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S01810 Summary:

S01810 Actions:

S01810 Committee Votes:

S01810 Floor Votes:

S01810 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          1810
 
                               2019-2020 Regular Sessions
 
                    IN SENATE
 
                                    January 16, 2019
                                       ___________
 
        Introduced  by  Sen.  RIVERA -- 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
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD03578-01-9
        S. 1810                             2
 
     1  agent  at  least  twenty-four hours prior to discharge from an inpatient
     2  admission pursuant to this subdivision, a utilization review agent shall
     3  not deny, on the basis of medical necessity or lack  of  prior  authori-
     4  zation,  coverage  for the inpatient substance use disorder treatment or
     5  nursing home care while a determination by the utilization review  agent
     6  is pending.
     7    §  2.  Paragraphs  1  and  3  of subsection (c) of section 4903 of the
     8  insurance law, paragraph 1 as amended and paragraph 3 as added by  chap-
     9  ter 41 of the laws of 2014, are amended to read as follows:
    10    (1)  A  utilization  review agent shall make a determination involving
    11  continued or extended health care services, additional services  for  an
    12  insured  undergoing  a  course  of  continued  treatment prescribed by a
    13  health care provider, or requests for inpatient substance  use  disorder
    14  treatment,  or  nursing home care or home health care services following
    15  an inpatient hospital admission, and shall provide notice of such deter-
    16  mination to the insured or the insured's designee, which may  be  satis-
    17  fied  by  notice to the insured's health care provider, by telephone and
    18  in writing within one business day of receipt of the necessary  informa-
    19  tion  except,  with  respect  to  home health care services following an
    20  inpatient hospital admission, within seventy-two hours of receipt of the
    21  necessary information when the day subsequent to the request falls on  a
    22  weekend  or  holiday and except, with respect to inpatient substance use
    23  disorder treatment or nursing home care,  within  twenty-four  hours  of
    24  receipt  of  the  request  for services when the request is submitted at
    25  least twenty-four hours prior to discharge from an inpatient  admission.
    26  Notification  of continued or extended services shall include the number
    27  of extended services approved, the new total of approved  services,  the
    28  date of onset of services and the next review date.
    29    (3)  Provided that a request for inpatient treatment for substance use
    30  disorder or nursing home care is submitted  to  the  utilization  review
    31  agent  at  least  twenty-four hours prior to discharge from an inpatient
    32  admission pursuant to this subsection, a utilization review agent  shall
    33  not  deny,  on  the basis of medical necessity or lack of prior authori-
    34  zation, coverage for the inpatient substance use disorder  treatment  or
    35  nursing  home care while a determination by the utilization review agent
    36  is pending.
    37    § 3. This act shall take effect on the ninetieth day  after  it  shall
    38  have become a law.