165.996 Personal Financial Gain Should Not Influence Medical Decisions: It is MSSNY policy that decisions involving medical care should be based upon the medical needs of the patient and independent of physician financial incentives and disincentives. (Council 9/22/94; Reaffirmed HOD 2014)
165.995 Organized Medical Staffs in Managed Care Entities: It is MSSNY policy that managed care entities establish self-governing medical staffs similar, if not identical, to those in hospitals. The principles of self-governance should include, but not be limited to: the development of medical Staff Bylaws which
165.994 Policy on Managed Care: MSSNY affirms the following policy as adopted by the Council on January 23, 1986, and amended by the Committee on Interspecialty on January 13, 1994: (1) No single pattern of health care delivery is necessarily suited to all patients or to all physicians; and
165.993 Emergency Services at Specialty Centers – Equity Coverage by Managed Care Entities: It is the position of MSSNY that those managed medical care organizations that limit or restrict fiscal coverage to certain hospitals and physicians make an exception for emergent critical care case situations (such as extensive burns,
165.992 Utilization Review Management: MSSNY affirms the following position with regard to Utilization Review Management applicable to managed care entities who utilize down-coding, site of service payment reductions, and restrictive patient referral policies as a means of economic disincentives as follows: Physicians who are trained and/or Board
165.991 Responsibility To Patients in Managed Care Plans: SUNSET HOD 2024
165.990 Profits and Administrative Costs of Managed Care Organizations: SUNSET HOD 2014
165.989 Retrospective Denial of Pre-Certified Services by Managed Care: The practice of retrospective denial of payment for care which has been pre-certified by an insurer should be banned, except when false or fraudulent information has knowingly been given to the insurer by the physician, hospital or ancillary service
165.988 Specialty Rosters in Managed Care: All managed care organizations should be required to maintain full rosters of medical specialists, representing all the specialties approved by the American Board of Medical Specialties and the American Osteopathic Board of Medical Specialties or otherwise provide access outside the managed care
165.987 Administrative Procedures, Standardization of Managed Care: SUNSET HOD 2014
