§ 2803-i. General hospital inpatient discharge review program. 1. A\ngeneral hospital inpatient discharge review program applicable to all\npatients other than beneficiaries of title XVIII of the federal social\nsecurity act (medicare) shall be established in accordance with this\nsection. No general hospital inpatient subject to the provisions of this\nsection may be discharged on the basis that inpatient hospital service\nin a general hospital is no longer medically necessary and that an\nappropriate discharge plan has been established unless a written notice\nof such determinations and a copy of the discharge plan have been\nprovided to the patient or the appointed personal representative of the\npatient. The patient or the appointed personal representative of the\npatient shall have the opportunity to sign the notice and a copy of the\ndischarge plan and receive a copy of both signed documents. Every\ngeneral hospital shall use a common notice developed and disseminated in\naccordance with rules and regulations adopted by the council and\napproved by the commissioner which shall indicate that the patient is to\nbe discharged, shall state the reasons therefor and shall state that the\npatient may request a review of such determinations. The patient, or the\nappointed personal representative of the patient may request a review of\nsuch determinations by the appropriate independent professional review\nagent (or "review agent") in accordance with subdivision four of this\nsection. Notwithstanding that the patient discharge review process\nprovided in accordance with federal law and regulation shall apply to\nbeneficiaries of title XVIII of the federal social security act\n(medicare), a written copy of the discharge plan, and discharge notice\nshall be provided to the beneficiary or the appointed personal\nrepresentative of the beneficiary. The beneficiary or the appointed\npersonal representative of the beneficiary shall have the opportunity to\nsign the documents and receive a copy of the signed documents.\n 2. (a) For patients eligible for payments by state governmental\nagencies for general hospital inpatient services as the patient's\nprimary payor, an independent professional review agent shall mean the\ncommissioner or his designee. In conducting general hospital inpatient\ndischarge reviews in accordance with this section, the commissioner may\nutilize the services of department personnel or other authorized\nrepresentatives, including a review agent approved in accordance with\nparagraph (b) of this subdivision.\n (b) For patients who are not beneficiaries of title XVIII of the\nfederal social security act (medicare) nor eligible for payments by\nstate governmental agencies as the patient's primary payor, an\nindependent professional review agent shall mean a third party payor of\nhospital services or other corporation approved by the commissioner in\nwriting for purposes of conducting general hospital inpatient discharge\nreviews in accordance with this section. For a third party payor of\nhospital services or other corporation to be approved as an independent\nprofessional review agent in accordance with this paragraph, such third\nparty payor or other corporation must meet the following criteria: (i)\nthe review agent shall employ or otherwise secure the services of\nadequate medical personnel qualified to determine the necessity of\ncontinued inpatient hospital services and the appropriateness of\nhospital discharge plans; (ii) the review agent shall demonstrate the\nability to render review decisions in a timely manner as provided in\nthis section; (iii) the review agent shall agree to provide ready access\nby the commissioner to all data, records and information it collects and\nmaintains concerning its review activities under this section; (iv) the\nreview agent shall agree to provide to the commissioner such data,\ninformation and reports as the commissioner determines necessary to\nevaluate the review proce
‹ Prev All New York sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.