Code of the District of Columbia

Subchapter VII. Hospital Outpatient Supplemental Payment.


§ 44–664.01. Definitions.

For the purposes of this subchapter, the term:

(1) "Department" means the Department of Health Care Finance.

(2) "Hospital" shall have the same meaning as provided in § 44-501(a)(1), but excludes any hospital operated by the federal government.

(3) "Hospital system" means any group of hospitals licensed separately, but operated, owned, or maintained by a common entity.

(4) "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.), and by § 1-307.02, and administered by the Department.

(5) "Outpatient gross patient revenue" means the amount calculated in accordance with generally accepted accounting principles for hospitals that is reported as the sum of Lines 18 and 19; Column 2; Worksheet G-2 of the Hospital and Hospital Health Care Complex Cost Report (Form CMS 2552-10), filed for the period between October 1 and September 30, 2018.


(Dec. 13, 2017, D.C. Law 22-33, § 5062, 64 DCR 7652; Oct. 30, 2018, D.C. Law 22-168, § 5032(a), 65 DCR 9388; Sept. 11, 2019, D.C. Law 23-16, § 5082(a), 66 DCR 8621; Dec. 3, 2020, D.C. Law 23-149, § 5002(a), 67 DCR 10493.)

Emergency Legislation

For temporary (90 days) amendment of this section, see § 5082(a) of Fiscal Year 2020 Budget Support Congressional Review Emergency Act of 2019 (D.C. Act 23-112, Sept. 4, 2019, 66 DCR 11964).

For temporary (90 days) amendment of this section, see § 5082(a) of Fiscal Year 2020 Budget Support Emergency Act of 2019 (D.C. Act 23-91, July 22, 2019, 66 DCR 8497).

For temporary (90 days) amendment of this section, see § 5032(a) of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) amendment of this section, see § 5032(a) of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).

For temporary (90-day) creation of this section, see § 5062 of the Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017, effective October 24, 2017 (D.C. Act 22-167; 64 DCR 10802).

For temporary (90-day) creation of this section, see § 5062 of the Fiscal Year 2018 Budget Support Emergency Act of 2017, effective July 20, 2017 (D.C. Act 22-104; 64 DCR 7032).


§ 44–664.02. Hospital Provider Fee Fund.

(a) There is established as a special fund the Hospital Provider Fee Fund ("Fund"), which shall be administered by the Department in accordance with subsections (c) and (d) of this section.

(b) Revenue from the following sources shall be deposited in the Fund:

(1) Fees collected under this subchapter; and

(2) Interest and penalties collected under this subchapter.

(c) Money in the Fund may only be used for the following purposes:

(1) Making Medicaid outpatient hospital access payments to hospitals as required under § 44-664.05, either directly or through payments to managed care organizations;

(2) Payment of administrative expenses incurred by the Department or its agent in performing the activities authorized by this subchapter in an amount not to exceed $150,000 annually; and

(3) Providing refunds to hospitals pursuant to § 44-664.04.

(d) Money in the Fund may not be used to replace money appropriated to the Medicaid program.

(e)(1) The money deposited into the Fund shall not revert to the unrestricted fund balance of the General Fund of the District of Columbia at the end of a fiscal year, or at any other time.

(2) Subject to authorization in an approved budget and financial plan, any funds appropriated in the Fund shall be continually available without regard to fiscal year limitation.


(Dec. 13, 2017, D.C. Law 22-33, § 5063, 64 DCR 7652; Dec. 3, 2020, D.C. Law 23-149, § 5002(b), 67 DCR 10493.)

Emergency Legislation

For temporary (90-day) creation of this section, see § 5063 of the Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017, effective October 24, 2017 (D.C. Act 22-167; 64 DCR 10802).

For temporary (90-day) creation of this section, see § 5063 of the Fiscal Year 2018 Budget Support Emergency Act of 2017, effective July 20, 2017 (D.C. Act 22-104; 64 DCR 7032).


§ 44–664.03. Hospital provider fee.

(a) Beginning October 1, 2019, and subject to § 44-664.04, the District may charge each hospital a fee based on its outpatient gross patient revenue. The fee shall be charged at a uniform rate necessary to generate the following:

(1) An amount equal to the non-federal share of the total available spending room under the outpatient Medicaid upper payment limit for private hospitals applicable to District Fiscal Year 2020, consistent with requirements and approvals from the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services; plus

(2) An amount equal to the non-federal share of the total available spending room under the outpatient Medicaid upper payment limit for District operated hospitals applicable to District Fiscal Year 2020, consistent with the federal approval of the authorizing Medicaid State Plan amendment or associated templates and other authorities; plus

(3) An amount equal to the Department's administrative expenses as described in § 44-664.02(c)(2).

