N.Y. Public Health Law Section 2803-I
General hospital inpatient discharge review program

1.

A general hospital inpatient discharge review program applicable to all patients other than beneficiaries of title XVIII of the federal social security act (medicare) shall be established in accordance with this section. No general hospital inpatient subject to the provisions of this section may be discharged on the basis that inpatient hospital service in a general hospital is no longer medically necessary and that an appropriate discharge plan has been established unless a written notice of such determinations and a copy of the discharge plan have been provided to the patient or the appointed personal representative of the patient. The patient or the appointed personal representative of the patient shall have the opportunity to sign the notice and a copy of the discharge plan and receive a copy of both signed documents. Every general hospital shall use a common notice developed and disseminated in accordance with rules and regulations adopted by the council and approved by the commissioner which shall indicate that the patient is to be discharged, shall state the reasons therefor and shall state that the patient may request a review of such determinations. The patient, or the appointed personal representative of the patient may request a review of such determinations by the appropriate independent professional review agent (or “review agent”) in accordance with subdivision four of this section. Notwithstanding that the patient discharge review process provided in accordance with federal law and regulation shall apply to beneficiaries of title XVIII of the federal social security act (medicare), a written copy of the discharge plan, and discharge notice shall be provided to the beneficiary or the appointed personal representative of the beneficiary. The beneficiary or the appointed personal representative of the beneficiary shall have the opportunity to sign the documents and receive a copy of the signed documents.

2.

(a) For patients eligible for payments by state governmental agencies for general hospital inpatient services as the patient’s primary payor, an independent professional review agent shall mean the commissioner or his designee. In conducting general hospital inpatient discharge reviews in accordance with this section, the commissioner may utilize the services of department personnel or other authorized representatives, including a review agent approved in accordance with paragraph (b) of this subdivision.

(b)

For patients who are not beneficiaries of title XVIII of the federal social security act (medicare) nor eligible for payments by state governmental agencies as the patient’s primary payor, an independent professional review agent shall mean a third party payor of hospital services or other corporation approved by the commissioner in writing for purposes of conducting general hospital inpatient discharge reviews in accordance with this section. For a third party payor of hospital services or other corporation to be approved as an independent professional review agent in accordance with this paragraph, such third party payor or other corporation must meet the following criteria:

(i)

the review agent shall employ or otherwise secure the services of adequate medical personnel qualified to determine the necessity of continued inpatient hospital services and the appropriateness of hospital discharge plans;

(ii)

the review agent shall demonstrate the ability to render review decisions in a timely manner as provided in this section;

(iii)

the review agent shall agree to provide ready access by the commissioner to all data, records and information it collects and maintains concerning its review activities under this section;

(iv)

the review agent shall agree to provide to the commissioner such data, information and reports as the commissioner determines necessary to evaluate the review process provided pursuant to this section;

(v)

the review agent shall provide assurances that review personnel shall not have a conflict of interest in conducting a discharge review for a patient based on hospital or professional affiliation; and

(vi)

the review agent meets such other performance and efficiency criteria regarding the conduct of reviews pursuant to this section established by the commissioner. The commissioner may withdraw approval of an independent professional review agent where such review agent fails to continue to meet approval criteria established pursuant to this paragraph.

(c)

(i) Each general hospital shall enter into contracts with one or more independent professional review agents approved by the commissioner in accordance with paragraph (b) of this subdivision for purposes of conducting general hospital inpatient discharge reviews in accordance with this section for patients, including uncompensated care patients, who are not beneficiaries of title XVIII of the federal social security act (medicare) nor eligible for payments by state governmental agencies as the patients’ primary payor; provided, however, a payor of hospital service included in the payor categories specified in paragraph (a) of subdivision one of § 2807-C (General hospital inpatient reimbursement for annual rate periods beginning on or after January first, nineteen hundred eighty-eight)section twenty-eight hundred seven-c of this article, other than state governmental agencies, may designate the review agent for their subscribers or beneficiaries or enrolled members and shall reimburse such designated review agent for costs of the discharge review program.

