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

(1)  Makes benefits available and accessible to eachenrollee electing the managed care plan in the defined service area withreasonable promptness and in a manner which promotes continuity in theprovision of health care services;

(2)  Provides access to sufficient numbers and typesof providers to ensure that all covered services will be accessible withoutunreasonable delay;

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

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

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

(6)  Allows standing referrals to specialists capableof providing and coordinating primary and specialty care for an enrollee'slife-threatening, chronic, degenerative, or disabling disease or condition. [L1998, c 178, pt of §2; am L 1999, c 137, §4]