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History
- Committed to rules
- Advanced to third reading
- 2nd report cal.
- 1st report cal.1145
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
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
Assembly Floor Calendar · Sponsor Richard Gottfried
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
Title of bill
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
Purpose
:
To decrease delays for post-acute care by adding nursing home care to the types of care for which an insurer must make a determination on authorization within twenty four hours.
Summary of provisions
:
Section one amends paragraphs (a) and (c) of subdivision 3 of section 4903 of the Public Health Law by requiring that health care plans make a determination involving continued or extended post acute nursing home care within twenty four hours of receipt of request for services and by prohibiting denial of nursing home coverage on the basis of medical necessity or lack of prior authorization while the determination is pending.
Section two makes the aforementioned amendments to paragraphs 1 and 3 of subsection (c) of section 4903 of the Insurance Law.
Section three provides that this act shall take effect 90 days after enactment.
Justification
:
Many patients require home care or skilled nursing home care upon discharge from the hospital. Hospitals increasingly experience delays in obtaining authorizations from insurers for post-acute care. Since most insurers pay hospitals based on diagnosis-related group systems, it does not cost the insurer any more to have patients stay in the hospital for a few extra days and doing so can reduce insurer costs for post-acute care. This is not good for patients, nor is it good for hospitals trying to operate as efficiently as possible.
State law has been modified twice in recent years to tighten timeframes for authorization for post-acute home care and substance abuse services. This legislation will extend the tightened timeframe to skilled nursing home services, requiring insurers to make determinations on requests for nursing home care following an inpatient admission within 24 hours of receipt of a request as long as the request is made at least 24 hours prior to discharge from the hospital. This change is particularly important now that the Medicaid nursing home benefit has moved from Medicaid fee-for-service to managed care.
Legislative history
:
New bill.
Fiscal implications
:
None.
Effective date
:
90 days after enactment.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.