(ii)

Notwithstanding any inconsistent provision of law, general hospital contract costs incurred in accordance with subparagraph (i) of this paragraph may be included as an additional charge for general hospital inpatient services in determining patient charges for payors included in the payor categories specified in paragraph (c) of subdivision one of § 2807-C (General hospital inpatient reimbursement for annual rate periods beginning on or after January first, nineteen hundred eighty-eight)section twenty-eight hundred seven-c of this article, or as a charge in addition to rates of payment for general hospital inpatient services in determining payment due for payors included in the payor categories specified in paragraph (b) of subdivision one of § 2807-C (General hospital inpatient reimbursement for annual rate periods beginning on or after January first, nineteen hundred eighty-eight)section twenty-eight hundred seven-c of this article, or paragraph (a) of such subdivision one if a payor has not designated a review agent for such payor’s subscribers or beneficiaries or enrolled members, or paragraph (a) or (b) of subdivision two of § 2807-C (General hospital inpatient reimbursement for annual rate periods beginning on or after January first, nineteen hundred eighty-eight)section twenty-eight hundred seven-c of this article. Such additional charges shall not be subject to maximum charge or rate of payment ceilings determined in accordance with § 2807-C (General hospital inpatient reimbursement for annual rate periods beginning on or after January first, nineteen hundred eighty-eight)section twenty-eight hundred seven-c of this article for such payors.

3.

(a) If a general hospital and the attending physician agree that inpatient hospital service in a general hospital is no longer medically necessary for a patient, other than a beneficiary of title XVIII of the federal social security act (medicare), and an appropriate discharge plan has been established for such patient, at that time the hospital shall provide the patient or the appointed personal representative of the patient with a written discharge notice and a copy of the discharge plan, meeting the requirements of subdivision one of this section.

(b)

If a general hospital has determined that inpatient hospital service in a general hospital is no longer medically necessary for a patient, other than a beneficiary of title XVIII of the federal social security act (medicare), and an appropriate discharge plan has been established for such patient but the attending physician has not agreed with the hospital’s determinations, the hospital may request by telephone a review of the validity of the hospital’s determinations by the appropriate independent professional review agent. Such review agent shall conduct a review of the hospital’s determinations and prior to the conclusion of the review shall provide an opportunity to the treating physician and an appropriate representative of the hospital to confer and provide information which may include the patient’s clinical records if requested by the review agent. Such review agent shall notify the hospital of the results of its review not later than one working day after the date the review agent has received the request, the records required to conduct such review, and the date of such conferring and receipt of any additional information requested. The hospital shall provide notice to the attending physician of the results of the review. If the review agent concurs with the hospital’s determinations, the hospital shall provide the patient or his appointed personal representative with a written notice of such determinations and notice that the patient shall be financially responsible for continued stay, and with a copy of the proposed discharge plan. The patient or the appointed personal representative of the patient shall have the opportunity to sign the notice and a copy of the proposed discharge plan and receive a copy of both signed documents. Every general hospital shall use a common notice developed and disseminated in accordance with rules and regulations adopted by the council and approved by the commissioner which shall indicate the determinations made, shall state the reasons therefor and that the patient’s attending physician has disagreed and shall state that the patient or the appointed personal representative of the patient may request a review of such determinations by the appropriate review agent.

4.

A patient in a general hospital, or the appointed personal representative of the patient, who receives a written notice in accordance with paragraph (a) or (b) of subdivision three of this section, may request a review by the appropriate review agent of the determinations set forth in such notice related to medical necessity of continued inpatient hospital service, the appropriateness of the discharge plan and the availability of required continuing health care services.

