Standing Referrals

(1) A carrier that requires an insured to designate a primary care provider shall allow such a primary care provider to authorize a standing referral for specialty health care, including mental health care, provided by a health care provider participating in such carrier's network when: (a) the primary care provider determines that such referrals are appropriate; (b) the provider of specialty health care agrees to a treatment plan for the insured and provides the primary care provider with all necessary clinical and administrative information on a regular basis; and (c) the health care services to be provided are consistent with the terms of the carrier's evidence of coverage. (2) Nothing in 958 CMR 3.505 shall be construed to permit a provider of specialty health care who is the subject of a referral to authorize any further referral of an insured to any other provider without the approval of the insured's carrier. (3) For the purposes of 958 CMR 3.505, "specialty health care" means health care services rendered by a provider other than a primary care provider.