D.C. Mun. Regs. tit. 10, r. 10-A1106
Access to quality and affordable health care for all its residents is a challenge in the District as it is across the nation. In 2003, 13 percent of District residents were uninsured. Of the remaining 87 percent, 24 percent were covered by Medicaid, 10 percent by Medicare only, and 53 percent through employer or individual insurance programs. 1106.1
The District has been taking steps to expand access to health care. Since 1998, the District has increased the number of people enrolled in Medicaid, the federally and locally funded benefit program, from 112,000 residents to 138,000. In 2002, more than 75 percent of the District's eligible residents were enrolled in Medicaid. 1106.2
The District has also enrolled more than 20,000 people in the locally funded DC HealthCare Alliance, one of the few programs in the nation that pays for health services for low-income people who do not qualify for Medicaid. 1106.3
Yet, many District residents still have poor health and high rates of chronic disease and disability. In 2003, life expectancy in the District was 68 years, compared to the national average of 76.7 years. The HIV/AIDS rate in the District is ten times the national average. Illnesses like asthma, hepatitis, tuberculosis, and diabetes are also more prevalent in the District than in the nation at large. Some of these disparities are due to higher risk factors in the city, such as obesity, poor nutrition, substance abuse, and violence. But these factors alone do not determine the well-being of District residents. The incidence of serious illness and need for hospitalization can also be reduced through preventive treatment and more effective primary care. Consequently, many of the health care initiatives in the city aim to improve the delivery of affordable primary care services to residents. 1106.4
The Primary Care Administration (PCA) of the District Department of Health is responsible for developing new primary care sites, developing systems to monitor the quality of services provided at health care clinics, and assisting in the physical improvement of clinic space to improve access and increase capacity. The PCA also provides financial assistance for the improvement of existing primary care and community health center facilities. PCA provides subsidies to nonprofit health centers across the District. PCA also co-funds the Medical Homes DC program. In addition, PCA designates Health Professional Shortage Areas, Medically Undeserved Populations (MUP) and Medically Underserved Areas (MUA), based on federal standards. 1106.5
According to the District of Columbia Primary Care Association (DCPCA), a local nonprofit health care organization, more than half of the District's residents live in neighborhoods without adequate primary health care facilities or services. Many of the existing community health centers have significant unmet capital needs and do not have access to funds to renovate or replace their facilities. 1106.6
In response to these long-term needs, DCPCA initiated a program called Medical Homes DC in 2003 (see text box next page). The program seeks to enlarge and enhance the current network of community health centers. A "medical home" is a primary care facility where a patient's health history is known, where a patient is seen regardless of their ability to pay, and where a patient can routinely seek non-emergency care. 1106.7
Building a Healthier City: The Medical Homes DC Initiative
Medical Homes DC is an initiative of the DC Primary Care Association designed to improve the quality and effectiveness of primary health centers in the city. The project will serve the uninsured and underinsured residents of the District, many of whom seek primary care at hospital emergency rooms. By reducing avoidable hospitalizations and overcrowding of emergency rooms, Medical Homes DC is intended to reduce overall health care costs. And, by increasing the availability of good primary health care, the initiative should improve the overall health of DC residents. Medical Homes DC works by providing capital grants for facility improvements, as well as technical assistance to participating health centers on a range of matters, including clinical practices, billing, documentation, management oversight and capacity building. A public-private partnership, Medical Homes received a three-year grant from the federal Health Resources Services Administration. The Mayor and Council have also committed $15 million in capital funding. Medical Homes DC launched a competitive process in 2005 to distribute $1 million in construction-related grants for health care centers embarking on facility improvement projects. Projects that targeted medically underserved areas of the District were given priority. Nine facilities were selected to receive grants. Collectively, these projects have the potential to create capacity for 125,000 patient visits per year. Fund raising efforts are underway to support future projects.
