D.C. Mun. Regs. tit. 7, r. 7-124
The Program shall establish a Program Panel of Healthcare Providers (hereinafter the "Panel") to furnish medical services, appliances, or supplies to District government employees or claimants who are injured while in the performance of duty, in accordance with the Act and rules and regulations of the Program.
If the Program decides to remove a qualified health professional from the Panel, the Program shall give all of the claimants currently being treated by that qualified health professional notice of the decision, as well as a list of up to three (3) alternative Panel qualified health professionals, at least thirty (30) days before the qualified health professional is removed from the Panel.
The Program shall take appropriate steps to ensure that medical records are maintained in a confidential manner.
The Program may require a claimant to submit to physical examinations as frequently as may be reasonably required to investigate a claimant's initial and continued eligibility for benefits under the Act, as provided at § 136 of this chapter.
Upon notification of an injury or acceptance of a claim for compensation, the Program shall provide the employee or claimant with a list of up to three (3) qualified health professionals from the Panel and inform the employee or claimant of the requirements in § 123 of this chapter.
Within thirty (30) days after receipt of a written request for prior authorization for any medical care, supply, or service, the Program shall provide the claimant and qualified health professional written notice approving, denying, or disputing the request. If no authorization is granted within thirty (30) days the medical care, supply, or service shall be deemed approved, provided the medical care, supply, or service is for a condition that has been accepted as compensable by the Program.
When the Program disputes or denies a request for prior authorization by a qualified health professional pursuant to § 124.7 of this chapter because the Program believes the necessity, character, or sufficiency of the medical care is improper, the Program shall:
If the Program denies a request for prior authorization for medical care, pursuant to § 124.7 of this chapter on any basis other than the necessity, character, or sufficiency of the medical care, the Program shall:
The Program shall not reimburse or pay costs incurred for services rendered by a healthcare provider who is not a member of the Program's Panel of Healthcare Providers, unless otherwise authorized by law or regulation or awarded on appeal. Reimbursement for costs incurred for services rendered by non-Panel healthcare providers shall be subject to utilization review and limited by the fee schedule prescribed in this chapter.
The Program may enter into a provider agreement with a healthcare provider that sets forth the provisions of this chapter and additional terms and conditions relating to the provision of services to District government employees and claimants, as determined by the Program to be reasonable and necessary to ensure appropriate care, including fee and payment guidelines.
The Program shall issue a decision on a request for reimbursement of medical services, appliances, or supplies submitted by a claimant pursuant to § 123.6 of this chapter within thirty (30) days of receipt of Form MR and required supporting documentation. The Program's decision shall include notice of claimant's right to appeal pursuant to § 156 of this chapter.
D.C. Mun. Regs. tit. 7, r. 7-124