Out-of-Network Providers. It is understood that in some instances Enrollees will require specialty care not available from a network provider and that the ICO will arrange that such services be provided by a non- network provider. In such event, ICO will negotiate a Single Case Agreement with a non-network provider at the applicable Medicaid or Medicare FFS rate to treat the Enrollee until a qualified network provider is available. The ICO shall make best efforts to have any non-network provider billing for services be enrolled in the Medicare Program or Michigan Medicaid Program, as appropriate and in the same manner as network providers under Section 2.7.1.2, prior to paying a Claim. 2.7.4.4.1. If the ICO’s network is unable to provide necessary medical services covered under the Contract to a particular Enrollee, the ICO must adequately and timely cover these services out of network for the Enrollee, for as long as the ICO is unable to provide them. The ICO must ensure that there is no cost to the Enrollee as though the service was provided by an in-network provider for the following services: 2.7.4.4.1.1. Ventilator care in a nursing facility with a Medicaid contract for a Ventilator Dependent Care Unit; and
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