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.