Legislation

Search OpenLegislation Statutes

This entry was published on 2014-09-22
The selection dates indicate all change milestones for the entire volume, not just the location being viewed. Specifying a milestone date will retrieve the most recent version of the location before that date.
SECTION 320
Records to be made available by organizations subject to the provisions of this chapter
Insurance (ISC) CHAPTER 28, ARTICLE 3
§ 320. Records to be made available by organizations subject to the
provisions of this chapter. (a) Every insurer shall, upon request of the
state department of social services or of a local social services
district for any records, or any information contained in such records,
pertaining to the coverage of any individual for such individual's
medical costs under any individual or group policy or other obligation
made by such organizations, or the medical benefits paid by or claims
made to such organizations pursuant to such policy or other obligation
in accordance with the limitations of subsection (c) hereof, make the
requested records or information available upon a certification by the
department of social services or the social services district that such
individual is an applicant for or recipient of medical assistance, or is
a person who is legally responsible for such an applicant or recipient,
pursuant to the social services law.

(b) The superintendent and the commissioner of the state department of
social services shall enter into a cooperative agreement setting forth
mutually agreeable procedures for requesting and furnishing appropriate
information, not inconsistent with any law pertaining to the
confidentiality and privacy of records, which procedures shall include
financial arrangements as may be necessary to reimburse insurers for
necessary costs incurred in furnishing requested information, and the
time and manner such procedures are to become effective. Such procedures
may be added to a new cooperative agreement which shall supersede the
agreement currently in existence between the superintendent and the
commissioner of social services.

(c) The department of social services or a local social services
district shall request only that information necessary to determine
whether any insurance benefits have been or should have been claimed and
paid with respect to items of medical care and services received by a
particular individual for which medical assistance coverage would
otherwise be available.

(d) Not later than the date upon which the procedures agreed to
pursuant to subsection (b) hereof become effective, the superintendent
shall establish guidelines to assure that information relating to an
individual certified to be an applicant for or recipient of medical
assistance, furnished to any insurer, is used only for the purpose of
identifying the records or information requested in such manner so as
not to violate the confidentiality provisions of the social services
law.

(e) (1) Every insurer shall, upon request of an authorized
representative of the state office of temporary and disability
assistance, or a social services district child support enforcement unit
established pursuant to section one hundred eleven-c of the social
services law, enter into an agreement with the state office of temporary
and disability assistance or a social services district to develop and
operate a data match system, using automated data exchanges to the
maximum extent feasible, in which each such insurer, pension fund,
retirement system or other organization shall provide for each calendar
quarter the name, record address, social security number or other
taxpayer identification number, and other identifying information for
each individual who maintains a demand deposit account, checking or
negotiable withdrawal order account, savings account, time deposit
account, or money-market mutual fund account at such institution and who
owes past-due support, as identified by the state office of temporary
and disability assistance or a social services district child support
enforcement unit by name and social security number or other taxpayer
identification number. Nothing herein shall be deemed to limit the
authority of a local social services district support collection unit
pursuant to section one hundred eleven-h of the social services law.

(2) No insurer which discloses information pursuant to paragraph one
of this subsection, or discloses any financial record to the state
office of temporary and disability assistance or a social services
district child support enforcement unit for the purpose of enforcing a
child support obligation of such person, shall be liable under any law
to any person for such disclosure, or for any other action taken in good
faith to comply with paragraph one of this subsection.

(f) "Insurer", as used in this section, means:

(1) (i) an insurer required to be licensed to do an insurance business
in this state under this chapter, including a corporation subject to
article forty-three or forty-seven of this chapter;

(ii) a pension fund, retirement system or other organization required
by law to make reports to, or which is subject to examination by, the
superintendent;

(iii) a health maintenance organization subject to article forty-four
of the public health law; or

(iv) a self-funded plan or any other insurer with respect to any
medical claim or benefit of a resident of this State; and

(2) any person or other entity acting on behalf of an insurer as
described in paragraph one of this subsection with respect to any
medical claim or benefit of a resident of this State.