STATE OF NEW YORK
________________________________________________________________________
1220
2023-2024 Regular Sessions
IN ASSEMBLY
January 13, 2023
___________
Introduced by M. of A. LUNSFORD -- read once and referred to the Commit-
tee on Health
AN ACT to amend the public health law, the mental hygiene law and the
insurance law, in relation to utilization review agents access to
electronic medical records
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 14 to read as follows:
3 14. The commissioner shall require every general hospital and every
4 clinic licensed pursuant to this article to adopt a process by which
5 access to electronic medical records are provided to utilization review
6 agents for purposes of article forty-nine of this chapter and article
7 forty-nine of the insurance law. Nothing contained herein shall prohibit
8 a health care plan from entering into an agreement with a health care
9 provider for the transmission of electronic medical records pursuant to
10 this subdivision.
11 § 2. Paragraph (g) of subdivision 1 of section 4902 of the public
12 health law, as added by chapter 705 of the laws of 1996, is amended to
13 read as follows:
14 (g) Establishment of appropriate policies and procedures to ensure
15 that all applicable state and federal laws to protect the confidentiali-
16 ty of individual medical records, including electronic medical records,
17 are followed;
18 § 3. Subdivision 7 of section 4905 of the public health law, as
19 amended by section 6 of subpart C of part AA of chapter 57 of the laws
20 of 2022, is amended to read as follows:
21 7. When making prospective, concurrent and retrospective determi-
22 nations, utilization review agents shall collect only such information
23 as is necessary to make such determination and shall not routinely
24 require health care providers to numerically code diagnoses or proce-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD01942-01-3
A. 1220 2
1 dures to be considered for certification or routinely request copies of
2 medical records of all patients reviewed. During prospective or concur-
3 rent review, copies of medical records shall only be required when
4 necessary to verify that the health care services subject to such review
5 are medically necessary. In such cases, only the necessary or relevant
6 sections of the medical record shall be required. A utilization review
7 agent may request copies of partial or complete medical records retros-
8 pectively. Medical records requested by utilization review agents for
9 purposes of this subdivision shall be made available electronically by
10 health care providers pursuant to subdivision fourteen of section twen-
11 ty-eight hundred three of this chapter and subdivision (f) of section
12 31.04 of the mental hygiene law.
13 § 4. Section 31.04 of the mental hygiene law is amended by adding a
14 new subdivision (f) to read as follows:
15 (f) The commissioner, in consultation with the commissioner of health
16 shall require every clinic licensed pursuant to this article to adopt a
17 process by which access to electronic medical records are provided to
18 utilization review agents for purposes of article forty-nine of the
19 public health law and article forty-nine of the insurance law. Nothing
20 contained herein shall prohibit a health care plan from entering into an
21 agreement with a clinic licensed pursuant to this article for the trans-
22 mission of electronic medical records pursuant to this subdivision.
23 § 5. Paragraph 7 of subsection (a) of section 4902 of the insurance
24 law, as added by chapter 705 of the laws of 1996, is amended to read as
25 follows:
26 (7) Establishment of appropriate policies and procedures to ensure
27 that all applicable state and federal laws to protect the confidentiali-
28 ty of individual medical records, including electronic medical records,
29 are followed;
30 § 6. Subsection (g) of section 4905 of the insurance law, as amended
31 by section 5 of subpart C of part AA of chapter 57 of the laws of 2022,
32 is amended to read as follows:
33 (g) When making prospective, concurrent and retrospective determi-
34 nations, utilization review agents shall collect only such information
35 as is necessary to make such determination and shall not routinely
36 require health care providers to numerically code diagnoses or proce-
37 dures to be considered for certification or routinely request copies of
38 medical records of all patients reviewed. During prospective or concur-
39 rent review, copies of medical records shall only be required when
40 necessary to verify that the health care services subject to such review
41 are medically necessary. In such cases, only the necessary or relevant
42 sections of the medical record shall be required. A utilization review
43 agent may request copies of partial or complete medical records retros-
44 pectively. Medical records requested by utilization review agents for
45 purposes of this subsection shall be made available electronically by
46 health care providers pursuant to subdivision fourteen of section twen-
47 ty-eight hundred three of the public health law and subdivision (f) of
48 section 31.04 of the mental hygiene law.
49 § 7. This act shall take effect immediately.