3305. ENROLLMENT AND SERVICES

3305 ENROLLMENT AND SERVICES 3305.1 Beneficiaries who are determined eligible for the Alliance program shall be automatically enrolled into a managed care plan, and shall be considered enrolled on the first day of the month in which an application is received by the Department pursuant to § 3301.6. 3305.2 A beneficiary in the Alliance program shall not be eligible for retroactive medical coverage prior to the month that the beneficiary is considered enrolled under § 3305.1. 3305.3 Health care and medical services provided pursuant to this Chapter shall be provided by an MCO that has a current contract with the Department to provide managed care health services on a capitated basis, except for services for the treatment of an emergency medical condition described under 42 C.F.R. § 440.255. 3305.4 Beneficiaries may opt to change their managed care provider within ninety (90) days from the date of the written notice submitted to the beneficiary under § 3301.9. 3305.5 Health care and medical services available pursuant to this Chapter (except for emergency medical services described under 42 C.F.R. § 440.255) are subject to District annual appropriations for this purpose, the allocation of funds for specific services, and limitations set forth in contracts with health care providers. 3305.6 The Department may limit coverage of health care and medical services by requiring prior authorization of certain services, limiting provider referrals, or instituting other measures to limit health care services. SOURCE: Final Rulemaking published at 48 DCR 9140 (October 5, 2001); as amended by Final Rulemaking published at 53 DCR 4135 (May 19, 2006); as amended by Final Rulemaking published at 60 DCR 8948 (June 14, 2013); as amended by Final Rulemaking published at 69 DCR 004550 (May 6, 2022). District of Columbia Municipal Regulations Public Health and Medicine 22-B DCMR § 3305