1403. BARRING RESPONSIBLE THIRD PARTIES FROM REFUSING TO PAY FOR ITEMS OR SERVICES BASED SOLELY ON THE ABSENCE OF PRIOR AUTHORIZATION

1403 BARRING RESPONSIBLE THIRD PARTIES FROM REFUSING TO PAY FOR ITEMS OR SERVICES BASED SOLELY ON THE ABSENCE OF PRIOR AUTHORIZATION 1403.1 If a responsible third-party payer, other than a third-party payer described in the first parenthetical of Section 1902(a)(25)(I)(ii)(II) of the Social Security Act, 42 U.S.C. § 1396(a)(25)(I)(ii)(II), requires prior authorization for an item or service furnished to a beneficiary, the responsible third-party payer shall accept the authorization provided by the District that the item or service is covered under the State Plan (or waiver of such plan) for the beneficiary, as if such authorization were the prior authorization made by the third party for such item or service. SOURCE: Final Rulemaking published at 73 DCR 006110 (April 17, 2026). District of Columbia Municipal Regulations Public Welfare 29 DCMR § 1403