(1) The CHIP program may impose the following requirements in the provision of benefits:

(a) the use of certain types of providers to the extent allowed by law;

(b) prior authorization for benefits other than emergency services;

(c) directing an enrollee to the appropriate level of care for receipt of covered benefits; and

(d) denial of payment to a provider for benefits provided to an enrollee if the participation requirements in this rule are not met by the enrollee or the enrollee's parent, or guardian.

(2) An enrollee must use the CHIP program's or the TPA's participating providers unless:

(a) the CHIP program authorizes a nonparticipating provider to provide a service; or

(b) the enrollee receives emergency services or emergency room screen.

(3) The TPA and participating providers must provide covered benefits as listed in this subchapter to enrollees in the same manner as those benefits are provided to non-CHIP members.