36-2908. Provision of emergency and specialty
services; reimbursement
A. Subject to the provisions of section 36-2909, services provided to members under
this article who have been determined eligible but who have not yet enrolled in the
system and who are in need of medical services on an emergency basis after they have been
determined eligible, irrespective of county of residence, shall be reimbursed, subject to
subsection B of this section, in accordance with rules adopted by the director if such
services are not otherwise covered by a provider contract.
B. Services provided on an emergency basis to members or to persons after they have
been determined eligible for such services but before they have enrolled in the system
without a demonstrated emergency need in accordance with rules adopted by the director
shall be reimbursed at no more than the rate for the service provided in other than an
emergency services setting.
C. The director shall prescribe rules providing for the reimbursement of specialty
services provided outside of the county of residence of the member if authorized by the
member's primary care physician or primary care practitioner.
D. Services provided pursuant to this section shall be provided in accordance with
rules adopted pursuant to section 36-2903.01, subsection E.
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