NY State Senate Bill 2025-S8203

Current Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 21, 2025	referred to insurance

2025-S8203 (ACTIVE) - Details

See Assembly Version of this Bill:: A7981
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3217-b, 4325 & 4905, Ins L; amd §§4406-c, 2803 & 4905, Pub Health L

2025-S8203 (ACTIVE) - Summary

Requires that a contract between an insurer and a hospital shall include a provision that provides for medical records requested by the insurer or its utilization review agent to be made available electronically by the hospital; limits the use of disclosed records.

2025-S8203 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S8203

SPONSOR: BAILEY
 
TITLE OF BILL:

An act to amend the insurance law and the public health law, in relation
to requiring providers to share electronic medical records with health-
care plans

 
PURPOSE OR GENERAL IDEA OF BILL:

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 Section 3217 of the insurance law by adding a new
subsection (p) to require that a contract between an insurer and a
hospital shall include a provision that provides for medical records
requested by the insurer or its utilization review agent to be made
available electronically by the hospital.

Section 2 amends Section 4325 of the insurance law by adding a new
subsection (p) to require that a contract between a corporation and a
hospital shall include a provision that provides for medical records
requested by the corporation or its utilization review agent to be made
available electronically by the hospital.

Section 3 amends Section 4905 of the insurance law to require medical
records to be made available to utilization review agents.

Section 4 amends Section 4406-c of the public health law by adding a new
subdivision 14 to require that a contract between an insurer and a
hospital shall include a provision that provides for medical records
requested by the insurer or its utilization review agent to be made
available electronically by the hospital.

Section 5 amends Section 2803 of the public health law to add a new
subdivision 15 limiting disclosed records be used exclusively for indi-
vidual claim care review, adjudication and to promote patient privacy
and shall not be used for any auditing function or to detect any histor-
ical patterns of billing or abuse; shall include the entire medical
record and not exclude data which may limit access to admission,
discharge, and treatment information; and not be used to by a health
care plan to separately request additional information to support a
coverage determination if the information is otherwise available in an
electronic medical record.

Section 6 amends Subdivision 7 of section 4905 of the public health law
to require medical records to be made available to utilization review
agents.

 
JUSTIFICATION:

The Department of Financial Services has promoted the sharing of elec-
tronic medical records ("EMR") 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 facsim-
ile communication. This inefficient method leads to miscommunication and
avoidable disputes between plans and providers with large volumes of
request and short compliance timeframes.

EMR sharing benefits patients, providers, and plans. Patient data indi-
cates that EMR sharing closed patient care gaps from 60-90 days to less
than 30 days and resulted in more accurate diagnoses and improved clin-
ical outcomes. EMR sharing also simplifies prior authorization require-
ments, resulting in fewer denials and quicker care. EMR sharing has also
proven to result in better care transition and discharge planning coor-
dination, which has reduced hospital readmissions and avoidable ER
costs. Finally, patients have found that EMR sharing helps them in
provider appeals when providers do not provide adequate access to their
own health records.

From a provider perspective, EMR 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.

In New York, in one of the hospital systems which recently implemented
mandatory EMR sharing (pre-6 and post-6 months) from EMR implementa-
tions, upended" cases have been reduced from 65% to 3.7%, thus dramat-
ically accelerating hospital payments. In New York City, one health plan
has successfully implemented EMR sharing with multiple large hospitals
within its network. The positive results with several Metro New York
hospital systems have been dramatic with Lack of Information (LOI)
denial rates dropping by two thirds with significant drops in appeals as
well.

EMR 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 to reduce
unnecessary readmissions. The secondary effect of these efficiencies has
been a 5% increase in provider quality scores.

 
PRIOR LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
The ninetieth day after it shall have become a law.

2025-S8203 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8203
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                               May 21, 2025
                                ___________
 
 Introduced  by  Sen.  BAILEY -- read twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to requiring  providers  to  share  electronic  medical  records  with
   healthcare plans

