Assembly Bill A9301

2015-2016 Legislative Session

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

download bill text pdf

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Archive: Last Bill Status - On Floor Calendar


  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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2015-A9301 (ACTIVE) - Details

See Senate Version of this Bill:
S6492
Law Section:
Public Health Law
Laws Affected:
Amd §4903, Pub Health L; amd §4903, Ins L
Versions Introduced in Other Legislative Sessions:
2017-2018: A7108, S7871
2019-2020: A3059, S1810

2015-A9301 (ACTIVE) - Summary

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.

2015-A9301 (ACTIVE) - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  9301

                          I N  A S S E M B L Y

                            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:

  Section 1. Paragraphs (a) and (c) of subdivision 3 of section 4903  of
the  public  health  law,  paragraph (a) as amended and paragraph (c) as
added by chapter 41 of the laws of 2014, are amended to read as follows:
  (a) A utilization review agent shall make  a  determination  involving
continued  or  extended health care services, additional services for an
enrollee undergoing a course of  continued  treatment  prescribed  by  a
health  care  provider, or requests for inpatient substance use disorder
treatment, OR NURSING HOME CARE or home health care  services  following
an inpatient hospital admission, and shall provide notice of such deter-
mination to the enrollee or the enrollee's designee, which may be satis-
fied  by notice to the enrollee's health care provider, by telephone and
in writing within one business day of receipt of the necessary  informa-
tion  except,  with  respect  to  home health care services following an
inpatient hospital admission, within seventy-two hours of receipt of the
necessary information when the day subsequent to the request falls on  a
weekend  or  holiday and except, with respect to inpatient substance use
disorder treatment OR NURSING HOME CARE,  within  twenty-four  hours  of
receipt  of  the  request  for services when the request is submitted at
least twenty-four hours prior to discharge from an inpatient  admission.
Notification  of continued or extended services shall include the number
of extended services approved, the new total of approved  services,  the
date of onset of services and the next review date.
  (c)  Provided that a request for inpatient treatment for substance use
disorder OR NURSING HOME CARE is submitted  to  the  utilization  review
agent  at  least  twenty-four hours prior to discharge from an inpatient
admission pursuant to this subdivision, a utilization review agent shall
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.
              

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