Requires insurance companies to establish and maintain API to facilitate patient and provider access to health information; includes patient access, provider directory and payer to payer exchange.
STATE OF NEW YORK
________________________________________________________________________
3947
2025-2026 Regular Sessions
IN ASSEMBLY
January 30, 2025
___________
Introduced by M. of A. PAULIN -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to requiring API to
facilitate patient and provider access to health information for
enrollees and contract providers
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The insurance law is amended by adding a new section 112 to
2 read as follows:
3 § 112. Information for enrollees and contracted providers. (a)
4 Commencing January first, two thousand twenty-six, to facilitate patient
5 and provider access to health information, any health care insurance
6 company authorized in this state to write health insurance shall estab-
7 lish and maintain the following application programming interfaces (API)
8 for the benefit of enrollees and contracted providers, as applicable:
9 (1) Patient access API;
10 (2) Provider directory API; and
11 (3) Payer-to-payer exchange API.
12 (b) In addition to the API described in subsection (a) of this
13 section, the department may require any health care insurance companies
14 authorized to write health insurance to establish and maintain the
15 following API, if and when final rules are published by the federal
16 government:
17 (1) Provider access API; and
18 (2) Prior authorization support API.
19 (c) The API described in subsection (b) of this section shall be in
20 accordance with standards published in a final rule issued by the feder-
21 al Centers for Medicare and Medicaid Services and published in the
22 Federal Register, and shall align with federal effective dates, includ-
23 ing enforcement delays and suspensions, issued by the federal Centers
24 for Medicare and Medicaid Services.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD06912-01-5
A. 3947 2
1 (d) For purposes of this section:
2 (1) "Application Programming Interface" or "API" means a set of rules
3 or protocols that allows different software applications to communicate
4 with each other, exchanging data and functionality, and acts as a stand-
5 ardized way for programs to interact and share information with one
6 another.
7 (2) "Patient access API" means a secure and public-facing API to make
8 patient membership, coverages, claims, clinical and prescription drug
9 formulary information available. This API requires authentication for
10 any user.
11 (3) "Provider directory API" means a secure and public facing API to
12 make provider information available.
13 (4) "Payer-to-Payer exchange API" means a secure and public facing API
14 to exchange patient data when a patient moves between payers to ensure
15 continued access to their health data and support continuity of care
16 between payers.
17 § 2. This act shall take effect immediately.
