District of Columbia

SUMMARY

In the 2017-2018 legislative term, the District of Columbia legislature introduced a bill related to the implementation of the Certificate of Need (CON) program for healthcare facilities and also passed the Telehealth Medicaid Expansion Act of 2017, which expands the scope of reimbursable telehealth services covered by Medicaid. For a complete listing of health related statutes visit the State Health Practice Database for Research.

 

LEGISLATION/REGULATION

Legislative Calendar

The District of Columbia’s current regular legislative session runs from 1/2/2018 – 12/31/2018. Bills from 2017 were carried over to 2018 for the 2017-2018 legislative term.

Recent Legislative Developments

Healthcare Transparency

  • None identified.

 

Healthcare Cost

  • None identified.

 

Healthcare Markets

2017-2018 B22-0233 Telehealth Medicaid Expansion Act of 2017: To amend the Telehealth Reimbursement Act of 2013 to expand the scope of reimbursable telehealth services covered by Medicaid, to clarify that all categories of Medicaid recipients are eligible for telehealth services, to establish eligibility and prior authorization requirements for remote patient monitoring services, to require operational standards and establish conditions of payment for remote patient monitoring services, to establish fees for remote patient monitoring services, to establish facility fees for telehealth services, to require the Mayor to seek the approval of the Centers for Medicare and Medicaid Services for any amendments to the District’s Medicaid State Plan necessary to implement the act, and to require the Department of Health Care Finance to issue rules. Passed– Act A22-0345, Law L22-0216 effective 7/3/18.
B2-0558 This bill requires health care facilities to add community benefits – health improvement services and benefits that are provided without charge – as a prerequisite to obtaining or maintaining a certificate of need. The community benefits must be made specifically available to District residents. Active– public hearing held 7/11/18.

 

Key Statutes

We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.

 

Healthcare Costs

  • D.C. Code §§ 48-855.01 — 48-855.03 requires that a health benefit plan that provides coverage for prescription drugs shall ensure that a required copayment or coinsurance applicable to a drug on a specialty tier does not exceed $150 per month for up to a 30-day supply of the specialty drug or $300 for a 90-day supply. On July 1 of each year, the limit on a required copayment or coinsurance applicable to a drug on a specialty tier shall increase by a percentage equal to the percentage change from the preceding year in the medical care component of the March Consumer Price Index for All Urban Consumers, Washington-Baltimore metropolitan area, as published by the Bureau of Labor Statistics of the United States Department of Labor.

 

Healthcare Markets

  • D.C. Code §§ 31-3861 — 31-3863 provides that a health insurer offering a health benefits plan in the District may not deny coverage for a healthcare service on the basis that the service is provided through telehealth if the same service would be covered when delivered in person.Additionally,Medicaid shall cover and reimburse for healthcare services appropriately delivered through telehealth if the same services would be covered when delivered in person.A health insurer shall reimburse the provider for the diagnosis, consultation, or treatment of the insured when the service is delivered through telehealth.

 

LITIGATION/ENFORCEMENT 

  • None identified.

 

KEY RESOURCES

District of Columbia Legislature

District of Columbia Office of the Attorney General

District of Columbia Department of Insurance