NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A2348
SPONSOR: McDonald 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:
Require providers to share electronic health records with plans for the
purpose of improving patient care and reducing administrative delays.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 amends Subdivision 13 of section 2803 of the public health
law, as amended by chapter 19 of the laws of 2022, is renumbered subdi-
vision 14 and adds a new subdivision 15 to require that providers
disclose electronic health records (EHR) to health care plans and permit
EHR portal access to an appropriate amount of clinical and utilization
management representatives.
Section 2 amends paragraph (g) of subdivision 1 of section 4902 of the
public health law, as added by chapter 705 of the laws of 1996, to
establish appropriate policies and procedures to ensure that all appli-
cable state and federal laws protect the confidentiality of electronic
medical records.
Section 3 amends 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, to require plans to be responsible for interoperability
protocols to ensure that different billing systems will promote access
to records.
Section 4 amends paragraph 7 of subsection (a) of section 4902 of the
insurance law, as added by chapter 705 of the laws of 1996, to prohibit
plans from seeking data they are not entitled to receive, instead being
limited to admission, discharge, and treatment data relevant to utiliza-
tion management processes.
Section 5 amends 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, to require medical records to be made available to utilization
review agents.
Section 6 sets forth the effective date.
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. Patient
data indicates 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 authori-
zation 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 73% reduction in lack of information
denials. A.consequence of reduced denials has been a concurrent
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 5% increase in provider quality scores.
Lastly, EHR sharing 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:
2021-2022: A.10302/5.9103
2023-2024: A.848/S.3111
FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
This act shall take effect immediately.
STATE OF NEW YORK
________________________________________________________________________
2348
2025-2026 Regular Sessions
IN ASSEMBLY
January 16, 2025
___________
Introduced by M. of A. McDONALD, ZINERMAN, HUNTER, STIRPE, BENDETT,
K. BROWN, McDONOUGH, NOVAKHOV, JACKSON, BUTTENSCHON, KELLES -- read
once and referred 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-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD01538-01-5
A. 2348 2
1 sary, health plans shall also seek to be Health Information Trust Alli-
2 ance (HITRUST) certified, which requires demonstrating and following
3 global standards for data security and privacy compliance.
4 § 2. Paragraph (g) of subdivision 1 of section 4902 of the public
5 health law, as added by chapter 705 of the laws of 1996, is amended to
6 read as follows:
7 (g) Establishment of appropriate policies and procedures to ensure
8 that all applicable state and federal laws to protect the confidentiali-
9 ty of individual medical records, including electronic medical records,
10 are followed;
11 § 3. Subdivision 7 of section 4905 of the public health law, as
12 amended by section 6 of subpart C of part AA of chapter 57 of the laws
13 of 2022, is amended to read as follows:
14 7. When making prospective, concurrent and retrospective determi-
15 nations, utilization review agents shall collect only such information
16 as is necessary to make such determination and shall not routinely
17 require health care providers to numerically code diagnoses or proce-
18 dures to be considered for certification or routinely request copies of
19 medical records of all patients reviewed. During prospective or concur-
20 rent review, copies of medical records shall only be required when
21 necessary to verify that the health care services subject to such review
22 are medically necessary. In such cases, only the necessary or relevant
23 sections of the medical record shall be required. A utilization review
24 agent may request copies of partial or complete medical records retros-
25 pectively. Medical records requested by utilization review agents for
26 purposes of this subdivision shall be made available electronically by
27 health care providers pursuant to subdivision fifteen of section twen-
28 ty-eight hundred three of this chapter and shall permit utilization
29 review agents direct access to retrieve such records directly.
30 § 4. Paragraph 7 of subsection (a) of section 4902 of the insurance
31 law, as added by chapter 705 of the laws of 1996, is amended to read as
32 follows:
33 (7) Establishment of appropriate policies and procedures to ensure
34 that all applicable state and federal laws to protect the confidentiali-
35 ty of individual medical records, including electronic medical records,
36 are followed;
37 § 5. Subsection (g) of section 4905 of the insurance law, as amended
38 by section 5 of subpart C of part AA of chapter 57 of the laws of 2022,
39 is amended to read as follows:
40 (g) When making prospective, concurrent and retrospective determi-
41 nations, utilization review agents shall collect only such information
42 as is necessary to make such determination and shall not routinely
43 require health care providers to numerically code diagnoses or proce-
44 dures to be considered for certification or routinely request copies of
45 medical records of all patients reviewed. During prospective or concur-
46 rent review, copies of medical records shall only be required when
47 necessary to verify that the health care services subject to such review
48 are medically necessary. In such cases, only the necessary or relevant
49 sections of the medical record shall be required. A utilization review
50 agent may request copies of partial or complete medical records retros-
51 pectively. Medical records requested by utilization review agents for
52 purposes of this subsection shall be made available electronically by
53 health care providers pursuant to subdivision fifteen of section twen-
54 ty-eight hundred three of the public health law.
55 § 6. This act shall take effect immediately.
