D.C. Mun. Regs. tit. 22, r. 22-B3301

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 22-B3301 - APPLICATION, REDETERMINATION, AND RENEWAL

3301.1

An applicant shall apply for the Alliance program by submitting to the Department an application form designated by the Department, which may be found on its website at https://dhcf.dc.gov/service/how-apply-medical-coverage. The application form may be submitted to the Department:

(a) In person;

(b) By mail;

(c) By phone; or

(d) Through other commonly available electronic means, including fax or online via a web-based portal.

3301.2

Applicants and beneficiaries for the Alliance program shall not be required to participate in an interview as a condition of eligibility during FY 2022. Waiver of participation in an interview in subsequent fiscal years is contingent on funding by the Council.

3301.3

An application and any required verification may be submitted by:

(a) The applicant;

(b) An adult who is in the applicant's household or family; or

(c) An authorized representative of the applicant, pursuant to §§ 3301.23.

3301.4

Where the Department requires additional information to determine eligibility, the Department shall provide written notice that includes a statement of the specific information needed to determine eligibility and the date by which an applicant or beneficiary shall provide the required information.

3301.5

The Department shall issue an eligibility determination, consistent with the timeframe described under §§ 3301.9 based on the receipt of an application that includes, at a minimum:

(a) The applicant's name;

(b) The applicant's District address. If the applicant is homeless, attests to their homelessness (consistent with §§ 3302.4), and cannot provide contact information, the applicant may select a mailing address provided from a list maintained by the DHS, or provide an email address or phone number for the Department to be able to contact the applicant; and

(c) A signature (via wet, digital, or electronic, as appropriate), under penalty of perjury.

3301.6

The applicant shall complete the application process described in paragraphs (a) through (b) of this subsection in order for the Department to determine whether an applicant meets the eligibility factors for the Alliance program:

(a) Provide a complete application for the Alliance program in accordance with §§ 3301.7; and

(b) Submit required verifications for financial and non-financial eligibility factors.

3301.7

An application shall be considered complete if all of the following requirements are met:

(a) All information including, demographic information, household composition, residency, and income, to determine eligibility is provided; and

(b) The application is signed and dated, under penalty of perjury.

3301.8

The Department shall use the date an application is received by the Department, as described under §§ 3301.5, to determine the earliest date for which health care and medical services under the Alliance program can be effective, consistent with the enrollment requirements described under §§ 3305.1.

3301.9

The Department shall issue written notice informing the applicant of the Department's eligibility determination within forty-five (45) calendar days of the date an application is received by the Department. The Department may extend the forty-five (45) day period pursuant to DC Official Code §§ 4-205.26 when a delay is caused by unusual circumstances such as:

(a) Circumstances wholly within the applicant's control;

(b) Circumstances beyond the applicant's control such as hospitalization or imprisonment; or

(c) An administrative or other emergency that could not be reasonably controlled by the Department.

3301.10

An applicant or the applicant's authorized representative pursuant to §§ 3301.23 may withdraw an application upon request, through a signed statement, and prior to an eligibility determination through the following means:

(a) In person;

(b) By mail;

(c) By phone, if a signed statement is additionally submitted; or

(d) Through other commonly available electronic means, including fax or

online via a web-based portal.

3301.11

A beneficiary shall notify the Department within ten (10) calendar days of any change in circumstances that directly affects the beneficiary's eligibility to receive benefits under the Alliance program.

3301.12

The Department shall re-determine eligibility for beneficiaries identified at §§ 3301.11 at the time the change is reported.

3301.13

Beginning on October 1, 2022, each Alliance program beneficiary shall renew eligibility every twelve (12) months by submitting a renewal form to the Department of Health Care Finance either in person, by mail, by other commonly available electronic means, including by fax or online via web-based portal, or by completing the renewal telephonically.

3301.14

The Department shall provide a renewal form to the beneficiary sixty (60) days before the end of the certification period and shall notify the beneficiary of the date the beneficiary shall provide the requested information (which may be through the modalities described in §§3301.13). The beneficiary shall provide the requested information at least thirty (30) days before the end of the certification period to avoid a lapse in coverage and to allow time for application processing, review, and an eligibility determination.

3301.15

Where the Department provides a beneficiary with a renewal form to begin the renewal process, the beneficiary shall:

(a) Provide, at a minimum, the information listed in paragraphs (a) - (b) of §§ 3301.5;

(b) Sign the form (via wet, digital, or electronic signature, as appropriate), under penalty of perjury; and

(c) Submit the form to the DHS, Economic Security Administration (ESA) in person, by mail, by phone, or through other commonly available electronic means (including by fax or online via a web-based portal) at least thirty (30) days before the end of the beneficiary's certification period.

