18 CRR-NY 511.3NY-CRR

STATE COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK
TITLE 18. DEPARTMENT OF SOCIAL SERVICES
CHAPTER II. REGULATIONS OF THE DEPARTMENT OF SOCIAL SERVICES
SUBCHAPTER E. MEDICAL CARE
ARTICLE 3. POLICIES AND STANDARDS GOVERNING PROVISION OF MEDICAL AND DENTAL CARE
PART 511. MEDICAL CARE-UTILIZATION THRESHOLDS
18 CRR-NY 511.3
18 CRR-NY 511.3
511.3 Excluded services.
Utilization thresholds do not apply to the following services:
(a) services furnished by or through a managed care program to persons enrolled in and receiving medical care from such program. Managed care programs include health maintenance organizations, preferred provider plans, physician case management programs or other managed medical care programs recognized by the department;
(b) services otherwise subject to prior approval or prior authorization;
(c) reproductive health and family planning services including: diagnosis, treatment, drugs, supplies, and related counseling furnished or prescribed by a physician or under a physician's supervision;
(d) until September 1, 1992, services provided by or under the direction of a primary provider under the recipient restriction program, as established by section 360-6.4 of this Title;
(e) methadone maintenance treatment services;
(f) services provided by private practitioners on a fee-for-service basis to inpatients in general hospitals certified under article 28 of the Public Health Law or article 31 of the Mental Hygiene Law and residential health care facilities;
(g) hemodialysis services;
(h) obstetrical services provided by a physician, hospital outpatient department, or free-standing diagnostic and treatment center-certified under article 28 of the Public Health Law; or
(i) services provided through or by referral from a preferred primary care provider designated pursuant to section 2807(12) of the Public Health Law.
18 CRR-NY 511.3
Current through July 31, 2021
End of Document