§432E-3  Access to services.  A managed
care plan shall demonstrate to the commissioner upon request that its plan:



(1)  Makes benefits available and accessible to each
enrollee electing the managed care plan in the defined service area with
reasonable promptness and in a manner which promotes continuity in the
provision of health care services;



(2)  Provides access to sufficient numbers and types
of providers to ensure that all covered services will be accessible without
unreasonable delay;



(3)  When medically necessary, provides health care
services twenty-four hours a day, seven days a week;



(4)  Provides a reasonable choice of qualified
providers of women's health services such as gynecologists, obstetricians,
certified nurse-midwives, and advanced practice nurses to provide preventive
and routine women's health care services;



(5)  Provides payment or reimbursement for adequately
documented emergency services as provided in this chapter; and



(6)  Allows standing referrals to specialists capable
of providing and coordinating primary and specialty care for an enrollee's
life-threatening, chronic, degenerative, or disabling disease or condition. [L
1998, c 178, pt of §2; am L 1999, c 137, §4]