(a)

If a patient while still hospitalized or while no longer an inpatient, or the appointed personal representative of such patient, requests a review by the appropriate review agent, the hospital shall promptly provide to the review agent the records required to review the determinations. Such request for a patient no longer an inpatient shall take place no later than thirty days after receipt of a notice provided in accordance with subdivision three of this section or seven days after receipt of a complete bill for all inpatient services rendered, whichever is later. The review agent shall conduct a review of such determinations and shall provide the treating physician and an appropriate representative of the hospital with an opportunity to confer and provide information prior to the conclusion of the review. The review agent shall provide written notice to the patient, or the appointed personal representative of the patient, and the hospital of the results of the review within three working days of receipt of the requests for review and the records required to review the determinations. The hospital shall provide notice to the attending physician of the results of the review.

(b)

Notwithstanding the provisions of paragraph (a) of this subdivision, if a patient while still an inpatient in the general hospital, or the appointed personal representative of the patient, requests a review by the appropriate review agent not later than noon of the first working day after the date the patient, or the appointed personal representative of the patient, receives the written notice, the hospital shall provide to the appropriate review agent the records required to review the determinations by the close of business of such working day. The appropriate review agent shall conduct a review of such determinations and provide written notice to the patient, or the appointed personal representative of the patient, and the hospital of the results of the review not later than one full working day after the date the review agent has received the request for review and such records. The hospital shall provide notice to the attending physician of the results of the review.

5.

Notwithstanding any inconsistent provision of law, if the appropriate review agent, upon any review conducted pursuant to paragraph (b) of subdivision three or pursuant to subdivision four of this section does not concur in the determinations, continued stay in a general hospital shall be deemed necessary and appropriate for the patient for purposes of payment for such continued stay in accordance with § 2807-C (General hospital inpatient reimbursement for annual rate periods beginning on or after January first, nineteen hundred eighty-eight)section twenty-eight hundred seven-c of this article.

6.

If a patient eligible for payment for inpatient hospital services under a case based payment per discharge determined in accordance with § 2807-C (General hospital inpatient reimbursement for annual rate periods beginning on or after January first, nineteen hundred eighty-eight)section twenty-eight hundred seven-c of this article, or the appointed personal representative of the patient, requests a review by the appropriate review agent in accordance with paragraph (b) of subdivision four of this section, the hospital may not demand or request any payment for additional inpatient hospital services provided to such patient subsequent to the proposed time of discharge and prior to noon of the day after the date the patient or the appointed personal representative of the patient receives notice of the results of the review by the review agent other than payment determined in accordance with § 2807-C (General hospital inpatient reimbursement for annual rate periods beginning on or after January first, nineteen hundred eighty-eight)section twenty-eight hundred seven-c of this article and deductibles, copayments, or other charges that would be authorized for a patient for whom inpatient hospital services in a general hospital continue to be necessary and appropriate.

7.

In any review conducted pursuant to paragraph (b) of subdivision three or pursuant to subdivision four of this section, the review agent shall solicit the views of the patient involved, or the appointed personal representative of the patient, and the attending physician.

8.

Each patient, or the appointed personal representative of the patient, provided a notice by a general hospital in accordance with subdivision three of this section shall be provided at such time by the hospital with a notice, in a form developed in accordance with rules and regulations adopted by the council and approved by the commissioner, of such patient’s right to request a discharge review in accordance with this section. The patient or the appointed personal representative of the patient shall have the opportunity to sign this form and receive a copy of the signed form.

9.

Upon discharge of a blind or visually impaired patient, a hospital shall offer to provide the patient’s discharge plan in a large print version or, at the patient’s or patient’s representative’s request, as an audio recording, to be made available to such patient or such patient’s representative on compact disc or other medium as the hospital may offer, or as an electronically transmitted digital file, in addition to a written copy of the discharge plan.

10.

The council shall adopt rules and regulations, subject to the approval of the commissioner, necessary to implement this section.

Source: Section 2803-I — General hospital inpatient discharge review program, https://www.­nysenate.­gov/legislation/laws/PBH/2803-I (updated Oct. 24, 2014; accessed Oct. 26, 2024).

