(a) A health benefits plan shall permit a member with chronic disabling or life threatening conditions to choose a health care specialist as the member’s primary care provider. The specialist must be a participant in the health benefits plan and be available to attend to the member.
(b) A specialist chosen by a member pursuant to subsection (a) of this section, shall be permitted to treat the member without the member first receiving a referral from another health care provider. The specialist may authorize referrals, procedures, tests, and medical services subject to the terms of a treatment plan developed by the specialist and approved by the insurer.
(c) A health benefits plan shall permit a member with a chronic disabling or life threatening condition to have direct access to a specialist qualified to treat the condition, subject to initial referral by the member’s primary care provider and a treatment plan approved by the member’s primary care provider. Such treatment plan shall ensure that the member will receive covered medically necessary procedures, tests, and medical services.
(Apr. 27, 1999, D.C. Law 12-274, § 201, 46 DCR 1294.)
1981 Ed., § 32-572.1.
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