{"data":{"id":"us-dc/d.c.-code-44-302.01","jurisdiction":"us-dc","citation":"D.C. Code § 44-302.01","heading":"Specialists as primary care providers.","body":"(a)\nA 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.\n\n(b)\nA 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.\n\n(c)\nA 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.","path":["Title 44. Charitable and Curative Institutions.","Chapter 3. Grievance Procedures for Health Benefits Plans.","Subchapter II. Access to Specialists as Primary Care Providers."],"source_url":"https://code.dccouncil.gov/us/dc/council/code/sections/44-302.01","current_through":"2026-08-20 (D.C. Law 26-175)","vintage":"","retrieved_at":"2026-08-29T05:44:07Z","sha256":"0609ffefa81108a0246320f90b9586262055468a3e1553a20fc8f15c14bf5a00","source_id":"us-dc","stale":false,"prev":"us-dc/d.c.-code-44-301.11","next":"us-dc/d.c.-code-44-302.02"},"notice":"GroundRules: Original legal text. Not legal advice."}