1401.1 Any individual, authorized representative, institutional health-care provider, or managed care plan that bills the District for health-care assistance furnished to a beneficiary shall provide the Department with written notice of any known or suspected third-party liability as required in D.C. Code § 4-606(a). The written notice of known or suspected third-party liability shall include the following:

1. (a) The beneficiary's name, date of birth, address, social security number, and Medicaid recipient number, if any;
2. (b) The name, address, and telephone number of the liable third-party, if known;
3. (c) A description of the incident causing the injury or illness, including the date and location;
4. (d) A description of the types of injuries sustained and whether treatment is ongoing; and
5. (e) A HIPAA release form signed and dated by the Medicaid recipient.

1401.2 A beneficiary, or if represented, the beneficiary's attorney, shall provide the Department and the District of Columbia Office of the Attorney General ("OAG") with written notice of any known or suspected third-party liability before taking any steps to recover damages or costs arising from an incident involving the third party. The written notice of intent to recover damages shall include the following:

1. (a) The beneficiary's name, date of birth, address, social security number, and Medicaid recipient number, if any;
2. (b) The name, address, and telephone number of the beneficiary's attorney, if any;
3. (c) The name, address, and telephone number of the third party;
4. (d) The name, address, and telephone number of the third party's attorney, if known;
5. (e) The name, address, and telephone number of the third party's insurer, if known;
6. (f) The name, address, and telephone number of beneficiary's insurer, if

known;

(g) A description of the incident causing the injury or illness, including the date and location; and

(h) A letter of representation from the beneficiary’s attorney, if any, which shall include the beneficiary’s signature.

1401.3 Upon receipt of a written notice of known or suspected liability of a third party pursuant to §§ 1401.1 and 1401.2, the Department shall respond to the beneficiary or, if represented, the beneficiary’s attorney within sixty (60) calendar days and provide the dollar amount or monetary value of health-care assistance provided to or paid for on behalf of the beneficiary by the District for the incident related to the injury or illness.

1401.4 A third-party payer shall respond to a state inquiry regarding a healthcare claim from the Department within sixty (60) days of receiving the inquiry.

1401.5 If the beneficiary separately institutes a proceeding against or settlement negotiations with a third party, the beneficiary or if represented, the beneficiary’s attorney shall inform the third party that the District also has a claim, and shall give the Department and OAG written notice of the action or settlement negotiations, by certified mail, email or personal service, within twenty (20) calendar days after instituting a proceeding or beginning settlement negotiations.

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