31, 1995).