D.C. Mun. Regs. tit. 29, r. 29-5313
Each subcontract entered into by each prepaid, capitated provider for services covered by the organization's Medicaid managed care provider agreement shall be submitted to the Department for approval prior to the execution of the subcontract.
No subcontract shall terminate the legal obligation of the prepaid, capitated provider to ensure that all activities carried out by the subcontractor conform to the provisions of the prepaid, capitated provider's Medicaid managed care provider agreement. Subject to these conditions, any service or function required to be provided by the prepaid, capitated provider may be subcontracted to a qualified organization or person.
The Department shall notify the prepaid, capitated provider, in writing, of its approval or disapproval of the proposed subcontract within fifteen (15) business days of receipt of the proposed subcontract and supporting documentation required by the Department. The Department shall specify the reasons for any disapproval, which shall be based only on District or Federal law or regulations. A managed care provider may not directly or indirectly restrict a subcontractor from engaging in business with other providers of Medicaid services.
Failure to notify the prepaid capitated provider of the approval or disapproval of the proposed subcontract within the fifteen (15) day time limit mentioned in § 5313.3 shall be construed as approval of the proposed subcontract.
If a prepaid, capitated provider executes a subcontract for services covered by the organization's Medicaid managed care provider agreement without the prior written approval of the Department, the Department may terminate the prepaid, capitated provider's Medicaid managed care provider agreement in accordance with the procedures of § 5320.
The Department may require the prepaid, capitated provider to furnish additional information relating to the ownership of the subcontractor, the subcontractor's ability to carry out the proposed obligations under the subcontract, and the procedures to be followed by the prepaid, capitated provider to monitor the execution of the subcontract.
Subject to the provisions of § 5313.1, a prepaid, capitated provider may enter into a subcontract with a health care provider who is not enrolled in the Medicaid program but who otherwise meets all other federal and District requirements for participation in the Medicaid program.
A prepaid, capitated provider shall not enter into a subcontract for Medicaid services with a health care provider who has been convicted of any crime or who has been the subject of any sanction described in § 1128 of the Social Security Act ( 42 U.S.C. 1320a -7). The Department shall not reimburse a prepaid, capitated provider for any services provided to a Medicaid recipient by a subcontractor who has been convicted of a crime or the subject of a sanction described in § 1128 of the Social Security Act.
Except as provided in § 5301.2, a prepaid, capitated provider shall not enter into a subcontract with a hospital located outside the District to provide inpatient hospital services to District AFDC and AFDC-related Medicaid recipients.
Each subcontract shall be in writing and shall contain, at a minimum, the following:
The prepaid, capitated provider shall notify the Department, in writing, of the termination of any subcontract and any arrangements made to ensure continuation of the services covered by the terminated subcontract not less than thirty (30) days prior to the effective date of the termination.
If the Department determines that the termination or expiration of a subcontract materially affects the ability of the prepaid, capitated provider to carry out its responsibility under its Medicaid managed care provider agreement, the Department may terminate the Medicaid managed care provider agreement.
D.C. Mun. Regs. tit. 29, r. 29-5313