BILL NUMBER: S5456
SPONSOR: COMRIE
 
TITLE OF BILL:
An act to amend the public health law and the insurance law, in relation
to requiring providers to share electronic health records with plans
 
PURPOSE:
The purpose of this bill is to require providers to share electronic
health records with plans for purposes of improving patient care and
reducing administrative delays.
 
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 of this bill would amend Subdivision 13 of section 2803 of the
Public Health Law to require that providers disclose electronic health
records (EHR) to health care plans and permit EHR portal access to an
appropriate amount of dinical and utilization management represen-
tatives.
Section 2 of this bill would amend paragraph (g) of subdivision 1 of
section 4902 of the Public Health Law to establish appropriate policies
and procedures to ensure that all applicable state and federal laws to
protect the confidentiality of electronic medical records.
Section 3 of this bill would amend subdivision 7 of section 4905 of the
Public Health Law to require plans to be responsible for interoperabi-
lity protocols to ensure that different billing systems will promote
access to records.
Section 4 of this bill would amend paragraph 7 of subsection (a) of
section 4902 of the Insurance Law to prohibit plans from seeking data
they are not entitled to receive, instead being limited to admission,
discharge and treatment data relevant to utilization management proc-
esses.
Section 5 of this bill would amend subsection (g) of section 4905 of the
Insurance Law to require medical records to be made available to utili-
zation review agents.
Section 6 of this bill provides that the effective date shall take
effect immediately.
 
JUSTIFICATION:
The Department of Financial Services has promoted the sharing of EHR 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 facsimile communication. This inefficient
method leads to miscommunication and avoidable disputes between plans
and providers with large volumes of request and short compliance time-
frames. EHR sharing benefits patients, providers and plans. For
patients' data shows that EHR sharing closed patient care gaps from
60-90 days to less than 30 days and resulted in more accurate diagnoses
and improved clinical outcomes. EHR sharing also simplifies prior
authorization requirements, resulting in fewer denials and quicker care.
EHR sharing has also proven to result in better care transition and
discharge planning coordination, which has reduced hospital readmissions
and avoidable ER costs. Finally, patients have found that EHR sharing
helps them in provider appeals, when providers do not provide adequate
access to their own health records. From a provider perspective, EHR
sharing in California has led to a 731 reduction in lack of infoLmation
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.
EHR 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 in order to
reduce unnecessary readmissions. The secondary effect of these efficien-
cies has been a 51 increase in provider quality scores. Last, EHR shar-
ing benefits plans as they are able to secure quality data that informs
patient care decisions and leads to nearly real time risk adjustments.
 
PRIOR LEGISLATIVE HISTORY:
2023-24: S.3111 (Mannion)- Referred to Health.
2021-22: S.9103 (Mannion) - Referred to Health.
 
FISCAL IMPLICATIONS:
None.
 
EFFECTIVE DATE:
This act shall take effect immediately.

Statutes affected:
S5456: 2803 public health law, 4902 public health law, 4902(1) public health law, 4905 public health law, 4905(7) public health law, 4902 insurance law, 4902(a) insurance law, 4905 insurance law, 4905(g) insurance law