(b) A psychiatric hospital that is an agency or a unit of the District government is exempt from the fee imposed under subsection (a) of this section, unless the exemption is adjudged to be unconstitutional or otherwise invalid, in which case a psychiatric hospital that is an agency or a unit of the District government shall pay the fee imposed by subsection (a) of this section.


(Dec. 13, 2017, D.C. Law 22-33, § 5064, 64 DCR 7652; Oct. 30, 2018, D.C. Law 22-168, § 5032(b), 65 DCR 9388; Sept. 11, 2019, D.C. Law 23-16, § 5082(b), 66 DCR 8621; Dec. 3, 2020, D.C. Law 23-149, § 5002(c), 67 DCR 10493.)

Emergency Legislation

For temporary (90 days) amendment of this section, see § 5082(b) of Fiscal Year 2020 Budget Support Congressional Review Emergency Act of 2019 (D.C. Act 23-112, Sept. 4, 2019, 66 DCR 11964).

For temporary (90 days) amendment of this section, see § 5082(b) of Fiscal Year 2020 Budget Support Emergency Act of 2019 (D.C. Act 23-91, July 22, 2019, 66 DCR 8497).

For temporary (90 days) amendment of this section, see § 5032(b) of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) amendment of this section, see § 5032(b) of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).

For temporary (90-day) creation of this section, see § 5064 of the Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017, effective October 24, 2017 (D.C. Act 22-167; 64 DCR 10802).

For temporary (90-day) creation of this section, see § 5064 of the Fiscal Year 2018 Budget Support Emergency Act of 2017, effective July 20, 2017 (D.C. Act 22-104; 64 DCR 7032).


§ 44–664.04. Applicability of fees.

(a) The fee imposed by § 44-664.03 shall not be due and payable until such time that the District obtains approvals required by the Centers for Medicare and Medicaid Services for authorizing the Medicaid payments described in § 44-664.05.

(b) The fee imposed by § 44-664.03 shall cease to be imposed, and any moneys remaining in the Fund shall be refunded to hospitals in proportion to the amounts paid by them, if:

(1) The Department makes changes in its rules that reduce the hospital inpatient or outpatient Medicaid payment rates, including adjustment to payment rates that are in effect on October 1, 2018; or

(2) The payments to hospitals required under § 44-664.05 are modified in any way other than to secure federal approval of such payments as described in § 44-664.05 or are not eligible for federal matching funds under section 1903(w) of the Social Security Act, approved July 30, 1965 (70 Stat. 349; 42 U.S.C. § 1396b(w)) ("Social Security Act").

(c) The fee imposed by § 44-664.03 shall not take effect or shall cease to be imposed if the fee is determined to be an impermissible tax under section 1903(w)(3)(B) of the Social Security Act by the Centers for Medicare and Medicaid Services.

(d) Should the fee imposed by § 44-664.03 not take effect or cease to be imposed, moneys in the Fund derived from the imposed fee shall be disbursed in accordance with § 44-664.05 to the extent federal matching is available. If federal matching is not available due to a determination by the Centers for Medicare and Medicaid Services that the fee is impermissible, any remaining moneys shall be refunded to hospitals in proportion to the amounts paid by them.


(Dec. 13, 2017, D.C. Law 22-33, § 5065, 64 DCR 7652; Oct. 30, 2018, D.C. Law 22-168, § 5032(c), 65 DCR 9388; Sept. 11, 2019, D.C. Law 23-16, § 5082(c), 66 DCR 8621; Dec. 3, 2020, D.C. Law 23-149, § 5002(d), 67 DCR 10493.)

Emergency Legislation

For temporary (90 days) amendment of this section, see § 5082(c) of Fiscal Year 2020 Budget Support Congressional Review Emergency Act of 2019 (D.C. Act 23-112, Sept. 4, 2019, 66 DCR 11964).

For temporary (90 days) amendment of this section, see § 5082(c) of Fiscal Year 2020 Budget Support Emergency Act of 2019 (D.C. Act 23-91, July 22, 2019, 66 DCR 8497).

For temporary (90 days) amendment of this section, see § 5032(c) of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) amendment of this section, see § 5032(c) of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).

