Bill Text: NY A09301 | 2015-2016 | General Assembly | Introduced

New York Assembly Bill 9301 (Prior Session Legislation)

Introduced

Bill Title: Requires a utilization review of a request for nursing home care after an inpatient hospital admission to be completed within 24 hours of the request.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2016-06-06 - ordered to third reading rules cal.67 [A09301 Detail]

Download: New_York-2015-A09301-Introduced.html



                STATE OF NEW YORK
        ________________________________________________________________________
                                          9301
                   IN ASSEMBLY
                                    February 17, 2016
                                       ___________
        Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
          Committee on Insurance
        AN ACT to amend the public health law and the insurance law, in relation
          to utilization review of coverage of nursing home  care  following  an
          inpatient hospital admission
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. Paragraphs (a) and (c) of subdivision 3 of section 4903  of
     2  the  public  health  law,  paragraph (a) as amended and paragraph (c) as
     3  added by chapter 41 of the laws of 2014, are amended to read as follows:
     4    (a) A utilization review agent shall make  a  determination  involving
     5  continued  or  extended health care services, additional services for an
     6  enrollee undergoing a course of  continued  treatment  prescribed  by  a
     7  health  care  provider, or requests for inpatient substance use disorder
     8  treatment, or nursing home care or home health care  services  following
     9  an inpatient hospital admission, and shall provide notice of such deter-
    10  mination to the enrollee or the enrollee's designee, which may be satis-
    11  fied  by notice to the enrollee's health care provider, by telephone and
    12  in writing within one business day of receipt of the necessary  informa-
    13  tion  except,  with  respect  to  home health care services following an
    14  inpatient hospital admission, within seventy-two hours of receipt of the
    15  necessary information when the day subsequent to the request falls on  a
    16  weekend  or  holiday and except, with respect to inpatient substance use
    17  disorder treatment or nursing home care,  within  twenty-four  hours  of
    18  receipt  of  the  request  for services when the request is submitted at
    19  least twenty-four hours prior to discharge from an inpatient  admission.
    20  Notification  of continued or extended services shall include the number
    21  of extended services approved, the new total of approved  services,  the
    22  date of onset of services and the next review date.
    23    (c)  Provided that a request for inpatient treatment for substance use
    24  disorder or nursing home care is submitted  to  the  utilization  review
    25  agent  at  least  twenty-four hours prior to discharge from an inpatient
    26  admission pursuant to this subdivision, a utilization review agent shall
    27  not deny, on the basis of medical necessity or lack  of  prior  authori-
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD13384-02-6