1400.1 Whenever the District provides health-care assistance to a beneficiary who has suffered an injury or illness under circumstances that would have created a liability upon a third party had the beneficiary instead of the District incurred the expense of the health-care assistance, the District shall have an independent, direct cause of action against that third party for the unreimbursed value and/or cost of the health-care assistance provided.

1400.2 As soon as the District begins providing health-care assistance to a beneficiary, it shall become subrogated to any right or claim that the beneficiary has against a third party for the care and treatment it has undertaken to provide or pay for as health-care assistance. Alternatively, or in addition to the legal subrogation effected under this subsection, the Department may require a beneficiary to execute a written assignment of that same right or claim.

1400.3 In determining the unreimbursed value of health and health-related care and treatment that the District undertakes to provide directly to a beneficiary, the Department shall refer directly to the agency or institution which rendered the care or treatment to determine health or health-related cost for care and treatment.

1400.4 All DHCF contractors, including managed care organizations who provide services to Medicaid beneficiaries, shall comply with all applicable federal and District statutes and regulations.

AUTHORITY: Unless otherwise noted, the authority for this chapter is.

SOURCE: Final Rulemaking published at 33 DCR 1320 (March 7, 1986); as amended by Final Rulemaking published at 73 DCR 006110 (April 17, 2026).