Senate Bill No. 246, introduced by Senator Luneau, establishes new requirements for health insurance insurers regarding the use of artificial intelligence (AI) in utilization review processes. The bill amends existing law to require insurers to inform insured individuals if AI was utilized in making adverse determinations, including providing the clinical rationale for such decisions. It defines "artificial intelligence" and outlines specific conditions under which AI can be used, ensuring that it does not replace the role of healthcare providers in the determination process. Insurers must also ensure that independent human judgment is involved in adverse determinations related to medical necessity or prior authorization claims.

Additionally, the bill mandates compliance with federal regulations and the Health Insurance Portability and Accountability Act (HIPAA) while allowing insured individuals the right to appeal decisions made with AI recommendations. If an appeal is based on the use of AI, the insurer is prohibited from using AI in any subsequent review of that claim. The bill also requires insurers to provide access to relevant documents concerning the AI used in the determination process. These provisions aim to enhance transparency and accountability in the utilization review process, effective August 1, 2026.

Statutes affected:
SB246 Original: 22:44(E)(2)