S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7981
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              April 16, 2025
                                ___________
 
 Introduced by M. of A. McDONALD -- read once and referred to the Commit-
   tee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to  requiring  providers  to  share  electronic  medical  records with
   healthcare plans
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1.  Section 3217-b of the insurance law is amended by adding a
 new subsection (p) to read as follows:
   (P)  A  CONTRACT  BETWEEN  AN  INSURER  AND A HOSPITAL SHALL INCLUDE A
 PROVISION THAT PROVIDES FOR MEDICAL RECORDS REQUESTED BY THE INSURER  OR
 ITS  UTILIZATION REVIEW AGENT TO BE MADE AVAILABLE ELECTRONICALLY BY THE
 HOSPITAL IN ACCORDANCE WITH SUBDIVISION FIFTEEN OF SECTION  TWENTY-EIGHT
 HUNDRED  THREE  OF THE PUBLIC HEALTH LAW, INCLUDING DIRECT ACCESS BY THE
 INSURER OR ITS UTILIZATION REVIEW AGENT  TO  RETRIEVE  SUCH  RECORDS  TO
 PERFORM  UTILIZATION  REVIEW PURSUANT TO TITLE ONE OF ARTICLE FORTY-NINE
 OF THIS CHAPTER.
   § 2. Section 4325 of the insurance law is  amended  by  adding  a  new
 subsection (p) to read as follows:
   (P)  A  CONTRACT  BETWEEN A CORPORATION AND A HOSPITAL SHALL INCLUDE A
 PROVISION THAT PROVIDES FOR MEDICAL RECORDS REQUESTED BY THE CORPORATION
 OR ITS UTILIZATION REVIEW AGENT TO BE MADE AVAILABLE  ELECTRONICALLY  BY
 THE  HOSPITAL  IN ACCORDANCE WITH SUBDIVISION FIFTEEN OF SECTION TWENTY-
 EIGHT HUNDRED THREE OF THE PUBLIC HEALTH LAW, INCLUDING DIRECT ACCESS BY
 THE CORPORATION OR ITS UTILIZATION REVIEW AGENT TO RETRIEVE SUCH RECORDS
 TO PERFORM UTILIZATION REVIEW PURSUANT TO TITLE ONE  OF  ARTICLE  FORTY-
 NINE OF THIS CHAPTER.
   §  3.  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:

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11577-01-5
 A. 7981                             2
              

