§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]

 

Case Notes

 

  Count of complaint alleging that managed care entities could not demonstrate that they would comply with Hawaii's access to care and providers mandate, this section, and that plaintiff was therefore entitled to a declaration that defendants' contracts with the entities were void, dismissed; it did not appear that plaintiff had actually alleged a violation of this section, and even if plaintiff could state a claim, the claim was unripe.  576 F. Supp. 2d 1114.