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1.  Section 3217-b of the insurance law is amended by adding a
 new subsection (p) to read as follows:
   (P) A CONTRACT BETWEEN AN INSURER  AND  A  HOSPITAL  SHALL  INCLUDE  A
 PROVISION  THAT PROVIDES FOR MEDICAL RECORDS REQUESTED BY THE INSURER OR
 ITS UTILIZATION REVIEW AGENT TO BE MADE AVAILABLE ELECTRONICALLY BY  THE
 HOSPITAL  IN ACCORDANCE WITH SUBDIVISION FIFTEEN OF SECTION TWENTY-EIGHT
 HUNDRED THREE OF THE PUBLIC HEALTH LAW, INCLUDING DIRECT ACCESS  BY  THE
 INSURER  OR  ITS  UTILIZATION  REVIEW  AGENT TO RETRIEVE SUCH RECORDS TO
 PERFORM UTILIZATION REVIEW PURSUANT TO TITLE ONE OF  ARTICLE  FORTY-NINE
 OF THIS CHAPTER.
   §  2.  Section  4325  of  the insurance law is amended by adding a new
 subsection (p) to read as follows:
   (P) A CONTRACT BETWEEN A CORPORATION AND A HOSPITAL  SHALL  INCLUDE  A
 PROVISION THAT PROVIDES FOR MEDICAL RECORDS REQUESTED BY THE CORPORATION
 OR  ITS  UTILIZATION REVIEW AGENT TO BE MADE AVAILABLE ELECTRONICALLY BY
 THE HOSPITAL IN ACCORDANCE WITH SUBDIVISION FIFTEEN OF  SECTION  TWENTY-
 EIGHT HUNDRED THREE OF THE PUBLIC HEALTH LAW, INCLUDING DIRECT ACCESS BY
 THE CORPORATION OR ITS UTILIZATION REVIEW AGENT TO RETRIEVE SUCH RECORDS
 TO  PERFORM  UTILIZATION  REVIEW PURSUANT TO TITLE ONE OF ARTICLE FORTY-
 NINE OF THIS CHAPTER.
   § 3. 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:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11577-01-5
 S. 8203                             2

 
   (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 PROVIDED ELECTRONICALLY BY  PARTIC-
 IPATING  HOSPITALS  PURSUANT  TO  SUBDIVISION FIFTEEN OF SECTION TWENTY-
 EIGHT HUNDRED THREE OF THE PUBLIC HEALTH LAW.
   § 4.  Section 4406-c of the public health law is amended by  adding  a
 new subdivision 14 to read as follows:
   14. A CONTRACT BETWEEN A HEALTH CARE PLAN AND A HOSPITAL SHALL INCLUDE
 A  PROVISION  THAT  PROVIDES FOR MEDICAL RECORDS REQUESTED BY THE HEALTH
 CARE PLAN OR ITS UTILIZATION REVIEW AGENT TO BE MADE AVAILABLE ELECTRON-
 ICALLY BY THE HOSPITAL IN ACCORDANCE WITH SUBDIVISION FIFTEEN OF SECTION
 TWENTY-EIGHT HUNDRED THREE OF THIS CHAPTER, INCLUDING DIRECT  ACCESS  BY
 THE  HEALTH  CARE  PLAN OR ITS UTILIZATION REVIEW AGENT TO RETRIEVE SUCH
 RECORDS TO PERFORM UTILIZATION REVIEW PURSUANT TO TITLE ONE  OF  ARTICLE
 FORTY-NINE OF THIS CHAPTER.
   §  5. Section 2803 of the public health law is amended by adding a new
 subdivision 15 to read as follows:
   15. (A) THE COMMISSIONER SHALL REQUIRE EVERY GENERAL HOSPITAL  SUBJECT
 TO  THIS  ARTICLE  THAT  PARTICIPATES  IN  A HEALTH CARE PLAN'S PROVIDER
 NETWORK TO TIMELY SHARE ELECTRONIC MEDICAL RECORDS WITH SUCH HEALTH CARE
 PLAN OR THEIR UTILIZATION  REVIEW  AGENT  FOR  PURPOSES  OF  UTILIZATION
 REVIEW PERFORMED PURSUANT TO ARTICLE FORTY-NINE OF THIS CHAPTER OR ARTI-
 CLE  FORTY-NINE  OF  THE INSURANCE LAW. SUCH SHARING AND TRANSMISSION OF
 ELECTRONIC MEDICAL RECORDS SHALL BE SET FORTH IN  THE  CONTRACT  BETWEEN
 THE  HEALTH  CARE  PLAN AND THE GENERAL HOSPITAL, IN ACCORDANCE WITH THE
 REQUIREMENTS OF THIS SUBDIVISION.
   (B) RECORDS DISCLOSED PURSUANT TO PARAGRAPH (A)  OF  THIS  SUBDIVISION
 SHALL:
   (I) BE USED EXCLUSIVELY FOR INDIVIDUAL CLAIM CARE REVIEW, ADJUDICATION
 AND  TO  PROMOTE  PATIENT PRIVACY AND SHALL NOT BE USED FOR ANY AUDITING
 FUNCTION OR TO DETECT ANY HISTORICAL PATTERNS OF BILLING OR ABUSE;
   (II) INCLUDE THE ENTIRE MEDICAL RECORD AND NOT EXCLUDE DATA WHICH  MAY
 LIMIT ACCESS TO ADMISSION, DISCHARGE, AND TREATMENT INFORMATION; AND
   (III)  NOT  BE  USED BY A HEALTH CARE PLAN TO SEPARATELY REQUEST ADDI-
 TIONAL INFORMATION TO SUPPORT A COVERAGE DETERMINATION IF  THE  INFORMA-
 TION IS OTHERWISE AVAILABLE IN AN ELECTRONIC MEDICAL RECORD.
   (C)  A  HEALTH  CARE  PLAN USING ELECTRONIC MEDICAL RECORDS UNDER THIS
 SUBDIVISION SHALL NOT SEEK INFORMATION THAT THEY ARE NOT ALREADY PERMIT-
 TED TO RECEIVE. HEALTH CARE PLANS SHALL PRIORITIZE THE  SAFEGUARDING  OF
 THEIR  ENROLLEES' DATA, INCLUDING THEIR PROTECTED HEALTH INFORMATION AND
 PERSONALLY IDENTIFIABLE INFORMATION, AND MUST IMPLEMENT INTEROPERABILITY
 PROTOCOLS THAT  ENSURE  DIFFERENT  BILLING  SYSTEMS  PROMOTE  ACCESS  TO
 RECORDS.  TO  THE EXTENT FEASIBLE AND NECESSARY, HEALTH CARE PLANS SHALL
 ALSO SEEK TO BE HEALTH INFORMATION TRUST ALLIANCE  (HITRUST)  CERTIFIED,
 WHICH  REQUIRES  DEMONSTRATING  AND  FOLLOWING GLOBAL STANDARDS FOR DATA
 SECURITY AND PRIVACY COMPLIANCE.
 S. 8203                             3
 
