1. (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.

2. (a-1) Effective October 1, 2025, the Mayor may, notwithstanding any other law:

   1. (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. (2) For enrollees under age 21:

      1. (A) Exclude home health services, nursing facility services, and services provided by an inpatient psychiatric hospital from coverage under the program; and
      2. (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.
3. (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.

4. (c)

   1. (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. (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).
5. (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.
6. (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.
7. (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.

Short Title

Section 5001 of D.C. Law 20-61 provided that Subtitle A of Title V of the act may be cited as the “DC HealthCare Alliance Preservation Amendment Act of 2013”.

Short title: Section 5034 of D.C. Law 17-219 provided that subtitle O of title V of the act may be cited as the “Safety Net Clinics Fee Amendment Act of 2008”.

Short title: Section 5051 of D.C. Law 16-192 provided that subtitle E of title V of the act may be cited as the “Health Care Privatization Benefit Amendment Act of 2006”.

History

July 12, 2001, D.C. Law 14-18, § 7, 48 DCR 4047

Mar. 2, 2007, D.C. Law 16-192, § 5052, 53 DCR 6899

Aug. 16, 2008, D.C. Law 17-219, § 5035, 55 DCR 7598

Sept. 20, 2012, D.C. Law 19-168, § 5112, 59 DCR 8025

Dec. 24, 2013, D.C. Law 20-61, § 5002, 60 DCR 12472

Dec. 6, 2025, D.C. Law 26-55, § 5043(a)

Editor's Notes

Applicability of D.C. Law 20-61: Section 11001 of D.C. Law 20-61 provided that, except as otherwise provided, the act shall apply as of October 1, 2013.

Emergency Legislation

For temporary (90 days) amendment of this section, see § 5002 of the Fiscal Year 2014 Budget Support Congressional Review Emergency Act of 2013 (D.C. Act 20-204, October 17, 2013, 60 DCR 15341, 20 DCSTAT 2311).

For temporary (90 days) amendment of this section, see § 5002 of the Fiscal Year 2014 Budget Support Emergency Act of 2013 (D.C. Act 20-130, July 30, 2013, 60 DCR 11384, 20 DCSTAT 1827).

For temporary (90 day) amendment of section, see § 5112 of Fiscal Year 2013 Budget Support Congressional Review Emergency Act of 2012 (D.C. Act 19-413, July 25, 2012, 59 DCR 9290).

For temporary (90 day) amendment of section, see § 5112 of Fiscal Year 2013 Budget Support Emergency Act of 2012 (D.C. Act 19-383, June 19, 2012, 59 DCR 7764).

For temporary (90 day) amendment of section, see § 5052 of Fiscal Year 2007 Budget Support Congressional Review Emergency Act of 2007 (D.C. Act 17-1, January 16, 2007, 54 DCR 1165).

For temporary (90 day) amendment of section, see § 5052 of Fiscal Year 2007 Budget Support Congressional Review Emergency Act of 2006 (D.C. Act 16-499, October 23, 2006, 53 DCR 8845).

For temporary (90 day) amendment of section, see § 5052 of Fiscal Year 2007 Budget Support Emergency Act of 2006 (D.C. Act 16-477, August 8, 2006, 53 DCR 7068).

For temporary (90 day) amendment of section, see § 2 of Health Care Privatization Benefit and Reimbursement Exemption Emergency Amendment Act of 2006 (D.C. Act 16-374, May 19, 2006, 53 DCR 4388).

For temporary (90 days) amendment of this section, see § 5043(a) of Fiscal Year 2026 Budget Support Emergency Act of 2025 (D.C. Act 26-146, Sept. 3, 2025, 72 DCR 9623).

For temporary (90 days) amendment of this section, see § 5043(a) of Fiscal Year 2026 Budget Support Congressional Review Emergency Act of 2025 (D.C. Act 26-210, Nov. 24, 2025, 72 DCR 13514).

Temporary Legislation

For temporary (225 day) amendment of section, see § 2 of Health Care Privatization Benefit and Reimbursement Exemption Temporary Amendment of Act of 2006 (D.C. Law 16-155, September 19, 2006, law notification 53 DCR 7927).

Effect of Amendments

The 2013 amendment by D.C. Law 20-61 rewrote (c)(2).

The 2012 amendment by D.C. Law 19-168 added the (c)(1) designation; added “and subject to paragraph (2) of this subsection” in (c)(1); and added (c)(2).

D.C. Law 17-219 added subsec. (e).

D.C. Law 16-192 added subsecs. (c) and (d).

Section References

This section is referenced in § 7-1401 and § 44-407.