Assembly Bill A3947

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3947
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             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:
 
   Section 1. The insurance law is amended by adding a new section 112 to
 read as follows:
   §  112.  INFORMATION  FOR  ENROLLEES  AND  CONTRACTED  PROVIDERS.  (A)
 COMMENCING JANUARY FIRST, TWO THOUSAND TWENTY-SIX, TO FACILITATE PATIENT
 AND  PROVIDER  ACCESS  TO  HEALTH INFORMATION, ANY HEALTH CARE INSURANCE
 COMPANY AUTHORIZED IN THIS STATE TO WRITE HEALTH INSURANCE SHALL  ESTAB-
 LISH AND MAINTAIN THE FOLLOWING APPLICATION PROGRAMMING INTERFACES (API)
 FOR THE BENEFIT OF ENROLLEES AND CONTRACTED PROVIDERS, AS APPLICABLE:
   (1) PATIENT ACCESS API;
   (2) PROVIDER DIRECTORY API; AND
   (3) PAYER-TO-PAYER EXCHANGE API.
   (B)  IN  ADDITION  TO  THE  API  DESCRIBED  IN  SUBSECTION (A) OF THIS
 SECTION, THE DEPARTMENT MAY REQUIRE ANY HEALTH CARE INSURANCE  COMPANIES
 AUTHORIZED  TO  WRITE  HEALTH  INSURANCE  TO  ESTABLISH AND MAINTAIN THE
 FOLLOWING API, IF AND WHEN FINAL RULES  ARE  PUBLISHED  BY  THE  FEDERAL
 GOVERNMENT:
   (1) PROVIDER ACCESS API; AND
   (2) PRIOR AUTHORIZATION SUPPORT API.
   (C)  THE  API  DESCRIBED IN SUBSECTION (B) OF THIS SECTION SHALL BE IN
 ACCORDANCE WITH STANDARDS PUBLISHED IN A FINAL RULE ISSUED BY THE FEDER-
 AL CENTERS FOR MEDICARE AND  MEDICAID  SERVICES  AND  PUBLISHED  IN  THE
 FEDERAL  REGISTER, AND SHALL ALIGN WITH FEDERAL EFFECTIVE DATES, INCLUD-
 ING ENFORCEMENT DELAYS AND SUSPENSIONS, ISSUED BY  THE  FEDERAL  CENTERS
 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
 
   (D) FOR PURPOSES OF THIS SECTION:
   (1)  "APPLICATION PROGRAMMING INTERFACE" OR "API" MEANS A SET OF RULES
 OR PROTOCOLS THAT ALLOWS DIFFERENT SOFTWARE APPLICATIONS TO  COMMUNICATE
 WITH EACH OTHER, EXCHANGING DATA AND FUNCTIONALITY, AND ACTS AS A STAND-
 ARDIZED  WAY  FOR  PROGRAMS  TO  INTERACT AND SHARE INFORMATION WITH ONE
 ANOTHER.
   (2) "PATIENT ACCESS API" MEANS A SECURE AND PUBLIC-FACING API TO  MAKE
 PATIENT  MEMBERSHIP,  COVERAGES,  CLAIMS, CLINICAL AND PRESCRIPTION DRUG
 FORMULARY INFORMATION AVAILABLE. THIS API  REQUIRES  AUTHENTICATION  FOR
 ANY USER.
   (3)  "PROVIDER  DIRECTORY API" MEANS A SECURE AND PUBLIC FACING API TO
 MAKE PROVIDER INFORMATION AVAILABLE.
   (4) "PAYER-TO-PAYER EXCHANGE API" MEANS A SECURE AND PUBLIC FACING API
 TO EXCHANGE PATIENT DATA WHEN A PATIENT MOVES BETWEEN PAYERS  TO  ENSURE
 CONTINUED  ACCESS  TO  THEIR  HEALTH DATA AND SUPPORT CONTINUITY OF CARE
 BETWEEN PAYERS.
   § 2. This act shall take effect immediately.