For temporary (90-day) creation of this section, see § 5065 of the Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017, effective October 24, 2017 (D.C. Act 22-167; 64 DCR 10802).

For temporary (90-day) creation of this section, see § 5065 of the Fiscal Year 2018 Budget Support Emergency Act of 2017, effective July 20, 2017 (D.C. Act 22-104; 64 DCR 7032).


§ 44–664.05. Medicaid outpatient hospital access payments; payments to MCOs.

*NOTE: This section has been amended by emergency legislation with identical permanent legislation that will become effective in January, 2022.*

(a) For visits and services beginning October 1, 2020, the District shall pay managed care organizations ("MCOs") at a rate sufficient to support payments to hospitals located in the District for outpatient services at a rate that is not less than 130% of the District Fiscal Year 2020 fee-for-service base rate and shall direct MCOs to pay such rate to their participating hospitals located in the District for such services.

(b) No payment shall be made under this section until such time that the Centers for Medicare and Medicaid Services approves the Medicaid State Plan amendment, associated template, and other authorities authorizing the Medicaid payments described in this section.

(b-1) For visits and services beginning October 1, 2021, the District shall make fee-for-service outpatient rate payments to hospitals at a rate that is an aggregate of 100% of Medicaid allowable costs for the fiscal year in which payments are being made.

(c) The Medicaid payment methodologies authorized under this section shall not be altered unless such alteration is necessary to gain approval from the Centers for Medicare and Medicaid Services.


(Dec. 13, 2017, D.C. Law 22-33, § 5066, 64 DCR 7652; Oct. 30, 2018, D.C. Law 22-168, § 5032(d), 65 DCR 9388; Sept. 11, 2019, D.C. Law 23-16, § 5082(d), 66 DCR 8621; Dec. 3, 2020, D.C. Law 23-149, § 5002(e), 67 DCR 10493; Aug. 23, 2021, D.C. Act 24-159, § 5002, 68 DCR 008602.)

Emergency Legislation

For temporary (90 days) amendment of this section, see § 5002 of Fiscal Year 2022 Budget Support Emergency Act of 2021 (D.C. Act 24-159, Aug. 23, 2021, 68 DCR 008602).

For temporary (90 days) amendment of this section, see § 5082(d) of Fiscal Year 2020 Budget Support Congressional Review Emergency Act of 2019 (D.C. Act 23-112, Sept. 4, 2019, 66 DCR 11964).

For temporary (90 days) amendment of this section, see § 5082(d) of Fiscal Year 2020 Budget Support Emergency Act of 2019 (D.C. Act 23-91, July 22, 2019, 66 DCR 8497).

For temporary (90 days) amendment of this section, see § 5032(d) of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) amendment of this section, see § 5032(d) of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).

For temporary (90-day) creation of this section, see § 5066 of the Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017, effective October 24, 2017 (D.C. Act 22-167; 64 DCR 10802).

For temporary (90-day) creation of this section, see § 5066 of the Fiscal Year 2018 Budget Support Emergency Act of 2017, effective July 20, 2017 (D.C. Act 22-104; 64 DCR 7032).


§ 44–664.06. Quarterly notice and collection.

(a) The fee imposed under § 44-664.03, which shall be calculated, due, and payable on a quarterly basis, shall be due and payable by the 15th of the last month of each DFY quarter; provided, that the fee shall not be due and payable until:

(1) The District issues written notice that the payment methodologies for payments to hospitals required under § 44-664.05 have been approved by the Centers for Medicare and Medicaid Services; and

(2) The District issues written notice to the hospital informing the hospital of its fee rate, outpatient gross patient revenue subject to the fee, and the fee amount owed on a quarterly basis, including, in the initial written notice from the District to the hospital, all fee amounts owed beginning with the period commencing on October 1 of each year, to ensure all applicable fee obligations have been identified.

(b)(1) If a hospital fails to pay the full amount of the fee in accordance with this subchapter, the unpaid balance shall accrue interest at the rate of 1.5% per month or any fraction thereof, which shall be added to the unpaid balance.

(2) The Chief Financial Officer may arrange a payment plan for the amount of the fee and interest in arrears.

(c) The payment by the hospital of the fee created in this subchapter shall be reported as an allowable cost for purposes of Medicaid hospital reimbursement.


(Dec. 13, 2017, D.C. Law 22-33, § 5067, 64 DCR 7652; Oct. 30, 2018, D.C. Law 22-168, § 5032(e), 65 DCR 9388; Sept. 11, 2019, D.C. Law 23-16, § 5082(e), 66 DCR 8621.)

