A.__A carrier may require that the care provided to an enrollee pursuant to this subsection be:

(1)__Pursuant to a treatment plan developed by the specialist and approved by the carrier in consultation with the enrollee's primary care provider or specialist and the enrollee or the enrollee's designee; and

(2)__In accordance with applicable quality assurance and utilization review standards of the carrier.

Nothing in this paragraph may be construed to prevent such a treatment plan for an enrollee from requiring a specialist to provide the primary care provider with regular updates on the specialty care provided as well as all necessary medical information.

B.__A carrier is not required under paragraph A to provide a referral to a specialist who is not a participating provider unless the carrier does not have an appropriate specialist who is a participating provider and is available and accessible to treat the enrollee's condition.

C.__If a carrier refers an enrollee to a nonparticipating specialist pursuant to paragraph A, services provided pursuant to the approved treatment plan must be provided at no additional cost to the enrollee beyond what the enrollee would otherwise pay for services received from such a specialist who is a participating provider.

3.__Specialists as primary care providers.__A carrier shall have a procedure by which an enrollee who has a special condition may receive a referral to a specialist for treatment of that condition.__That specialist must be responsible for and capable of providing and coordinating the enrollee's primary and specialty care. If the enrollee's care would most appropriately be coordinated by such a specialist, the carrier shall refer the enrollee to the specialist in accordance with the following.

A.__The specialist must be permitted to treat the enrollee without a referral from the enrollee's primary care provider