D.C. Mun. Regs. tit. 29, § 1403
Barring Responsible Third Parties From Refusing to Pay for Items or Services Based Solely on the Absence of Prior Authorization
Effective Apr 17, 202673 DCR 006110Authority: Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6)), and in An Act To enable the District of Columbia to receive Federal financial assistance under title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 744; D.C. Official Code § 1-307.02). Source: Final Rulemaking published at 73 DCR 006110 (April 17, 2026).District of Columbia, Office of the Secretary
1403.1 If a responsible third-party payer, other than a third-party payer described in the first parenthetical of Section 1902(a)(25)(I)(ii)(II) of the Social Security Act, 42 U.S.C. § 1396(a)(25)(I)(ii)(II), requires prior authorization for an item or service furnished to a beneficiary, the responsible third-party payer shall accept the authorization provided by the District that the item or service is covered under the State Plan (or waiver of such plan) for the beneficiary, as if such authorization were the prior authorization made by the third party for such item or service.
SOURCE: Final Rulemaking published at 73 DCR 006110 (April 17, 2026).