This bill aims to revise laws concerning the use of artificial intelligence (AI) in health insurance, specifically imposing restrictions on health insurance issuers that utilize AI for utilization review or management functions. It mandates that any AI, algorithm, or software tool used must consider a covered person's medical history, individual clinical circumstances, and other relevant clinical information, rather than relying solely on group datasets. Additionally, the bill stipulates that AI should not replace healthcare provider decision-making, must be non-discriminatory, and should be subject to audits and compliance reviews. It also emphasizes that determinations of medical necessity must be made exclusively by licensed healthcare professionals.

Furthermore, the bill amends existing legislation to prohibit unfair claim settlement practices, including the improper use of AI in claims processing. It introduces a new provision that specifically addresses the use of AI in claims, ensuring that it aligns with the regulations set forth in the newly established section. The bill also includes a definition of "artificial intelligence" and outlines penalties for health insurance issuers that fail to comply with these new requirements. Overall, the legislation seeks to enhance transparency, accountability, and fairness in the application of AI within the health insurance sector.

Statutes affected:
LC Text: 33-18-201