 
   (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 PROVIDED ELECTRONICALLY BY  PARTIC-
 IPATING  HOSPITALS  PURSUANT  TO  SUBDIVISION FIFTEEN OF SECTION TWENTY-
 EIGHT HUNDRED THREE OF THE PUBLIC HEALTH LAW.
   § 4.  Section 4406-c of the public health law is amended by  adding  a
 new subdivision 14 to read as follows:
   14. A CONTRACT BETWEEN A HEALTH CARE PLAN AND A HOSPITAL SHALL INCLUDE
 A  PROVISION  THAT  PROVIDES FOR MEDICAL RECORDS REQUESTED BY THE HEALTH
 CARE PLAN OR ITS UTILIZATION REVIEW AGENT TO BE MADE AVAILABLE ELECTRON-
 ICALLY BY THE HOSPITAL IN ACCORDANCE WITH SUBDIVISION FIFTEEN OF SECTION
 TWENTY-EIGHT HUNDRED THREE OF THIS CHAPTER, INCLUDING DIRECT  ACCESS  BY
 THE  HEALTH  CARE  PLAN OR ITS UTILIZATION REVIEW AGENT TO RETRIEVE SUCH
 RECORDS TO PERFORM UTILIZATION REVIEW PURSUANT TO TITLE ONE  OF  ARTICLE
 FORTY-NINE OF THIS CHAPTER.
   §  5. Section 2803 of the public health law is amended by adding a new
 subdivision 15 to read as follows:
   15. (A) THE COMMISSIONER SHALL REQUIRE EVERY GENERAL HOSPITAL  SUBJECT
 TO  THIS  ARTICLE  THAT  PARTICIPATES  IN  A HEALTH CARE PLAN'S PROVIDER
 NETWORK TO TIMELY SHARE ELECTRONIC MEDICAL RECORDS WITH SUCH HEALTH CARE
 PLAN OR THEIR UTILIZATION  REVIEW  AGENT  FOR  PURPOSES  OF  UTILIZATION
 REVIEW PERFORMED PURSUANT TO ARTICLE FORTY-NINE OF THIS CHAPTER OR ARTI-
 CLE  FORTY-NINE  OF  THE INSURANCE LAW. SUCH SHARING AND TRANSMISSION OF
 ELECTRONIC MEDICAL RECORDS SHALL BE SET FORTH IN  THE  CONTRACT  BETWEEN
 THE  HEALTH  CARE  PLAN AND THE GENERAL HOSPITAL, IN ACCORDANCE WITH THE
 REQUIREMENTS OF THIS SUBDIVISION.
   (B) RECORDS DISCLOSED PURSUANT TO PARAGRAPH (A)  OF  THIS  SUBDIVISION
 SHALL:
   (I) BE USED EXCLUSIVELY FOR INDIVIDUAL CLAIM CARE REVIEW, ADJUDICATION
 AND  TO  PROMOTE  PATIENT PRIVACY 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 A HEALTH CARE PLAN TO SEPARATELY REQUEST ADDI-
 TIONAL INFORMATION TO SUPPORT A COVERAGE DETERMINATION IF  THE  INFORMA-
 TION IS OTHERWISE AVAILABLE IN AN ELECTRONIC MEDICAL RECORD.
   (C)  A  HEALTH  CARE  PLAN USING ELECTRONIC MEDICAL RECORDS UNDER THIS
 SUBDIVISION SHALL NOT SEEK INFORMATION THAT THEY ARE NOT ALREADY PERMIT-
 TED TO RECEIVE. HEALTH CARE PLANS SHALL PRIORITIZE THE  SAFEGUARDING  OF
 THEIR  ENROLLEES' DATA, INCLUDING THEIR PROTECTED HEALTH INFORMATION AND
 PERSONALLY IDENTIFIABLE INFORMATION, AND MUST IMPLEMENT INTEROPERABILITY
 PROTOCOLS THAT  ENSURE  DIFFERENT  BILLING  SYSTEMS  PROMOTE  ACCESS  TO
 RECORDS.  TO  THE EXTENT FEASIBLE AND NECESSARY, HEALTH CARE PLANS SHALL
 ALSO SEEK TO BE HEALTH INFORMATION TRUST ALLIANCE  (HITRUST)  CERTIFIED,
 WHICH  REQUIRES  DEMONSTRATING  AND  FOLLOWING GLOBAL STANDARDS FOR DATA
 SECURITY AND PRIVACY COMPLIANCE.
 A. 7981                             3
 
   (D) FOR PURPOSES OF THIS  SUBDIVISION,  "HEALTH  CARE  PLAN"  MEANS  A
 HEALTH MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR
 OF THIS CHAPTER, AN INSURER LICENSED TO WRITE ACCIDENT AND HEALTH INSUR-
 ANCE  PURSUANT TO ARTICLE THIRTY-TWO OF THE INSURANCE LAW, A CORPORATION
 ORGANIZED PURSUANT TO ARTICLE FORTY-THREE OF THE INSURANCE LAW, A MUNIC-
 IPAL  COOPERATIVE  HEALTH  BENEFIT  PLAN  CERTIFIED  PURSUANT TO ARTICLE
 FORTY-SEVEN OF THE INSURANCE LAW, OR A STUDENT HEALTH  PLAN  ESTABLISHED
 OR  MAINTAINED  PURSUANT TO SECTION ONE THOUSAND ONE HUNDRED TWENTY-FOUR
 OF THE INSURANCE LAW.
   § 6. 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 PROVIDED ELECTRONICALLY BY HEALTH
 CARE PROVIDERS PURSUANT TO SUBDIVISION FIFTEEN OF  SECTION  TWENTY-EIGHT
 HUNDRED THREE OF THIS CHAPTER.
   §  7.  This  act shall take effect on the ninetieth day after it shall
 have become a law; provided that sections one, two and four of this  act
 shall  apply  to contracts issued, renewed, modified, altered or amended
 on or after such date.