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.

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.