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.
LBD02606-01-7
S. 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.
