10203.1 DHCF shall disenroll a beneficiary from the My Health GPS program if DHCF determines that the beneficiary no longer meets the eligibility requirements as set forth under § 10201.

10203.2 If DHCF takes action to disenroll an enrolled beneficiary from the My Health GPS program as set forth in § 10203.1, DHCF shall issue a written notice to the beneficiary at least thirty (30) calendar days prior to the effective date of the intended disenrollment, which shall contain the following information:

1. (a) A clear statement of the intended action to disenroll the beneficiary from the My Health GPS program;
2. (b) An explanation of the reason(s) for the intended action;
3. (c) Citations to the laws or regulations supporting the intended action;
4. (d) An explanation of the beneficiary's right to request that DHCF reconsider its decision to disenroll the beneficiary, including the timeframe and procedures for making a request for reconsideration;
5. (e) An explanation of the beneficiary's right to request a Fair Hearing, including the timeframe and procedures for requesting a hearing; and
6. (f) The circumstances under which the beneficiary's current My Health GPS services will be continued if a reconsideration or Fair Hearing is requested.

10203.3 A request for reconsideration of the decision to disenroll a beneficiary made pursuant to § 10203.2(d) must be submitted in writing, by mail, fax, or in person, to DHCF within thirty (30) calendar days of the date of the notice of disenrollment described in § 10203.2. The request for reconsideration shall include information and documentation as follows:

1. (a) A written statement by the beneficiary, or the beneficiary's designated representative, describing the reason(s) why the decision to disenroll the beneficiary should not be upheld;
2. (b) A written statement by a clinician familiar with the beneficiary's health care needs describing the reason(s) why the decision to disenroll the beneficiary should not be upheld; and
3. (c) Any additional, relevant documentation in support of the request.

10203.4 For beneficiaries currently receiving My Health GPS services, a timely filed request for reconsideration will stay the termination of services until a reconsideration decision is issued.

10203.5 DHCF shall issue a reconsideration decision no more than thirty (30) calendar days from the date of receipt of the documentation required in § 10203.3.

10203.6 If DHCF decides to uphold the disenrollment determination, the reconsideration decision shall contain the following:

(a) A description of all documents that were reviewed;

(b) The justification(s) for the intended action(s) and the effective date of the action(s);

(c) An explanation of the beneficiary’s right to request a Fair Hearing, including the timeframes and procedures for requesting a hearing; and

(d) The circumstances under which My Health GPS services will be provided during the pendency of a Fair Hearing.

10203.7 A request to appeal the reconsideration decision issued pursuant to § 10203.5 must be submitted within ninety (90) calendar days of the date of issuance of the reconsideration decision by requesting a Fair Hearing with the Office of Administrative Hearings in writing, in person, or by telephone, in accordance with 1 DCMR § 2971.

10203.8 DHCF shall not disenroll a beneficiary from the My Health GPS program while a Fair Hearing is pending if the beneficiary files the Fair Hearing request prior to the effective date of the proposed action to disenroll the beneficiary.

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