New York Senate Bill S04792 Latest Draft

   
  STATE OF NEW YORK ________________________________________________________________________ 4792 2023-2024 Regular Sessions  IN SENATE February 14, 2023 ___________ 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. LBD08060-01-3 
 S. 4792 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.