(a) When an MA recipient applies for an increase in or an exemption from a utilization threshold for a particular provider service type pursuant to sections 511.4 and 511.5 of this Part, the recipient is automatically eligible for additional service units of that provider service type, in addition to any medical care, services or supplies required to address an urgent medical need or medical emergency, if:

1. (1) the application indicates that the recipient has received notification pursuant to section 511.2(c) of this Part that he/she has reached the utilization threshold; and
2. (2) the application is rejected during the automated review process (for reasons other than the inability to verify the applicant's status as an MA recipient) or the application is referred to the medical review team.

(c) An MA recipient who meets the requirements of subdivision (a) or (b) of this section will be authorized to receive additional service units as follows:

1. (1) for physician/medical clinic services, two encounters;
2. (2) for pharmacy services, six formulary codes;
3. (3) for laboratory services, four procedures; and
4. (4) for psychiatrist/mental health clinic services, four encounters.