2800
Declaration of policy and statement of purpose 2801
Definitions 2801‑A
Establishment or incorporation of hospitals 2801‑B
Improper practices in hospital staff appointments and extension of professional privileges prohibited 2801‑C
Injunctions 2801‑D
Private actions by patients of residential health care facilities 2801‑E
Voluntary residential health care facility rightsizing demonstration program 2801‑F
Residential health care facility quality incentive payment program 2801‑G
Community forum on hospital closure 2801‑H
Personal caregiving and compassionate caregiving visitors to nursing home residents during declared local or state health emergencies 2802
Approval of construction 2802‑A
Transitional care unit demonstration program 2802‑B
Health equity impact assessments 2803
Commissioner and council 2803‑A
Authority to contract 2803‑AA
Sickle cell disease information distribution 2803‑AA*2
Nursing home infection control competency audit 2803‑B
Uniform reports and accounting systems for hospital costs 2803‑C
Rights of patients in certain medical facilities 2803‑C‑1
Rights of patients in certain medical facilities 2803‑C‑2
Lesbian, gay, bisexual and transgender, and people living with HIV long-term care facility residents’ bill of rights 2803‑D
Reporting abuses of persons receiving care or services in residential health care facilities 2803‑E
Residential health care facilities 2803‑E*2
Reporting incidents of possible professional misconduct 2803‑F
Respite projects 2803‑G
Board of visitors in county owned residential health care facility 2803‑H
Health related facility 2803‑I
General hospital inpatient discharge review program 2803‑J
Information for maternity patients 2803‑J*2
Nursing home nurse aide registry 2803‑K
In-patient nasogastric feeding procedures 2803‑L
Community service plans 2803‑M
Discharge of hospital patients to adult homes 2803‑N
Hospital care for maternity patients 2803‑O
Hospital care for mastectomy, lumpectomy, and lymph node dissection patients 2803‑O‑1
Required protocols for fetal demise 2803‑P
Disclosure of information concerning family violence 2803‑Q
Family councils in residential health care facilities 2803‑R
Dissemination of information about the abandoned infant protection act 2803‑S
Access to product recall information 2803‑T
Preadmission information 2803‑U
Hospital substance use disorder policies and procedures 2803‑V
Lymphedema information distribution 2803‑V*2
Standing orders for newborn care in a hospital 2803‑W
Independent quality monitors for residential health care facilities 2803‑W*2
Disclosure of information concerning pregnancy complications 2803‑X
Requirements related to nursing homes and related assets and operations 2803‑Y
Provision of residency agreement 2803‑Z
Transfer, discharge and voluntary discharge requirements for residential health care facilities 2803‑Z*2
Antimicrobial resistance prevention and education 2804
Units for hospital and health-related affairs 2804‑A
State task force on clinical practice guidelines and medical technology assessment 2805
Approval of hospitals 2805‑A
Disclosure of financial transactions 2805‑B
Admission of patients and emergency treatment of nonadmitted patients 2805‑C
Every private proprietary nursing home having a capacity of eighty patients or more may have a licensed medical doctor in attendance, upo... 2805‑D
Limitation of medical, dental or podiatric malpractice action based on lack of informed consent 2805‑E
Reports of residential health care facilities 2805‑F
Money deposited or advanced for admittance to nursing homes 2805‑G
Maintenance of records 2805‑H
Immunizations 2805‑I
Treatment of sexual offense victims and maintenance of evidence in a sexual offense 2805‑J
Medical, dental and podiatric malpractice prevention program 2805‑K
Investigations prior to granting or renewing privileges 2805‑L
Adverse event reporting 2805‑M
Confidentiality 2805‑N
Child abuse prevention 2805‑O
Identification of veterans and their spouses by nursing homes, residential health care facilities, and adult care facilities 2805‑P
Emergency treatment of rape survivors 2805‑Q
Hospital visitation by domestic partner 2805‑R
Patients unable to verbally communicate 2805‑S
Circulating nurse required 2805‑T
Clinical staffing committees and disclosure of nursing quality indicators 2805‑U
Credentialing and privileging of health care practitioners providing telemedicine services 2805‑V
