Bill Text: NY S07871 | 2017-2018 | General Assembly | 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 (Republican 1-0)
Status: (Introduced - Dead) 2018-06-12 - SUBSTITUTED BY A7108 [S07871 Detail]
Download: New_York-2017-S07871-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 7871 IN SENATE March 5, 2018 ___________ Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Health 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. LBD02606-01-7S. 7871 2 1 zation, coverage for the inpatient substance use disorder treatment or 2 nursing home care while a determination by the utilization review agent 3 is pending. 4 § 2. Paragraphs 1 and 3 of subsection (c) of section 4903 of the 5 insurance law, paragraph 1 as amended and paragraph 3 as added by chap- 6 ter 41 of the laws of 2014, are amended to read as follows: 7 (1) A utilization review agent shall make a determination involving 8 continued or extended health care services, additional services for an 9 insured undergoing a course of continued treatment prescribed by a 10 health care provider, or requests for inpatient substance use disorder 11 treatment, or nursing home care or home health care services following 12 an inpatient hospital admission, and shall provide notice of such deter- 13 mination to the insured or the insured's designee, which may be satis- 14 fied by notice to the insured's health care provider, by telephone and 15 in writing within one business day of receipt of the necessary informa- 16 tion except, with respect to home health care services following an 17 inpatient hospital admission, within seventy-two hours of receipt of the 18 necessary information when the day subsequent to the request falls on a 19 weekend or holiday and except, with respect to inpatient substance use 20 disorder treatment or nursing home care, within twenty-four hours of 21 receipt of the request for services when the request is submitted at 22 least twenty-four hours prior to discharge from an inpatient admission. 23 Notification of continued or extended services shall include the number 24 of extended services approved, the new total of approved services, the 25 date of onset of services and the next review date. 26 (3) Provided that a request for inpatient treatment for substance use 27 disorder or nursing home care is submitted to the utilization review 28 agent at least twenty-four hours prior to discharge from an inpatient 29 admission pursuant to this subsection, a utilization review agent shall 30 not deny, on the basis of medical necessity or lack of prior authori- 31 zation, coverage for the inpatient substance use disorder treatment or 32 nursing home care while a determination by the utilization review agent 33 is pending. 34 § 3. This act shall take effect on the ninetieth day after it shall 35 have become a law.