(a) The provisions of subchapter I of this chapter shall not apply in cases directly involving coverage determinations or benefit requirements under the federal Medicare program. The provisions of subchapters II and III of this chapter shall not apply in cases directly involving federal Medicare benefits.
(b) Any complaint by a member involving coverage or benefits provided pursuant to the federal Medicare program shall be resolved in accordance with federal laws, regulations, and procedures established for fair hearings and appeals for the Medicare programs and with any appropriate District law.
(Apr. 27, 1999, D.C. Law 12-274, § 102, 46 DCR 1294.)
1981 Ed., § 32-571.2.
Structure District of Columbia Code
Title 44 - Charitable and Curative Institutions
Chapter 3 - Grievance Procedures for Health Benefits Plans
Subchapter I - Grievance and Appeals Procedure
§ 44–301.02. Medicare not applicable
§ 44–301.03. Establishment of grievance system
§ 44–301.04. Grievance process
§ 44–301.05. Informal internal review. [Repealed]
§ 44–301.06. Internal appeals process
§ 44–301.06a. Appeals of rescissions to the Department of Insurance, Securities, and Banking
§ 44–301.07. External appeals process for matters other than rescissions
§ 44–301.08. Certification and general requirements for independent review organizations
§ 44–301.09. Assessment of insurers
§ 44–301.10. Reporting requirements
§ 44–301.11. Availability of District external review procedures for self-insured plans