S 5456: Requires providers to share electronic health records with plans for purposes of improving patient care and reducing administrative delays.

  
  STATE OF NEW YORK ________________________________________________________________________ 5456 2025-2026 Regular Sessions  IN SENATE February 21, 2025 ___________ Introduced by Sen. COMRIE -- 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: 1 Section 1. Section 2803 of the public health law is amended by adding 2 a new subdivision 15 to read as follows: 3 15. (a) The commissioner shall require every general hospital subject 4 to this article to timely share electronic medical records to utiliza- 5 tion review agents for purposes of article forty-nine of this chapter 6 and article forty-nine of the insurance law. Nothing contained herein 7 shall prohibit a health care plan from entering into an agreement with a 8 health care provider for the sharing and transmission of electronic 9 medical records pursuant to this section. 10 (b) Records disclosed pursuant to paragraph (a) of this subdivision 11 shall: 12 (i) be used exclusively for individual claim/care review and adjudi- 13 cation and shall not be used for any auditing function or to detect any 14 historical patterns of billing or abuse; 15 (ii) include the entire medical record and not exclude data which may 16 limit access to admission, discharge, and treatment information; and 17 (iii) not be used by health plans to separately request additional 18 information to support a coverage determination if the information is 19 otherwise available in an electronic medical record. 20 (c) Health plans utilizing electronic medical records under this 21 subdivision shall not seek information that they are not already permit- 22 ted to receive. Health plans shall prioritize the safeguarding of their 23 insureds' data, including their protected health information and 24 personally identifiable information. To the extent feasible and neces- 25 sary, health plans shall also seek to be Health Information Trust Alli- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01538-01-5 
 S. 5456 2 1 ance (HITRUST) certified, which requires demonstrating and following 2 global standards for data security and privacy compliance. 3 § 2. Paragraph (g) of subdivision 1 of section 4902 of the public 4 health law, as added by chapter 705 of the laws of 1996, is amended to 5 read as follows: 6 (g) Establishment of appropriate policies and procedures to ensure 7 that all applicable state and federal laws to protect the confidentiali- 8 ty of individual medical records, including electronic medical records, 9 are followed; 10 § 3. Subdivision 7 of section 4905 of the public health law, as 11 amended by section 6 of subpart C of part AA of chapter 57 of the laws 12 of 2022, is amended to read as follows: 13 7. When making prospective, concurrent and retrospective determi- 14 nations, utilization review agents shall collect only such information 15 as is necessary to make such determination and shall not routinely 16 require health care providers to numerically code diagnoses or proce- 17 dures to be considered for certification or routinely request copies of 18 medical records of all patients reviewed. During prospective or concur- 19 rent review, copies of medical records shall only be required when 20 necessary to verify that the health care services subject to such review 21 are medically necessary. In such cases, only the necessary or relevant 22 sections of the medical record shall be required. A utilization review 23 agent may request copies of partial or complete medical records retros- 24 pectively. Medical records requested by utilization review agents for 25 purposes of this subdivision shall be made available electronically by 26 health care providers pursuant to subdivision fifteen of section twen- 27 ty-eight hundred three of this chapter and shall permit utilization 28 review agents direct access to retrieve such records directly. 29 § 4. Paragraph 7 of subsection (a) of section 4902 of the insurance 30 law, as added by chapter 705 of the laws of 1996, is amended to read as 31 follows: 32 (7) Establishment of appropriate policies and procedures to ensure 33 that all applicable state and federal laws to protect the confidentiali- 34 ty of individual medical records, including electronic medical records, 35 are followed; 36 § 5. Subsection (g) of section 4905 of the insurance law, as amended 37 by section 5 of subpart C of part AA of chapter 57 of the laws of 2022, 38 is amended to read as follows: 39 (g) When making prospective, concurrent and retrospective determi- 40 nations, utilization review agents shall collect only such information 41 as is necessary to make such determination and shall not routinely 42 require health care providers to numerically code diagnoses or proce- 43 dures to be considered for certification or routinely request copies of 44 medical records of all patients reviewed. During prospective or concur- 45 rent review, copies of medical records shall only be required when 46 necessary to verify that the health care services subject to such review 47 are medically necessary. In such cases, only the necessary or relevant 48 sections of the medical record shall be required. A utilization review 49 agent may request copies of partial or complete medical records retros- 50 pectively. Medical records requested by utilization review agents for 51 purposes of this subsection shall be made available electronically by 52 health care providers pursuant to subdivision fifteen of section twen- 53 ty-eight hundred three of the public health law. 54 § 6. This act shall take effect immediately.