New York Senate Bill S09992

New York 2025-2026 Regular Session

• Introduced: 4/21/26
• Refer: 4/21/26

Caption

Requires insurance companies to establish and maintain API to facilitate patient and provider access to health information; includes patient access, provider directory and payer to payer exchange.

Summary

This bill would amend the New York Insurance Law to require health insurance companies authorized to write health insurance in the state to establish and maintain certain application programming interfaces (APIs) beginning January 1, 2027. The required APIs include a patient access API, a provider directory API, and a payer-to-payer exchange API. These tools are intended to make it easier for enrollees and contracted providers to access health information and to support continuity of care when a patient changes insurers. The bill also authorizes the Department of Financial Services to require additional APIs, specifically a provider access API and a prior authorization support API, if and when final federal rules are issued. Any such additional requirements must align with standards and effective dates published by the federal Centers for Medicare and Medicaid Services, including any enforcement delays or suspensions. The bill defines the required APIs and specifies that the patient access API would provide authenticated access to membership, coverage, claims, clinical, and prescription drug formulary information, while the provider directory API would make provider information available and the payer-to-payer exchange API would support transfer of patient data between payers.

Impact

The bill would create a new section 112 in the Insurance Law and impose new compliance obligations on health insurers operating in New York. It would require insurers to build and maintain interoperable digital interfaces for patient, provider, and insurer-to-insurer data exchange, potentially affecting information technology systems, data governance, and consumer access practices across the health insurance market. The measure also gives the state department authority to expand API requirements in step with federal CMS rulemaking, tying state implementation to federal interoperability and prior authorization standards.

Sentiment

The available record does not include committee debate or recorded votes, so there is no direct evidence of support or opposition from the legislative process. Based on the bill text, the measure appears to be framed as a consumer-access and care-coordination initiative, suggesting a generally pro-transparency and pro-interoperability policy approach. The absence of transcripts or votes means sentiment can only be inferred from the bill’s stated purpose rather than from expressed legislative positions.

Contention

The main potential points of contention are likely to be the compliance burden on health insurers, the cost and technical complexity of implementing and maintaining multiple APIs, and the extent to which state requirements should track evolving federal CMS rules. Insurers may be concerned about implementation timelines, data security, and operational costs, while consumer and provider advocates would likely favor improved access to claims, coverage, formulary, and provider directory information. Another possible issue is the bill’s reliance on future federal rulemaking for additional APIs, which could create uncertainty about the scope and timing of later obligations.