D.C. would set up one Medicaid provider application once budgeted

The Mayor would set up one application, and department approval would count across D.C. Medicaid managed care plans. This covers providers seeking approval or renewal with a D.C. Medicaid managed care plan. After department approval, a plan could not require its own credential approval as a condition of payment. These rules would apply once their financial effect appears in an approved D.C. budget and financial plan. The Mayor would have until January 1, 2028, to set up the application.

The department could not demand a renewal application solely because a provider changes employers or the provider's or employer's tax ID changes. This covers providers whose tax ID, employer's tax ID, or employer changes. For an employer change, the new employer must already be on at least one D.C. Medicaid managed care plan's provider list. This rule would apply once its financial effect appears in an approved D.C. budget and financial plan.

The department would decide applications or identify missing information, and plans would add approved providers to billing systems. These rules cover provider approval and renewal for D.C. Medicaid managed care plans. If the department needs more than 30 days to decide a complete application, it must tell the provider and give an estimated decision date. These rules would apply once their financial effect appears in an approved D.C. budget and financial plan. The department would decide a complete application within 30 days of receiving it or return an incomplete one within 10 days. A plan would update its billing systems within seven business days of receiving approved credentials.