Code of the District of Columbia

§ 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 December, 2021.*

(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.