D.C. Mun. Regs. tit. 29, r. 29-5302
Prepaid, capitated providers shall enter into risk comprehensive, non -risk, or other risk contracts with the Department to provide a predefined set of services to AFDC and AFDC-related recipients for a fixed, prepaid, capitated fee.
Prepaid, capitated providers shall be federally qualified HMOs or shall meet the requirements of an HMO as defined in the State Plan of Medical Assistance.
Unless a prepaid, capitated provider has received a waiver from the federal Health Care Financing Administration the provider shall maintain the sum of its membership of Medicaid and Medicare beneficiaries below seventy -five percent (75%) of its total enrollment.
Each prepaid, capitated provider shall establish a Medicaid Advisory Committee, which shall meet at least quarterly to advise the provider on matters regarding service to AFDC and AFDC -related Medicaid enrollees. At least two (2) members of the Advisory Committee shall be AFDC and AFDC -related Medicaid recipients enrolled in the provider's plan.
D.C. Mun. Regs. tit. 29, r. 29-5302