The provisions of §19.1719 of this title (relating to Verification for Health Maintenance Organizations and Preferred Provider Benefit Plans) and §21.2807 of this title (relating to Effect of Filing a Clean Claim) apply to a physician or a provider that provides to an enrollee or an insured of an MCC:

1. (1) care related to an emergency or its attendant episode of care as required by state or federal law; or
2. (2) specialty or other medical care or health care services at the request of the MCC, the physician, or the provider because the services are not reasonably available from a physician or a provider who is included in the MCC's network.

Source Note:The provisions of this §21.2823 adopted to be effective October 5, 2003, 28 TexReg 8647; amended to be effective February 16, 2014, 39 TexReg 747.