   (D) FOR PURPOSES OF THIS  SUBDIVISION,  "HEALTH  CARE  PLAN"  MEANS  A
 HEALTH MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR
 OF THIS CHAPTER, AN INSURER LICENSED TO WRITE ACCIDENT AND HEALTH INSUR-
 ANCE  PURSUANT TO ARTICLE THIRTY-TWO OF THE INSURANCE LAW, A CORPORATION
 ORGANIZED PURSUANT TO ARTICLE FORTY-THREE OF THE INSURANCE LAW, A MUNIC-
 IPAL  COOPERATIVE  HEALTH  BENEFIT  PLAN  CERTIFIED  PURSUANT TO ARTICLE
 FORTY-SEVEN OF THE INSURANCE LAW, OR A STUDENT HEALTH  PLAN  ESTABLISHED
 OR  MAINTAINED  PURSUANT TO SECTION ONE THOUSAND ONE HUNDRED TWENTY-FOUR
 OF THE INSURANCE LAW.
   § 6. 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-
 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 PROVIDED ELECTRONICALLY BY HEALTH
 CARE PROVIDERS PURSUANT TO SUBDIVISION FIFTEEN OF  SECTION  TWENTY-EIGHT
 HUNDRED THREE OF THIS CHAPTER.
   §  7.  This  act shall take effect on the ninetieth day after it shall
 have become a law; provided that sections one, two and four of this  act
 shall  apply  to contracts issued, renewed, modified, altered or amended
 on or after such date.

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Senate Bill S8203

Sponsored By

Current Bill Status - In Senate Committee Insurance Committee

2025-S8203 (ACTIVE) - Details

2025-S8203 (ACTIVE) - Summary

2025-S8203 (ACTIVE) - Sponsor Memo

2025-S8203 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S8203

Share this bill

Sponsored By

Jamaal T. Bailey

Current Bill Status - In Senate Committee Insurance Committee

2025-S8203 (ACTIVE) - Details

2025-S8203 (ACTIVE) - Summary

2025-S8203 (ACTIVE) - Sponsor Memo

2025-S8203 (ACTIVE) - Bill Text download pdf

Comments