What's happening
This bill requires insurance utilization review agents to make timely coverage decisions for nursing home care following a hospital admission, similar to existing requirements for substance use disorder and home health care.
Why it matters
Reduces risk of discharge delays. By mandating faster insurance decisions about nursing home care after hospital stays, the bill helps prevent patients from being stuck in hospitals longer than medically necessary, which can improve patient flow and reduce costs.
Aligns patient protections across care types. Extends the same timely-review protections already in place for substance use disorder and home health care to nursing home care, closing a gap that could leave vulnerable patients waiting for coverage decisions.
Limits denials during review period. Insurers cannot deny coverage for nursing home care while a timely request is under review, which means patients are less likely to face abrupt gaps in care or be forced to pay out-of-pocket while waiting for an insurance decision.
Potentially eases transitions for families. Families navigating post-hospital care will have clearer timelines and fewer last-minute surprises, reducing stress and uncertainty during a critical period when arranging nursing home placement.
Albany, before your first meeting.
Every bill that moved yesterday, summarized in a sentence and ranked by impact. The Albany Scorecard follows on Sundays.
Free. Unsubscribe in one click. Want alerts on specific bills? Create an account.
Who cares
Headline styles
Faster Nursing Home Review
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Committed to rules
- Substitution reconsidered
- 3rd reading cal.982
- Substituted for S7871
- Referred to health
- Delivered to senate
- Passed assembly
- Advanced to third reading cal.695
- Reported
- Referred to insurance
- Referred to insurance
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.
Speed Up Nursing Home Reviews
In Senate Committee · Rules · Sponsor Kemp Hannon
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
7108
2017-2018 Regular Sessions
IN ASSEMBLY
April 10, 2017
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 Assembly, 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 determination to the enrollee or the enrollee's designee, which may be satisfied by notice to the enrollee's health care provider, by telephone and in writing within one business day of receipt of the necessary information 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
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02606-01-7
A. 7108 2
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 authorization, coverage for the inpatient substance use disorder treatment or nursing home care while a determination by the utilization review agent is pending.
§ 2. Paragraphs 1 and 3 of subsection (c) of section 4903 of the insurance law, paragraph 1 as amended and paragraph 3 as added by chapter 41 of the laws of 2014, are amended to read as follows:
(1) A utilization review agent shall make a determination involving continued or extended health care services, additional services for an insured 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 determination to the insured or the insured's designee, which may be satisfied by notice to the insured's health care provider, by telephone and in writing within one business day of receipt of the necessary information 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.
(3) 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 subsection, a utilization review agent shall not deny, on the basis of medical necessity or lack of prior authorization, coverage for the inpatient substance use disorder treatment or nursing home care while a determination by the utilization review agent is pending.
§ 3. This act shall take effect on the ninetieth day after it shall have become a law.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.