Sec. 10.67.06.02. Benefits — Primary Care Services

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An MCO shall provide to its enrollees medically necessary primary care services that are provided:

A. By the enrollee's PCP;

B. At the direction of the enrollee's PCP; or

C. With respect to a primary care service that is self-referred pursuant to Regulation .28 of this chapter:

(1) By an appropriate practitioner, acting within the scope of the practitioner's license, certification, or other legal authorization, and in accordance with the practitioner's training and experience; or

(2) By a clinic that furnishes health care services by or under the direction of a physician.

                    
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