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If the MCO or primary care provider , in consultation with the MCO medical director and a specialist with expertise in serving the enrollee 's condition or disease , determines that the enrollee 's care would most appropriately be coordinated by such a specialist , the MCO shall permit a standing referral and direct access to the specialist . Under the stop loss program , the MCO will manage , coordinate and pay for mental health outpatient visits and inpatient hospital days for patients who exceed their 20 outpatient visits or 30 inpatient days ( 1 ) benefit . Note that under this suggested language , the MCO would be responsible for coordinating with public agencies that seek to coordinate with it . In both instances , the MCO must seek disenrollment through the formal process described in Chapter 23 of this Protocol . If the hospital is not part of the MCO 's network and an initial triage reveals the visit to be non-emergent , the MCO will be responsible for paying the hospital a triage fee in accordance with State law . Under the stop loss program , the MCO will manage , coordinate and pay for inpatient chemical dependence rehabilitation or treatment days for patients who exceed their 30 day inpatient benefit .