265.994           Determination of Where Medically Necessary Services  Are to be Provided to Patients Enrolled in Managed Care Entities: 

265.994           Determination of Where Medically Necessary Services  Are to be Provided to Patients Enrolled in Managed Care Entities: 

MSSNY has adopted the position that in the event that a patient enrolled in a managed care program is referred to the emergency room of a local hospital following direct or verbal contact with a participating physician, this visit be covered and reimbursable whether categorized as emergent or not.  (HOD 1994-262; Reaffirmed HOD 2014; Reaffirmed HOD 2024)