Each community-based health maintenance organization shall offer coverage that allows
an enrollee who suffers from a life-threatening condition or a degenerative, disabling
condition requiring a regimen of specialized medical treatment lasting for six months
or more to receive a standing referral for specialty care case management by a physician
or specialty care center with expertise in treating the condition. Under such specialty care case management, the provider shall coordinate primary
and specialty care for the enrollee under a treatment plan approved by the health
maintenance organization in consultation with the enrollee's primary care provider
and the specialist physician or specialty care center.
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