Healthcare (Medicaid)

This bill creates a centralized Medicaid credentialing system managed by the District's Department of Health Care Finance (DHCF), replacing the current process where each Medicaid Managed Care Organization (MCO) independently credentials providers. It requires DHCF to develop a single application process by 2027, allowing providers credentialed through DHCF to serve all MCOs without additional MCO-specific requirements. The bill sets strict timelines: DHCF must notify providers of missing application information within 10 days and issue temporary credentials within 30 days of receiving a complete application. This directly affects healthcare providers (like doctors and clinics) and Medicaid patients by reducing delays in care access and administrative burdens.

This bill prohibits health care entities in Washington, D.C. from charging fees for providing personal medical records to individuals or their representatives. It specifically exempts fees when records are requested to support claims or appeals under the Social Security Act, or for other federal or District needs-based benefits (like Medicaid or housing assistance). The law applies to patients, their legal representatives, nonprofit legal services staff, or attorneys acting on their behalf. Health care providers must provide these records without cost for these specific purposes. The bill does not affect fees for general medical record requests unrelated to benefits claims.

This bill amends Washington D.C.'s 2010 health insurance law to allow private insurers and Medicaid managed care organizations to count specific social services toward their required medical care spending. It permits including evidence-based programs addressing food insecurity, reentry support for justice-involved individuals, and housing stability services in their medical loss ratio calculation. These services must aim to improve health outcomes and reduce disparities for D.C. residents. The bill defines "social determinants of health" as community conditions affecting health, referencing CDC and CMS guidelines. It directly affects D.C. health insurers and managed care plans by expanding eligible expenses under existing insurance regulations.