Emergency Legislation

For temporary (90 days) amendment of this section, see § 5082(e) of Fiscal Year 2020 Budget Support Congressional Review Emergency Act of 2019 (D.C. Act 23-112, Sept. 4, 2019, 66 DCR 11964).

For temporary (90 days) amendment of this section, see § 5082(e) of Fiscal Year 2020 Budget Support Emergency Act of 2019 (D.C. Act 23-91, July 22, 2019, 66 DCR 8497).

For temporary (90 days) amendment of this section, see § 5032(e) of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) amendment of this section, see § 5032(e) of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).

For temporary (90-day) creation of this section, see § 5067 of the Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017, effective October 24, 2017 (D.C. Act 22-167; 64 DCR 10802).

For temporary (90-day) creation of this section, see § 5067 of the Fiscal Year 2018 Budget Support Emergency Act of 2017, effective July 20, 2017 (D.C. Act 22-104; 64 DCR 7032).


§ 44–664.07. Multi-hospital systems, closure, merger, and new hospitals.

(a) If a hospital system conducts, operates, or maintains more than one hospital licensed by the Department of Health, the hospital system shall pay the fee for each hospital separately.

(b)(1) Notwithstanding any other provision in this subchapter, if a hospital system or person ceases to conduct, operate, or maintain a hospital that is subject to a fee under § 44-664.03, as evidenced by the transfer or surrender of the hospital license, the fee for the DFY in which the cessation occurs shall be adjusted by multiplying the fee computed under § 44-664.03 by a fraction, the numerator of which is the number of days in the year during which the hospital system or person conducted, operated, or maintained the hospital, and the denominator of which is 365.

(2) Immediately upon ceasing to conduct, operate, or maintain a hospital, the hospital system or person shall pay the fee for the year as so adjusted, to the extent not previously paid.

(c) Notwithstanding any other provision in this subchapter a hospital system or person who conducts, operates, or maintains a hospital, upon notice by the Department, shall pay the fee computed under § 44-664.03 and subsection (a) of this section in installments on the due date stated in the notice and on the regular installment due dates for the DFY occurring after the due dates of the initial notice.


(Dec. 13, 2017, D.C. Law 22-33, § 5068, 64 DCR 7652.)

Emergency Legislation

For temporary (90-day) creation of this section, see § 5068 of the Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017, effective October 24, 2017 (D.C. Act 22-167; 64 DCR 10802).

For temporary (90-day) creation of this section, see § 5068 of the Fiscal Year 2018 Budget Support Emergency Act of 2017, effective July 20, 2017 (D.C. Act 22-104; 64 DCR 7032).


§ 44–664.08. Rules.

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


(Dec. 13, 2017, D.C. Law 22-33, § 5069, 64 DCR 7652.)

Emergency Legislation

For temporary (90-day) creation of this section, see § 5069 of the Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017, effective October 24, 2017 (D.C. Act 22-167; 64 DCR 10802).

For temporary (90-day) creation of this section, see § 5069 of the Fiscal Year 2018 Budget Support Emergency Act of 2017, effective July 20, 2017 (D.C. Act 22-104; 64 DCR 7032).


§ 44–664.09. Sunset.

This subchapter shall expire on September 30, 2029.


(Dec. 13, 2017, D.C. Law 22-33, § 5070, 64 DCR 7652; Oct. 30, 2018, D.C. Law 22-168, § 5032(f), 65 DCR 9388; Sept. 11, 2019, D.C. Law 23-16, § 5082(f), 66 DCR 8621.)

Emergency Legislation

For temporary (90 days) amendment of this section, see § 5082(f) of Fiscal Year 2020 Budget Support Congressional Review Emergency Act of 2019 (D.C. Act 23-112, Sept. 4, 2019, 66 DCR 11964).

For temporary (90 days) amendment of this section, see § 5082(f) of Fiscal Year 2020 Budget Support Emergency Act of 2019 (D.C. Act 23-91, July 22, 2019, 66 DCR 8497).

For temporary (90 days) amendment of this section, see § 5032(f) of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) amendment of this section, see § 5032(f) of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).

For temporary (90-day) creation of this section, see § 5070 of the Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017, effective October 24, 2017 (D.C. Act 22-167; 64 DCR 10802).

For temporary (90-day) creation of this section, see § 5070 of the Fiscal Year 2018 Budget Support Emergency Act of 2017, effective July 20, 2017 (D.C. Act 22-104; 64 DCR 7032).