(III) THE MEMBER

(4) A TREATMENT PLAN MAY:

(I) LIMIT THE NUMBER OF VISITS TO THE SPECIALIST;

(II) LIMIT THE PERIOD OF TIME IN WHICH VISITS TO THE
SPECIALIST ARE AUTHORIZED; AND

(III) REQUIRE THE SPECIALIST TO COMMUNICATE REGULARLY
WITH THE PRIMARY CARE PROVIDER PHYSICIAN REGARDING THE TREATMENT AND
HEALTH STATUS OF THE MEMBER

(5) THE PROCEDURE BY WHICH A MEMBER MAY RECEIVE A STANDING
REFERRAL TO A SPECIALIST MAY NOT INCLUDE A REQUIREMENT THAT A MEMBER
SEE A PROVIDER IN ADDITION TO THE PRIMARY CARE PHYSICIAN BEFORE THE
STANDING REFERRAL IS GRANTED.

(C) (1) EACH CARRIER THAT DOES NOT ALLOW DIRECT ACCESS TO
SPECIALISTS SHALL ESTABLISH AND IMPLEMENT A PROCEDURE BY WHICH A
SPECIALIST MAY ACT AS THE PRIMARY A CARE COORDINATOR FOR THE TREATMENT
OF A SPECIFIC DISEASE OR CONDITION IN ACCORDANCE WITH THIS SUBSECTION.

(2) THE PROCEDURE SHALL AUTHORIZE A SPECIALIST TO ACT AS THE
PRIMARY CARE COORDINATOR FOR THE TREATMENT OF A SPECIFIC DISEASE OR
CONDITION OF A MEMBER IF:

(I) THE MEMBER HAS A DISEASE OR CONDITION THAT;

1. IS LIFE THREATENING, DEGENERATIVE, CHRONIC, OR

DISABLING; AND

2. REQUIRES SPECIALIZED MEDICAL CARE FOR AT LEAST 1

YEAR;

(II) THE MEMBER REQUESTS THAT A SPECIALIST ACT AS THE
MEMBER'S PRIMARY CARE COORDINATOR WITHIN 30 DAYS AFTER:

1. ENROLLMENT; OR

2. THE MEMBER IS DIAGNOSED WITH A LIFE THREATENING,
DEGENERATIVE, CHRONIC, OR DISABLING DISEASE OR CONDITION, AND THE
CARRIER, THE PRIMARY CARE PHYSICIAN. AND THE SPECIALIST DETERMINE THAT
THE MEMBER'S CARE WOULD MOST APPROPRIATELY BE COORDINATED BY A
SPECIALIST FOR THE SPECIFIC DISEASE OR CONDITION; AND

(III) THE SPECIALIST:

1. HAS EXPERTISE IN TREATING THE LIFE THREATENING,
DEGENERATIVE, CHRONIC, OR DISABLING DISEASE OR CONDITION AND

2. IS PART OF THE CARRIER'S PROVIDER PANEL.