Code of the District of Columbia

Part B. Office of Medicaid Operations Reform.


§ 4–204.11. Short title.

This part may be cited as the “Office of Medicaid Operations Reform Establishment Act of 2002”.


(Oct. 1, 2002, D.C. Law 14-190, § 1501, 49 DCR 6968; Nov. 13, 2003, D.C. Law 15-39, § 1502(a), 50 DCR 5668.)

Effect of Amendments

D.C. Law 15-39 deleted “Public Provider” following “Medicaid”.

Emergency Legislation

For temporary (90 day) approval of proposed amendments to the District of Columbia State Plan for Medical Assistance, see § 1902 of Fiscal Year 2003 Budget Support Amendment Emergency Act of 2002 (D.C. Act 14-544, December 4, 2002, 49 DCR 11700).

For the temporary (90 day) Medicaid State Plan Amendment Approval provisions, see § 1902 of the Fiscal Year 2003 Budget Support Amendment Congressional Review Emergency Act of 2003 (D.C. Act 15-27, February 24, 2003, 50 DCR 2151).

For temporary (90 day) amendment of section, see § 1502(a) of Fiscal Year 2004 Budget Support Emergency Act of 2003 (D.C. Act 15-105, June 20, 2003, 50 DCR 5613).

For temporary (90 day) amendment of section, see § 1502(a) of Fiscal Year 2004 Budget Support Congressional Review Emergency Act of 2003 (D.C. Act 15-149, September 22, 2003, 50 DCR 8360).

For the temporary (90 day) Medicaid State Plan Amendment Approval provisions, see § 1902 of the Fiscal Year 2003 Budget Support Amendment Second Congressional Review Emergency Act of 2003 (D.C. Act 15-103, June 20, 2003, 50 DCR 5499).

Short Title

Short title of title XV of Law 15-39: Section 1501 of D.C. Law 15-39 provided that title XV of the act may be cited as the Medicaid and Tobacco Funding Amendment Act of 2003.

Editor's Notes

Section 1902 of D.C. Law 14-307 provided: “Pursuant to section 1(a)(2) of An Act To enable the District of Columbia to receive Federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 744; D.C. Official Code § 1-307.02(a)(2)), the Council of the District of Columbia approves the proposed amendments to the District of Columbia State Plan for Medical Assistance to authorize the Medicaid Program to remove the requirement that requires that rates paid to hospitals, nursing facilities, and intermediate care facilities for persons with mental retardation be adjusted annually for inflation; to add provisions that require that payments made to hospitals, nursing facilities, and intermediate care facilities for persons with mental retardation for inflation adjustments in subsequent fiscal years be contingent upon the availability of funds; to increase the pharmacy dispensing fee effective April 1, 2003; and to remove provisions authorizing payment exceptions to the cost ceilings applicable to nursing facilities; and to approve a waiver to the District of Columbia State Plan for Medical Assistance to expand coverage of its Medicaid Program to childless adults 50 to 64 years of age.” Establishment of the Office of Medicaid Public Provider Operations Reform, see Mayor’s Order 2002-101, June 28, 2002 ( 49 DCR 5997).


§ 4–204.12. Definitions.

For the purposes of this part, the term:

(1) “Director” means the Director of the Office of Medicaid Operations Reform.

(1A) “Foster Care and Adoption Assistance” means the programs authorized by Part E of Title IV of the Social Security Act, approved June 17, 1980 (94 Stat. 501; 42 U.S.C. § 670 et seq.).

(2) “Medicaid” means the medical assistance programs authorized by title XIX of the Social Security Act, approved July 30, 1965 (79 Stat. 343; 42 U.S.C. § 1396 et seq.), or by § 1-307.02, and administered by the Department of Health.

(2A) “Medicare” means the health insurance programs authorized by Title XVIII of the Social Security Act, approved July 30, 1965 (79 Stat. 290; 42 U.S.C. § 1395 et seq.).

(3) “Office” means the Office of Medicaid Operations Reform.


(Oct. 1, 2002, D.C. Law 14-190, § 1502, 49 DCR 6968; Nov. 13, 2003, D.C. Law 15-39, § 1502(b), 50 DCR 5668.)

Effect of Amendments

D.C. Law 15-39, in pars. (1) and (3), deleted “Public Provider” following “Medicaid”; added pars. (1A) and (2A); and in par. (2), substituted “or by” for “and by”.

Emergency Legislation

For temporary (90 day) amendment of section, see § 1502(b) of Fiscal Year 2004 Budget Support Emergency Act of 2003 (D.C. Act 15-105, June 20, 2003, 50 DCR 5613).

For temporary (90 day) amendment of section, see § 1502(b) of Fiscal Year 2004 Budget Support Congressional Review Emergency Act of 2003 (D.C. Act 15-149, September 22, 2003, 50 DCR 8360).


§ 4–204.13. Establishment of the Office of Medicaid Operations Reform.

(a) There is established an Office of Medicaid Operations Reform.

(b) The Mayor shall appoint a Director of the Office who shall be responsible for the management and operations of the Office and serve at the pleasure of the Mayor.

(c) The Mayor shall establish an External Medicaid Task Force to advise the Director.

(d) The Mayor shall fix the compensation of the Director pursuant to subchapter IX of Chapter 6 of Title 1.

