Assembly Bill A1082

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1082
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              January 8, 2025
                                ___________
 
 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:
 
   Section 1. Section 2803 of the public health law is amended by  adding
 a new subdivision 15 to read as follows:
   15.  THE  COMMISSIONER  SHALL REQUIRE EVERY GENERAL HOSPITAL AND EVERY
 CLINIC LICENSED PURSUANT TO THIS ARTICLE TO ADOPT  A  PROCESS  BY  WHICH
 ACCESS  TO ELECTRONIC MEDICAL RECORDS ARE PROVIDED TO UTILIZATION REVIEW
 AGENTS FOR PURPOSES OF ARTICLE FORTY-NINE OF THIS  CHAPTER  AND  ARTICLE
 FORTY-NINE OF THE INSURANCE LAW. NOTHING CONTAINED HEREIN SHALL PROHIBIT
 A  HEALTH  CARE  PLAN FROM ENTERING INTO AN AGREEMENT WITH A HEALTH CARE
 PROVIDER FOR THE TRANSMISSION OF ELECTRONIC MEDICAL RECORDS PURSUANT  TO
 THIS SUBDIVISION.
   §  2.  Paragraph  (g)  of  subdivision 1 of section 4902 of the public
 health law, as added by chapter 705 of the laws of 1996, is  amended  to
 read as follows:
   (g)  Establishment  of  appropriate  policies and procedures to ensure
 that all applicable state and federal laws to protect the confidentiali-
 ty of individual medical records, INCLUDING ELECTRONIC MEDICAL  RECORDS,
 are followed;
   §  3.  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, is amended to read as follows:
   7.  When  making  prospective,  concurrent  and retrospective determi-
 nations, utilization review agents shall collect only  such  information
 as  is  necessary  to  make  such  determination and shall not routinely
 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.
                                                            LBD01511-01-5
              

 A. 1082                             2
 
 dures  to be considered for certification or routinely request copies of
 medical records of all patients reviewed. During prospective or  concur-
 rent  review,  copies  of  medical  records  shall only be required when
 necessary to verify that the health care services subject to such review
 are  medically  necessary. In such cases, only the necessary or relevant
 sections of the medical record shall be required. A  utilization  review
 agent  may request copies of partial or complete medical records retros-
 pectively.  MEDICAL RECORDS REQUESTED BY UTILIZATION REVIEW  AGENTS  FOR
 PURPOSES  OF  THIS SUBDIVISION SHALL BE MADE AVAILABLE ELECTRONICALLY BY
 HEALTH CARE PROVIDERS PURSUANT TO SUBDIVISION FIFTEEN OF  SECTION  TWEN-
 TY-EIGHT  HUNDRED  THREE  OF THIS CHAPTER AND SUBDIVISION (F) OF SECTION
 31.04 OF THE MENTAL HYGIENE LAW.
   § 4. Section 31.04 of the mental hygiene law is amended  by  adding  a
 new subdivision (f) to read as follows:
   (F)  THE COMMISSIONER, IN CONSULTATION WITH THE COMMISSIONER OF HEALTH
 SHALL REQUIRE EVERY CLINIC LICENSED PURSUANT TO THIS ARTICLE TO ADOPT  A
 PROCESS  BY  WHICH  ACCESS TO ELECTRONIC MEDICAL RECORDS ARE PROVIDED TO
 UTILIZATION REVIEW AGENTS FOR PURPOSES  OF  ARTICLE  FORTY-NINE  OF  THE
 PUBLIC  HEALTH LAW AND ARTICLE FORTY-NINE OF THE INSURANCE LAW.  NOTHING
 CONTAINED HEREIN SHALL PROHIBIT A HEALTH CARE PLAN FROM ENTERING INTO AN
 AGREEMENT WITH A CLINIC LICENSED PURSUANT TO THIS ARTICLE FOR THE TRANS-
 MISSION OF ELECTRONIC MEDICAL RECORDS PURSUANT TO THIS SUBDIVISION.
   § 5. Paragraph 7 of subsection (a) of section 4902  of  the  insurance
 law,  as added by chapter 705 of the laws of 1996, is amended to read as
 follows:
   (7) Establishment of appropriate policies  and  procedures  to  ensure
 that all applicable state and federal laws to protect the confidentiali-
 ty  of individual medical records, INCLUDING ELECTRONIC MEDICAL RECORDS,
 are followed;
   § 6. 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,
 is amended to read as follows:
   (g) When making prospective,  concurrent  and  retrospective  determi-
 nations,  utilization  review agents shall collect only such information
 as is necessary to make  such  determination  and  shall  not  routinely
 require  health  care  providers to numerically code diagnoses or proce-
 dures to be considered for certification or routinely request copies  of
 medical  records of all patients reviewed. During prospective or concur-
 rent review, copies of medical  records  shall  only  be  required  when
 necessary to verify that the health care services subject to such review
 are  medically  necessary. In such cases, only the necessary or relevant
 sections of the medical record shall be required. A  utilization  review
 agent  may request copies of partial or complete medical records retros-
 pectively.  MEDICAL RECORDS REQUESTED BY UTILIZATION REVIEW  AGENTS  FOR
 PURPOSES  OF  THIS  SUBSECTION SHALL BE MADE AVAILABLE ELECTRONICALLY BY
 HEALTH CARE PROVIDERS PURSUANT TO SUBDIVISION FIFTEEN OF  SECTION  TWEN-
 TY-EIGHT  HUNDRED  THREE OF THE PUBLIC HEALTH LAW AND SUBDIVISION (F) OF
 SECTION 31.04 OF THE MENTAL HYGIENE LAW.
   § 7. This act shall take effect immediately.