Chapter 6B. Medicaid Provider Reimbursement.

§ 44–671.01. Definitions

For the purposes of this chapter, the term:

(1) "Covered Hospital" means a hospital, as defined in § 44-501(a)(9), except the term shall not include:

(A) A hospital operated by the federal government;

(B) A specialty hospital, as defined by the State Plan;

(D) A hospital that serves an economically underserved area, as defined in the State Plan or by the Department in a managed care directed payment plan.

(2) "Department" means the Department of Health Care Finance.

(3) "Medicaid" means the medical assistance programs authorized by Title XIX of the Social Security Act, approved July 30, 1965 (79 Stat. 343; 42 U.S.C. § 1396 et seq.) and by § 1-307.02, and administered by the Department.

(4) "State Plan" means the District of Columbia Medicaid State Plan.

§ 44–671.02. Medicaid hospital provider reimbursement.

(a) Beginning October 1, 2023, the Department shall fund capitation rates for each managed care organization at a level that complies with the minimum reimbursement levels established in §§ 44-664.05(b-1) and 44-664.13(a)(2), and that ensures a covered hospital receives:

(1) Maximum outpatient hospital reimbursements of 110% of the fee-for-service rate methodology set forth in the State Plan; and

(2) Maximum inpatient hospital reimbursements equal to the negotiated managed care hospital rates that were in effect on March 31, 2023, for the managed care organization for inpatient hospital services.

(b) If necessary to ensure federal concurrence with the provisions of this section, the Department shall, by September 30, 2023, submit a state plan amendment or a managed care directed payment proposal to the Center for Medicare and Medicaid Services.

§ 44–671.03. Annual hospital costs reporting.

By December 31, 2023, and by December 31 of each year thereafter, the Department shall publish on its website a report on District all-payer hospital costs.

§ 44–671.04. Medicaid physician provider reimbursement.

The Mayor may direct the Department to make changes to the physician reimbursement methodology set forth in the State Plan for implementation no later than October 1, 2024.