(e) The Director is authorized to hire staff in the Career Service, consistent with budgetary authorization, as he or she deems necessary to perform the functions of the Office. The Director may engage qualified volunteers in accordance with District of Columbia law.

(f) If spending pressures generated by the Medicaid, Medicare, and Foster Care and Adoption Assistance programs make it necessary that funds from the Medicaid and Special Education Reform Fund be made available for expenditure by the Department of Human Services, the Child and Family Services Agency, the Department of Mental Health, or the Department of Health, the Director, in accordance with § 4-204.55(a)(2)(A), shall submit to the Mayor either a plan to generate savings comparable to the funds allocated or a performance plan to ensure future reduction of costs and maximization of third-party revenues.

(g) The Director shall have the authority to delegate to other employees of the Office any of the Director’s powers and duties.


(Oct. 1, 2002, D.C. Law 14-190, § 1503, 49 DCR 6968; Nov. 13, 2003, D.C. Law 15-39, § 1502(c), 50 DCR 5668.)

Effect of Amendments

D.C. Law 15-39, in subsec. (a), deleted “Public Provider” following “Medicaid”; rewrote subsec. (f) which had read as follows: “(f) If spending pressures generated by the Medicaid program make it necessary that funds from the Tobacco Settlement Trust Fund be made available for expenditure by the Department of Human Services or the Child and Family Services Agency, the Director shall submit to the Mayor a plan to generate savings comparable to the funds allocated in accordance with § 7-1811.03(b)(5)(A)(i).”

Emergency Legislation

For temporary (90 day) amendment of section, see § 1502(c) of Fiscal Year 2004 Budget Support Emergency Act of 2003 (D.C. Act 15-105, June 20, 2003, 50 DCR 5613).

For temporary (90 day) amendment of section, see § 1502(c) of Fiscal Year 2004 Budget Support Congressional Review Emergency Act of 2003 (D.C. Act 15-149, September 22, 2003, 50 DCR 8360).


§ 4–204.14. Purposes, powers, and duties of the Office.

The primary purpose of the Office is to redesign the District of Columbia’s Medicaid, Medicare, and Foster Care and Adoption Assistance infrastructure to improve the operational management of Medicaid, Medicare, and Foster Care and Adoption Assistance programs on an agency level. The Office shall:

(1) Provide technical assistance and support to District of Columbia agencies for the purpose of documenting and processing Medicaid, Medicare, and Foster Care and Adoption Assistance claims, and maximizing Medicaid, Medicare, and Foster Care and Adoption Assistance reimbursements, where not duplicative of assistance already provided to District of Columbia agencies by the State Medicaid Office;

(2) Manage Medicaid, Medicare, and Foster Care and Adoption Assistance costs and project revenues in liaison with the State Medicaid, Medicare, and Foster Care and Adoption Assistance Office and the Chief Financial Officer;

(3) Review and support legislation ensuring service expansion for all entitled residents in collaboration with the Mayor and the State Medicaid Office;

(4) Oversee the implementation of Medicaid, Medicare, and Foster Care and Adoption Assistance reforms within District of Columbia agencies to fulfill statutory requirements;

(5) Prepare an annual report for the Mayor and the Council on the Office’s activities and recommendations; and

(6) Engage in other activities as needed to carry out the purposes of this part.


(Oct. 1, 2002, D.C. Law 14-190, § 1504, 49 DCR 6968; Nov. 13, 2003, D.C. Law 15-39, § 1502(d), 50 DCR 5668; Mar. 13, 2004, D.C. Law 15-105, § 30(a), 51 DCR 881.)

Effect of Amendments

D.C. Law 15-39, in the introductory paragraph, substituted “Medicaid, Medicare, and Foster Care and Adoption Assistance infrastructure” for “Medicaid infrastructure” and substituted “Medicaid, Medicare, and Foster Care and Adoption Assistance Programs” for “Medicaid programs”; in par. (1), substituted “Medicaid, Medicare, and Foster Care and Adoption Assistance claims, and maximizing Medicaid, Medicare, and Foster Care and Adoption Assistance reimbursements,” for “Medicaid claims, and maximizing Medicaid reimbursements,”; and in pars. (2) and (4), substituted “Medicaid, Medicare, and Foster Care and Adoption Assistance” for Medicaid“.

D.C. Law 15-105, in par. (6), validated a previously made technical correction.

Emergency Legislation

For temporary (90 day) amendment of section, see § 1502(d) of Fiscal Year 2004 Budget Support Emergency Act of 2003 (D.C. Act 15-105, June 20, 2003, 50 DCR 5613).

For temporary (90 day) amendment of section, see § 1502(d) of Fiscal Year 2004 Budget Support Congressional Review Emergency Act of 2003 (D.C. Act 15-149, September 22, 2003, 50 DCR 8360).


§ 4–204.15. Rules.

The Mayor, pursuant to Chapter 5 of Title 2, may issue rules to implement the provisions of this part.


(Oct. 1, 2002, D.C. Law 14-190, § 1505, 49 DCR 6968.)


§ 4–204.16. Applicability.

This part shall apply as of October 1, 2002.


(Oct. 1, 2002, D.C. Law 14-190, § 1506, 49 DCR 6968; Mar. 13, 2004, D.C. Law 15-105, § 30(b), 51 DCR 881.)

Effect of Amendments

D.C. Law 15-105 validated a previously made technical correction.