10202.1 All beneficiaries who meet the eligibility criteria set forth in § 10201 may participate in the My Health GPS program.

10202.2 A beneficiary shall only be assigned to a single My Health GPS entity at any time in accordance with the process set forth below:

1. (a) An eligible beneficiary shall be assigned to the My Health GPS entity that currently provides the beneficiary's primary care services or to a My Health GPS entity that is part of a corporate entity that currently provides the beneficiary's primary care services; or
2. (b) If the beneficiary has a relationship with more than one (1) My Health GPS entity, as determined by the Department of Health Care Finance (DHCF) through a review of Medicaid claims submitted during the past twelve (12) months, the beneficiary shall be assigned to the My Health GPS entity seen most frequently during the review period; or
3. (c) If a beneficiary who meets the criteria described in (b) has seen multiple My Health GPS entities with equal frequency during the review period, the beneficiary shall be assigned to the entity seen most recently during the review period; or
4. (d) If the beneficiary does not have a prior relationship with any My Health GPS entity, as determined by DHCF through a review of Medicaid claims submitted during the past twelve (12) months, the beneficiary shall be assigned to a My Health GPS entity based on the entity's capacity to serve additional beneficiaries and the geographic proximity of the beneficiary to the entity.

10202.3 The initial assignment of eligible beneficiaries shall occur after the prospective entity has successfully completed the application process and received approval to become a My Health GPS provider from DHCF. Eligible beneficiaries who enter the program after the initial assignment period shall be assigned on a time basis established in accordance with guidance published to the DHCF website or within thirty (30) days of receipt of a referral from a My Health GPS provider, whichever is earlier.

10202.4 After an assignment is made, DHCF shall provide the beneficiary with the following information in writing:

1. (a) A clear statement that the beneficiary has been identified as eligible to participate in the My Health GPS program;

2. (b) A clear explanation of the benefits of the My Health GPS program and the services provided;

3. (c) Information regarding the My Health GPS entity to which the beneficiary has been assigned;
4. (d) A clear explanation of the beneficiary's right to select a different My Health GPS entity or to 'opt out' of the My Health GPS program; and
5. (e) Instructions on selecting a different My Health GPS entity and 'opting out' of the My Health GPS program.10202.5 DHCF shall provide any other provider furnishing primary care services to an eligible beneficiary with:- (a) Notification that the beneficiary served by the provider has been determined eligible for the My Health GPS program and assigned to a My Health GPS entity;
6. (b) A clear explanation of the benefits of the My Health GPS program and the services provided; and
7. (c) Information regarding the My Health GPS entity to which each beneficiary has been assigned.10202.6 A beneficiary who has been assigned to a My Health GPS entity shall have the right to select a different entity or to 'opt out' of the My Health GPS program.10202.7 A beneficiary may notify DHCF at any time that the beneficiary wishes to select a different My Health GPS entity or 'opt out' of the program.10202.8 A beneficiary who has been assigned to a My Health GPS entity and wishes to be assigned to a different entity shall notify DHCF. The assignment to the new entity shall occur as follows:- (a) If the beneficiary notifies DHCF of the new selection prior to the twentieth (20^th) day of the month, the beneficiary shall be re-assigned to the new entity effective the first (1^st) day of the month following the month in which the beneficiary notified DHCF of the new selection;
8. (b) If the beneficiary notifies DHCF on or after the twentieth (20^th) day of the month, the beneficiary shall be re-assigned to the new entity effective the first (1^st) day of the second (2^nd) month following the month in which the

beneficiary notified DHCF of the new selection; and

(c) The beneficiary shall remain eligible to receive My Health GPS services from the beneficiary's current My Health GPS entity until the effective date of the beneficiary's assignment to the new entity.

10202.9 DHCF may reassign a beneficiary from the My Health GPS program if:

(a) A beneficiary is assigned to a My Health GPS entity that has not submitted an initial claim for a person-centered care plan in accordance with § 10207.12 within the first two (2) quarters following the effective date of the beneficiary assignment, as described in § 10202.3; or

(b) DHCF determines through an internal review, at least annually, that the beneficiary is no longer actively participating in the My Health GPS program and the beneficiary's My Health GPS entity has not submitted claims for reimbursement of Health Home services by the quarter in which the beneficiary's next annual assessment and care plan fall.

10202.10 If DHCF reassigns a beneficiary to a new My Health GPS entity, DHCF shall notify the entity to which the beneficiary was previously assigned of the reassignment in writing, including the following information:

(a) A clear statement explaining why the beneficiary has been re-assigned;

(b) Specific reference to the applicable sections of the rules, statute or provider manual; and

(c) The effective date of the re-assignment.

10202.11 The effective date of a beneficiary's enrollment in the My Health GPS program shall be the date on which the My Health GPS provider completes the components of the beneficiary's person-centered care plan in accordance with § 10207.12.

SOURCE: Final Rulemaking published at 65 DCR 0636 (January 26, 2018); as amended by Final Rulemaking published at 66 DCR 5381 (April 26, 2019); as amended by Final Rulemaking published at 72 DCR 010392 (September 26, 2025).