Hospitals are an important part of the health care delivery system. Hospitals are another important part of the health care delivery system. There are numerous hospitals in the District, including large full-service facilities such as the George Washington University Hospital, Georgetown University Hospital, and the Washington Hospital Center, and more specialized facilities such as Walter Reed Medical Center, which serves the military and family members, the National Rehabilitation Center, and the Psychiatric Institute of Washington. The text box to the right includes a list of existing hospitals located within the District of Columbia. 1106.9
The distribution of these facilities across the city is presently uneven, with most hospital beds on the west side of the city and only one full-service hospital east of the Anacostia River. 1106.10
The health care facility policies in the Comprehensive Plan seek to provide a more equitable geographic distribution of community health care facilities throughout the city. The primary means of achieving this goal is the establishment of a comprehensive network of community-based health centers. While some centers already exist, they are often located in outmoded facilities that need to be renovated or replaced. 1106.11
Policy CSF-2.1.1: Primary and Emergency Care
Ensure that high quality, affordable primary health centers are available and accessible to all District residents. Emergency medical facilities should be geographically distributed so that all residents have safe, convenient access to such services. New or rehabilitated health care facilities should be developed in medically underserved and/or high poverty neighborhoods, and in areas with high populations of senior citizens, the physically disabled, the homeless, and others with unmet health care needs. 1106.12
Policy CSF-2.1.2: Public-Private Partnerships
Develop public-private partnerships to build and operate a strong, cohesive network of community health centers in areas with few providers or health programs. 1106.13
Policy CSF-2.1.3: Coordination to Better Serve Special Needs Residents
Design and coordinate health and human services to ensure the maximum degree of independence for senior citizens, the disabled, and the physically and mentally handicapped. 1106.14
Policy CSF-2.1.4: Drug and Alcohol Treatment Facilities
Develop an adequate number of equitably distributed and conveniently located drug and alcohol treatment facilities to provide easily accessible, high quality services to those District residents in need of such services. 1106.15
Policy CSF-2.1.5: Mental Health Facilities
Provide easily accessible, and equitably distributed high quality mental health treatment facilities for District residents in need of such services. 1106.16
Policy CSF-2.1.6: Health Care Planning
Improve the coordination of health care facility planning with planning for other community services and facilities, and with broader land use and transportation planning efforts in the city. Coordinate city population and demographic forecasts with health care providers to ensure that their plans are responsive to anticipated growth and socio-economic changes. 1106.17
Policy CSF-2.1.7: Hospices and Long-Term Care Facilities
Support the development of hospices and other long-term care facilities for persons with advanced HIV/AIDS, cancer, and other disabling illnesses. 1106.18
Action CSF-2.1.A: Implement Medical Homes DC
Work with DCPCA and other partners to implement the recommendations of the Medical Homes DC initiative, including the modernization of primary care facilities and development of new facilities in under-served areas. 1106.19
Hospitals in the District of Columbia
Action CSF-2.1.B: Review Zoning Issues
Review and assess zoning regulations to identify barriers to, and create opportunities for, the development of primary care facilities and neighborhood clinics, including the reuse of existing non-residential buildings in residential zones, after a public review and approval process that provides an opportunity to address neighborhood impacts.
The provisions of Title 10, Part A of the DCMR accessible through this web interface are codification of the District Elements of the Comprehensive Plan for the National Capital. As such, they do not represent the organic provisions adopted by the Council of the District of Columbia. The official version of the District Elements only appears as a hard copy volume of Title 10, Part A published pursuant to section 9 a of the District of Columbia Comprehensive Plan Act of 1994, effective April 10, 1984 (D.C. Law 5-76; D.C. Official Code § 1 -301.66)) . In the event of any inconsistency between the provisions accessible through this site and the provisions contained in the published version of Title 10, Part A, the provisions contained in the published version govern. A copy of the published District Elements is available www.planning.dc.gov.
D.C. Mun. Regs. tit. 10, r. 10-A1106