Overview
The District of Columbia established its own health insurance exchange under the Affordable Care Act, whereas most states maintain exchanges facilitated by the federal government.
In provider market oversight, the District of Columbia requires the State Health and Planning Development Agency (SHPDA) to issue a certificate of need for all proposals to offer or develop institutional health services or acquire assets. The SHPDA also has the authority to approve the closure or termination of a health care facility. Statutory law also requires the Attorney General to review the conversion of any non-profit healthcare entity to a for-profit entity. The Attorney General will approve a conversion only if the entity has taken actions to protect the value of its charitable assets.
The District of Columbia has also enacted laws to advance telehealth. First, health insurers that offer benefit plans in the District must cover services delivered via telehealth if the same service would be covered when provided in person. Second, health insurers must reimburse covered providers for diagnosis, consultation, and treatment services provided through telehealth. This does not require, however, that the insurers reimburse covered providers at the same rate as if the services were provided in person. Third, health insurers may not require deductibles, copayments, or coinsurance amounts that exceed the amounts that apply to their in-person counterparts. In addition, the Telehealth Medicaid Expansion Act of 2017 broadened the scope of services covered by Medicaid. The Act added behavioral health care services, rehabilitation services, medication management services, remote patient monitoring, and more.
D.C. is also the jurisdiction of the antitrust enforcement case against the proposed $54 billion merger between Anthem and Cigna. The DOJ brought an enforcement action for potential violation of the Clayton Antitrust Act to avoid a decrease in competition in the insurance market. The D.C. Circuit Court of Appeals affirmed the district court’s decision to block the merger. Anthem appealed to the Supreme Court, but the petition was ultimately dismissed and the merger was abandoned.
See below for an overview of existing District of Columbia mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/2/2023 - 1/1/2024 (2023-2024 term). *Current session bill updates are ongoing. Check back weekly for updates.
B2-0558 – District of Columbia
Introduced: 2017 Status: Inactive / Dead
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 …
B22-0106 – District of Columbia
Introduced: 2017 Status: Enacted
This legislation allows licensed pharmacy practitioners to prescribe and dispense self-administered hormonal contraceptives and also requires insurers to cover certain health care services without cost-sharing, including breast cancer screening and counseling, screening for HIV and …
B22-0233 – District of Columbia
Introduced: 2017 Status: Enacted
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 …
B22-0333 – District of Columbia
Introduced: 2017 Status: Enacted
Law 22-60 enables advanced practice registered nurses to sign, certify, stamp, or endorse all documents related to healthcare within their scope of practice.
B22-0405 – District of Columbia
Introduced: 2017 Status: Enacted
Law 22-176 establishes the maximum fee of $5,000 for filing a certificate of need application by a federally qualified health center for projects located in Wards 7 and 8.
D.C. Code § 31-3109. Filing and rate requirements: Drug Abuse, Alcohol, Abuse and Mental Illness Insurance Coverage – District of Columbia
Introduced: Status: Enacted
Notwithstanding the provisions of any other law, any health insurer that issues health benefits plan or certificates in the District shall file with the Commissioner all rates and rating plans, rules, and classifications that it …
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D.C. Code § 31-3110. Health maintenance organizations: Drug Abuse, Alcohol, Abuse and Mental Illness Insurance Coverage – District of Columbia
Introduced: Status: Enacted
The requirements of this chapter shall apply to health maintenance organizations 5 years from February 28, 1987, unless the Mayor requests the Council to extend the exemption to a time certain and the Council, by …
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D.C. Code § 31-3112. Excluded programs: Drug Abuse, Alcohol, Abuse and Mental Illness Insurance Coverage – District of Columbia
Introduced: Status: Enacted
This chapter shall not be applicable to the District of Columbia Alliance Program, Medicaid Program, and Post-1987 District of Columbia Employees’ Health Insurance Benefits Plan.
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D.C. Code § 31-3131. Definitions: Health Benefits Plans Prompt Payment – District of Columbia
Introduced: Status: Enacted
Definitions of relevant network provider and asepects of benefit design in D.C. health care system.
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D.C. Code § 31-3132. Prompt payment: Health Benefits Plans Prompt Payment – District of Columbia
Introduced: Status: Enacted
For covered services rendered to its members, a health insurer shall reimburse any person entitled to reimbursement under the health benefits plan within 30 days after the receipt of a clean claim.
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United States et al. v. Anthem, Inc., and Cigna Corp. – California, Colorado, Connecticut, District of Columbia, Federal, Georgia, Iowa, Maine, Maryland, New Hampshire, New York, Tennessee, Virginia
District Court: District of Columbia Status: Decided
On April 28, 2017, the D.C. Circuit Court of Appeals affirmed the District Court’s decision to block the proposed $54 billion merger between Anthem and …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
FY 2020 BUDGET
Washington D.C. budgets on a biennium basis with the Executive biennium budget submitted to the Legislature on or before December 20th. The legislature adopts a budget in either April or May and the biennial budget cycle begins in July. See Washington D.C.’s Department of Health budget for the fiscal year 2020 on page E-53 here.
KEY RESOURCES
District of Columbia Legislature
District of Columbia Office of the Attorney General
District of Columbia Department of Insurance