3301.16

The renewal process shall be complete if all of the following requirements are met:

(a) All information including, but not limited to demographic information, household composition, residency, and income, to determine eligibility is provided;

(b) The application is signed and dated, under penalty of perjury, consistent with §§ 3301.15(b); and

(c) The application (either paper, electronic, or telephonic) is received by the Department.

3301.17

The Department shall issue a written notice of termination to the beneficiary if the beneficiary has not returned the renewal form or submitted a telephonic or online renewal, and ESA has not received all information necessary to renew eligibility by 30 days prior to the end of the beneficiary's certification period.

3301.18

Where a beneficiary has not submitted a complete renewal, as described under §§ 3301.16 by the end of the beneficiary's certification period, the beneficiary shall be given an additional ninety (90) day grace period beyond the end of the beneficiary's certification period to complete the renewal requirements. If the beneficiary completes the renewal consistent with requirements under §§ 3301.16 during this grace period, the beneficiary's case will be re-opened without requiring the submission of a new application. In cases where the renewal is completed during the grace period, if the Department determines the individual remains eligible, coverage shall be reinstated retroactive to the end of the prior certification period without interruption. If the Department determines the individual ineligible for coverage, the Department shall issue a notice notifying the beneficiary that they are no longer eligible for coverage.

3301.19

The Department shall begin the termination process for Alliance program eligibility in accordance with the requirements described in section 3308 when:

(a) A beneficiary fails to complete the renewal requirements (described under §§ 3301.16) and meet the requirements set forth under §§ 3301.15 by thirty (30) days before the end of the certification period;

(b) The beneficiary no longer meets all eligibility factors;

(c) The beneficiary requests termination; or

(d) The beneficiary fails to respond to a request for verification of information, as described under §§ 3301.4.

3301.20

Upon receipt of a request for termination of eligibility by the beneficiary or the beneficiary's authorized representative in writing (including a written request submitted through mail, or other commonly available electronic means including by fax or online via a web-based portal) or telephonically, the Department shall terminate the beneficiary's eligibility on:

(a) The last day of the month in which the Department receives the request where there are fifteen (15) or more days remaining in the month;

(b) The last day of the month following the month in which the Department receives the request where there are fewer than fifteen (15) days remaining in the month; or

(c) A date earlier than those referenced in paragraphs (a) and (b), upon request by the beneficiary.

3301.21

A request to terminate Alliance program eligibility shall be complete if all of the following requirements are met:

(a) The request is submitted in person, by mail, by phone, or through other commonly available electronic means (including fax or online via a webbased portal);

(b) The request is signed and dated by the beneficiary or the beneficiary's authorized representative, under penalty of perjury;

(c) The request includes all information necessary to determine the identity of the individual seeking termination, including but not limited to the individual's name, date of birth, address, phone number, and beneficiary identification number (if one was assigned and is available).

3301.22

The Department shall provide written notice of voluntary, and may waive the requirement that notice be provided no later than fifteen (15) calendar days before the action as stated under §§ 3308.4.

3301.23

An individual may designate someone to be an authorized representative to act on the individual's behalf and assist with an application, a redetermination of eligibility, and other on-going communications with the Department. If so, the Department shall require the following:

(a) The designation of an authorized representative shall be in writing and signed by the individual seeking representation, except that legal documentation of authority to act on behalf of an individual under District law, including a court order establishing legal guardianship or power of attorney, may serve in the place of a signed written authorization;

(b) The authority of an authorized representative shall be valid until the represented individual or authorized representative notifies the Department that the representative is no longer authorized to act on the individual's behalf, or there is a change in the legal document of authority to act on the individual's behalf; and

(c) Any authorized representative to agree to maintain, or be legally bound to maintain, the confidentiality of any information regarding the represented individual provided by the Department.

D.C. Mun. Regs. tit. 22, r. 22-B3301

Notice of Final Rulemaking published at 48 DCR 9140 (October 5, 2001); as amended by Notice of Final Rulemaking published at 53 DCR 4135 (May 19, 2006); Amended by Final Rulemaking published at 69 DCR 4550 (5/6/2022); amended by Final Rulemaking published at 71 DCR 4695 (4/26/2024)

AUTHORITY: Unless otherwise noted, the authority for this chapter is the Health Care Privatization Amendment Act of 2001, 48 DCR 7860 (July 12, 2001); and the District of Columbia Financial Responsibility and Management Assistance Act of 1995 § 207(d), D.C. Code, 2001 Ed. § 47-392.07(d).