C.__The provider agrees otherwise to adhere to that carrier's policies and procedures, including procedures regarding referrals, obtaining prior authorization and providing services pursuant to a treatment plan, if any, approved by the carrier.

4.__Construction.__This section may not be construed to require the coverage of benefits that would not have been covered if the provider involved had remained a participating provider.

§4312.__Coverage for participation in approved clinical trials

1.__Coverage.__If a carrier provides coverage to a qualified enrollee, the carrier:

A.__May not deny that qualified__enrollee participation in an approved clinical trial;

B.__Subject to subsection 3, may not deny, limit or impose additional conditions on the coverage of routine patient costs for items and services furnished in connection with participation in the trial.__If one or more participating providers are participating in a clinical trial, this section may not be construed to prevent a plan or issuer from requiring that a qualified enrollee participate in the trial through such a participating provider if the provider will accept the enrollee as a participant in the trial; and

C.__May not discriminate against the enrollee on the basis of the enrollee's participation in the trial.

2.__Payment.__ Under this section, a carrier shall provide for payment for routine patient costs but is not required to pay for costs of items and services that are reasonably expected to be paid for by the sponsors of an approved clinical trial.__In the case of covered items and services provided by a participating provider, the payment rate must be at the agreed rate.__If the services are provided by a nonparticipating provider, the payment rate must be at the rate the carrier would normally pay for comparable services.

3.__Construction.__This section may not be construed to limit a carrier's coverage of clinical trials.

§4313.__Access to needed prescription drugs