02. Covered trials. (a) A health insurer shall not limit or deny coverage, or impose additional conditions on the payment for the coverage, of routine patient care costs of items, drugs, and services furnished to a qualified individual in connection with participation in an approved clinical trial. A health insurer shall not be required to pay for costs of items, services, or drugs that are customarily provided by the sponsors of an approved clinical trial. (b) In the case of health care services provided by a participating provider, the payment rate shall be at the network negotiated rate, based on the member’s plan design. In case of a non-participating provider, the payment shall be at the rate that the member’s plan would otherwise pay to a non-participating provider for the same services, less any applicable co-payments and deductibles. (June 5, 2008, D.C. Law 17-166, § 3, 55 DCR 5174.)
District of Columbia Legal Code