S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    848
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 11, 2023
                                ___________
 
 Introduced by M. of A. McDONALD -- read once and referred to the Commit-
   tee on Health
 
 AN ACT to amend the public health law and the insurance law, in relation
   to requiring providers to share electronic health records with plans
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 13 of section 2803 of the public health law, as
 amended by chapter 19 of the laws of 2022, is renumbered subdivision  14
 and a new subdivision 15 is added to read as follows:
   15.  (A) THE COMMISSIONER SHALL REQUIRE EVERY GENERAL HOSPITAL SUBJECT
 TO THIS ARTICLE TO TIMELY SHARE ELECTRONIC MEDICAL RECORDS  TO  UTILIZA-
 TION  REVIEW  AGENTS  FOR PURPOSES OF ARTICLE FORTY-NINE OF THIS CHAPTER
 AND ARTICLE FORTY-NINE OF THE INSURANCE LAW.   NOTHING CONTAINED  HEREIN
 SHALL PROHIBIT A HEALTH CARE PLAN FROM ENTERING INTO AN AGREEMENT WITH A
 HEALTH  CARE  PROVIDER  FOR  THE  SHARING AND TRANSMISSION OF ELECTRONIC
 MEDICAL RECORDS PURSUANT TO THIS SECTION.
   (B) RECORDS DISCLOSED PURSUANT TO PARAGRAPH (A)  OF  THIS  SUBDIVISION
 SHALL:
   (I)  BE  USED EXCLUSIVELY FOR INDIVIDUAL CLAIM/CARE REVIEW AND ADJUDI-
 CATION AND SHALL NOT BE USED FOR ANY AUDITING FUNCTION OR TO DETECT  ANY
 HISTORICAL PATTERNS OF BILLING OR ABUSE;
   (II)  INCLUDE THE ENTIRE MEDICAL RECORD AND NOT EXCLUDE DATA WHICH MAY
 LIMIT ACCESS TO ADMISSION, DISCHARGE, AND TREATMENT INFORMATION; AND
   (III) NOT BE USED BY HEALTH PLANS  TO  SEPARATELY  REQUEST  ADDITIONAL
 INFORMATION  TO  SUPPORT  A COVERAGE DETERMINATION IF THE INFORMATION IS
 OTHERWISE AVAILABLE IN AN ELECTRONIC MEDICAL RECORD.
   (C) HEALTH PLANS  UTILIZING  ELECTRONIC  MEDICAL  RECORDS  UNDER  THIS
 SUBDIVISION SHALL NOT SEEK INFORMATION THAT THEY ARE NOT ALREADY PERMIT-
 TED TO RECEIVE.  HEALTH PLANS SHALL PRIORITIZE THE SAFEGUARDING OF THEIR
 INSUREDS'   DATA,  INCLUDING  THEIR  PROTECTED  HEALTH  INFORMATION  AND
 PERSONALLY IDENTIFIABLE INFORMATION. TO THE EXTENT FEASIBLE  AND  NECES-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02514-01-3
              

 A. 848                              2
 
 SARY,  HEALTH PLANS SHALL ALSO SEEK TO BE HEALTH INFORMATION TRUST ALLI-
 ANCE (HITRUST) CERTIFIED, WHICH  REQUIRES  DEMONSTRATING  AND  FOLLOWING
 GLOBAL STANDARDS FOR DATA SECURITY AND PRIVACY COMPLIANCE.
   §  2.  Paragraph  (g)  of  subdivision 1 of section 4902 of the public
 health law, as added by chapter 705 of the laws of 1996, is  amended  to
 read as follows:
   (g)  Establishment  of  appropriate  policies and procedures to ensure
 that all applicable state and federal laws to protect the confidentiali-
 ty of individual medical records, INCLUDING ELECTRONIC MEDICAL  RECORDS,
 are followed;
   §  3.  Subdivision  7  of  section  4905  of the public health law, as
 amended by section 6 of subpart C of part AA of chapter 57 of  the  laws
 of 2022, is amended to read as follows:
   7.  When  making  prospective,  concurrent  and retrospective determi-
 nations, utilization review agents shall collect only  such  information
 as  is  necessary  to  make  such  determination and shall not routinely
 require health care providers to numerically code  diagnoses  or  proce-
 dures  to be considered for certification or routinely request copies of
 medical records of all patients reviewed. During prospective or  concur-
 rent  review,  copies  of  medical  records  shall only be required when
 necessary to verify that the health care services subject to such review
 are medically necessary. In such cases, only the necessary  or  relevant
 sections  of  the medical record shall be required. A utilization review
 agent may request copies of partial or complete medical records  retros-
 pectively.  MEDICAL  RECORDS  REQUESTED BY UTILIZATION REVIEW AGENTS FOR
 PURPOSES OF THIS SUBDIVISION SHALL BE MADE AVAILABLE  ELECTRONICALLY  BY
 HEALTH  CARE  PROVIDERS PURSUANT TO SUBDIVISION FIFTEEN OF SECTION TWEN-
 TY-EIGHT HUNDRED THREE OF THIS  CHAPTER  AND  SHALL  PERMIT  UTILIZATION
 REVIEW AGENTS DIRECT ACCESS TO RETRIEVE SUCH RECORDS DIRECTLY.
   §  4.  Paragraph  7 of subsection (a) of section 4902 of the insurance
 law, as added by chapter 705 of the laws of 1996, is amended to read  as
 follows:
   (7)  Establishment  of  appropriate  policies and procedures to ensure
 that all applicable state and federal laws to protect the confidentiali-
 ty of individual medical records, INCLUDING ELECTRONIC MEDICAL  RECORDS,
 are followed;
   §  5.  Subsection (g) of section 4905 of the insurance law, as amended
 by section 5 of subpart C of part AA of chapter 57 of the laws of  2022,
 is amended to read as follows:
   (g)  When  making  prospective,  concurrent and retrospective determi-
 nations, utilization review agents shall collect only  such  information
 as  is  necessary  to  make  such  determination and shall not routinely
 require health care providers to numerically code  diagnoses  or  proce-
 dures  to be considered for certification or routinely request copies of
 medical records of all patients reviewed. During prospective or  concur-
 rent  review,  copies  of  medical  records  shall only be required when
 necessary to verify that the health care services subject to such review
 are medically necessary. In such cases, only the necessary  or  relevant
 sections  of  the medical record shall be required. A utilization review
 agent may request copies of partial or complete medical records  retros-
 pectively.  MEDICAL  RECORDS  REQUESTED BY UTILIZATION REVIEW AGENTS FOR
 PURPOSES OF THIS SUBSECTION SHALL BE MADE  AVAILABLE  ELECTRONICALLY  BY
 HEALTH  CARE  PROVIDERS PURSUANT TO SUBDIVISION FIFTEEN OF SECTION TWEN-
 TY-EIGHT HUNDRED THREE OF THE PUBLIC HEALTH LAW.
   § 6. This act shall take effect immediately.