NY State Senate Bill 2023-S3111

Senate Bill S3111

2023-2024 Legislative Session

Requires providers to share electronic health records with plans for purposes of improving patient care and reducing administrative delays

download bill text pdf

Current Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 03, 2024	referred to health
Jan 27, 2023	referred to health

2023-S3111 (ACTIVE) - Details

See Assembly Version of this Bill:: A848
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §§2803, 4902 & 4905, Pub Health L; amd §§4902 & 4905, Ins L
Versions Introduced in 2021-2022 Legislative Session:: S9103, A10302

2023-S3111 (ACTIVE) - Summary

Requires providers to share electronic health records with plans for purposes of improving patient care and reducing administrative delays.

2023-S3111 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S3111

SPONSOR: MANNION
 
TITLE OF BILL:

An act to amend the public health law and the insurance law, in relation
to requiring providers to share electronic health records with plans

 
PURPOSE:

The purpose of this bill is to require providers to share electronic
health records with plans for purposes of improving patient care and
reducing administrative delays.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 of this bill would amend Subdivision 13 of section 2803 of the
Public Health Law to require that providers disclose electronic health
records (EHR) to health care plans and permit EHR portal access to an
appropriate amount of dinical and utilization management represen-
tatives.

Section 2 of this bill would amend paragraph (g) of subdivision 1 of
section 4902 of the Public Health Law to establish appropriate policies
and procedures to ensure that all applicable state and federal laws to
protect the confidentiality of electronic medical records.

Section 3 of this bill would amend subdivision 7 of section 4905 of the
Public Health Law to require plans to be responsible for interoperabi-
lity protocols to ensure that different billing systems will promote
access to records.

Section 4 of this bill would amend paragraph 7 of subsection (a) of
section 4902 of the Insurance Law to prohibit plans from seeking data
they are not entitled to receive, instead being limited to admission,
discharge and treatment data relevant to utilization management proc-
esses.

Section 5 of this bill would amend subsection (g) of section 4905 of the
Insurance Law to require medical records to be made available to utili-
zation review agents.

Section 6 of this bill provides that the effective date shall take
effect immediately.

 
JUSTIFICATION:

The Department of Financial Services has promoted the sharing of EHR as
a method to reduce administrative complexity and cost. Currently, during
medical necessity reviews, plans request data that is supplied by
providers by means of paper or facsimile communication. This inefficient
method leads to miscommunication and avoidable disputes between plans
and providers with large volumes of request and short compliance time-
frames. EHR sharing benefits patients, providers and plans. For
patients' data shows that EHR sharing closed patient care gaps from
60-90 days to less than 30 days and resulted in more accurate diagnoses
and improved clinical outcomes. EHR sharing also simplifies prior
authorization requirements, resulting in fewer denials and quicker care.
EHR sharing has also proven to result in better care transition and
discharge planning coordination, which has reduced hospital readmissions
and avoidable ER costs. Finally, patients have found that EHR sharing
helps them in provider appeals, when providers do not provide adequate
access to their own health records. From a provider perspective, EHR
sharing in California has led to a 731 reduction in lack of information
denials. A consequence of reduced denials has been a concurre nt
reduction in appeals. Fully automated records access has decreased the
cost of prior authorization requests from $11 per claim to $2 per claim
and has reduced the administrative burden from 21 minutes to 4 minutes.
EHR sharing also allows different provider types to communicate more
efficiently. In an integrated EHR setting primary care physicians are
automatically notified of patient admissions, enhancing patient care
between providers and enabling more timely interventions in order to
reduce unnecessary readmissions. The secondary effect of these efficien-
cies has been a 51 increase in provider quality scores. Last, EHR shar-
ing benefits plans as they are able to secure quality data that informs
patient care decisions and leads to nearly real time risk adjustments.

 
PRIOR LEGISLATIVE HISTORY:

2021-22: S.9103 (Mannion) - Referred to Health.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S3111 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3111
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 27, 2023
                                ___________
 
 Introduced  by  Sen. MANNION -- read twice and ordered printed, and when
   printed to be committed to the Committee 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

 S. 3111                             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.

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