Observation services 2805‑W
Patient notice of observation services 2805‑X
Hospital-home care-physician collaboration program 2805‑Y
Identification and assessment of human trafficking victims 2805‑Z
Hospital domestic violence policies and procedures 2806
Hospital operating certificates 2806‑A
Temporary operator 2806‑B
Residential health care facilities 2807
Hospital reimbursement provisions 2807‑A
General hospital nineteen hundred eighty-six and nineteen hundred eighty-seven inpatient rates and charges 2807‑AA
Nurse loan repayment program 2807‑B
Outstanding payments and reports due under subdivision eighteen of section twenty-eight hundred seven-c, sections twenty-eight hundred se... 2807‑C
General hospital inpatient reimbursement for annual rate periods beginning on or after January first, nineteen hundred eighty-eight 2807‑D
Hospital assessments 2807‑D‑1
Hospital quality contributions 2807‑DD
Temporary nursing home stability contributions 2807‑E
Uniform bills 2807‑F
Health maintenance organization payment factor 2807‑FF
New York managed care organization provider tax 2807‑I
Service and quality improvement grants 2807‑J
Patient services payments 2807‑K
General hospital indigent care pool 2807‑L
Health care initiatives pool distributions 2807‑M
Distribution of the professional education pools 2807‑N
Palliative care education and training 2807‑O
Early intervention services pool 2807‑P
Comprehensive diagnostic and treatment centers indigent care program 2807‑R
Funding for expansion of cancer services 2807‑S
Professional education pool funding 2807‑T
Assessments on covered lives 2807‑U
Transfers for tax credits 2807‑V
Tobacco control and insurance initiatives pool distributions 2807‑W
High need indigent care adjustment pool 2807‑X
Grants for long term care demonstration projects 2807‑Y
Pool administration 2807‑Z
Review of eligible federally qualified health center capital projects 2808
Residential health care facilities 2808‑A
Liability of certain persons 2808‑B
Certification of financial statements and financial information 2808‑C
Reimbursement of general hospital inpatient services 2808‑D
Nursing home quality improvement demonstration program 2808‑E
Residential health care for children with medical fragility in transition to young adults and young adults with medical fragility demonst... 2808‑E*2
Nursing home ratings 2809
Residential health care facilities 2810
Residential health care facilities 2811
Discounts and splitting fees with medical referral services 2812
Construction 2813
Separability 2814
Health networks, global budgeting, and health care demonstrations 2815
Health facility restructuring program 2815‑A
Community health care revolving capital fund 2816
Statewide planning and research cooperative system 2816‑A
Cardiac services information 2817
Community health centers capital program 2818
Health care efficiency and affordability law of New Yorkers (HEAL NY) capital grant program 2819
Hospital acquired infection reporting 2820
Home based primary care for the elderly demonstration project 2821
State electronic health records (EHR) loan program 2822
Residential care off-site facility demonstration project 2823
Supportive housing development program 2824
Central service technicians 2824*2
Surgical technology and surgical technologists 2825
Capital restructuring financing program 2825‑A
Health care facility transformation program: Kings county project 2825‑B
Oneida county health care facility transformation program: Oneida county project 2825‑C
Essential health care provider support program 2825‑D
Health care facility transformation program: statewide 2825‑E
Health care facility transformation program: statewide II 2825‑F
Health care facility transformation program: statewide III 2825‑G
Health care facility transformation program: statewide IV 2825‑H
Health care facility transformation program: statewide V 2825‑I
Healthcare safety net transformation program 2826
Temporary adjustment to reimbursement rates 2827
Plant-based food options 2828
Residential health care facilities 2828*2
Essential support persons allowed for individuals with disabilities during a state of emergency 2829
Nursing homes 2830
Surgical smoke evacuation 2830*2
Regulation of the billing of facility fees
Green check means up to date. Up to date

Accessed:
Oct. 26, 2024

Last modified:
Oct. 24, 2014

§ 2803-I’s source at nysenate​.gov

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