5301.1 Each prepaid, capitated provider shall execute a Medicaid managed care provider agreement with the Department.

5301.2 Each prepaid, capitated provider shall admit or refer all AFDC and AFDC-related Medicaid recipients requiring hospital care only to a hospital located in the District unless:

1. (a) Emergency care is required and a non-District hospital is the closest emergency facility to the recipient at the time of the emergency; or
2. (b) The enrollee requires a specialized service not available in a hospital located in the District.

5301.3 Each prepaid, capitated provider shall maintain a staffed business office in the District.

SOURCE: Final Rulemaking published at 42 DCR 1566, 1567 (March 31, 1995).