District of Columbia Code
Title 44 - Charitable and Curative Institutions
Chapter 3 - Grievance Procedures for Health Benefits Plans

Subchapter I - Grievance and Appeals Procedure

§ 44–301.01. Definitions - For the purposes of this chapter, the term (1) “Adverse...

§ 44–301.02. Medicare not applicable - (a) The provisions of subchapter I of this chapter shall...

§ 44–301.03. Establishment of grievance system - (a)(1) A member or member representative shall have a right...

§ 44–301.04. Grievance process - (a) A member or member representative may appeal any adverse...

§ 44–301.05. Informal internal review. [Repealed] - Repealed. (Apr. 27, 1999, D.C. Law 12-274, § 105, 46...

§ 44–301.06. Internal appeals process - (a)(1) An insurer shall establish and maintain an internal appeals...

§ 44–301.06a. Appeals of rescissions to the Department of Insurance, Securities, and Banking - If an insurer denies a member or member representative’s appeal...

§ 44–301.07. External appeals process for matters other than rescissions - (a) The Director shall establish and maintain an external appeals...

§ 44–301.08. Certification and general requirements for independent review organizations - (a) Each independent review organization selected by the Director to...

§ 44–301.09. Assessment of insurers - The Mayor shall assess all insurers to cover all the...

§ 44–301.10. Reporting requirements - (a) Every insurer shall submit to the Director, an annual...

§ 44–301.11. Availability of District external review procedures for self-insured plans - A group health plan that is located in the District...

Subchapter II - Access to Specialists as Primary Care Providers

§ 44–302.01. Specialists as primary care providers - (a) A health benefits plan shall permit a member with...

§ 44–302.02. Standing referrals to specialists - (a) In general, subject to subsection (b) of this section,...

§ 44–302.03. Direct access to qualified specialists for females’ health services - (a) Every health benefits plan that requires or provides a...

Subchapter III - Notification of Health Care Provider Termination; Continuance of Coverage

§ 44–303.01. When a health care provider leaves a plan - If a contract between an insurer and a health care...

Subchapter IV - Regulations and Standards

§ 44–304.01. Regulations and standards; compliance - (a) Within 120 days of April 27, 1999, the Director...