D.C. Mun. Regs. tit. 26, r. 26-A4708

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

Rule 26-A4708 - ENFORCEMENT

4708.1

The Commissioner may require a modification to the Access Plan, order an appropriate corrective action plan that shall be followed by the health carrier, or use any other enforcement powers permitted under District of Columbia law or regulation to obtain the health carrier's compliance with this chapter, if the Commissioner determines that one or more of the following has occurred:

(a) The health carrier has not contracted with a sufficient number of participating providers to ensure that covered persons will have reasonably accessible health care services in a geographic area;

(b) The health carrier's Access Plan does not ensure reasonable access to covered benefits;

(c) The health carrier's appeals process regarding coverage and billing is inaccessible or if its decisions are not in conformity with applicable law and regulations; or

(d) The health carrier has not complied with a provision of this chapter.

4708.2

The Commissioner will not arbitrate, mediate, or settle disputes regarding a decision not to include a provider in a network plan or provider network, or regarding any other dispute between a health carrier, its intermediaries, or providers, arising under or by reason of a provider contract or the contract's termination.

D.C. Mun. Regs. tit. 26, r. 26-A4708

Final Rulemaking published at 70 DCR 2231 (2/17/2023)