Bill Text: NY A09086 | 2019-2020 | 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 (Democrat 2-0)

Status: (Introduced - Dead) 2020-01-17 - referred to insurance [A09086 Detail]

Download: New_York-2019-A09086-Introduced.html

---

                STATE OF NEW YORK
        ________________________________________________________________________

                                          9086

                   IN ASSEMBLY

                                    January 17, 2020
                                       ___________

        Introduced by M. of A. GOTTFRIED, REYES -- 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.
                                                                   LBD03578-02-0
        A. 9086                             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.