The bill amends section 3902.50 of the Revised Code and enacts a new section, 3902.80, to establish regulations regarding the use of artificial intelligence (AI) by health insurers in Ohio. It updates the definition of the relevant sections by replacing the reference to section 3902.72 with section 3902.80. The new section outlines specific requirements for health plan issuers, including the obligation to file an annual report with the superintendent of insurance detailing their use of AI in utilization review processes. This report must include information about the algorithms used, the data sets for training, and the outcomes of the AI applications, among other details.

Additionally, the bill prohibits health plan issuers from making decisions about a covered person's care solely based on AI-derived results. It mandates that determinations of medical necessity must involve a licensed physician or qualified provider who considers the individual circumstances of the covered person. Any decision made using AI must be accompanied by a clear explanation of the rationale behind it. The superintendent is granted the authority to audit the use of AI algorithms by health plan issuers and may engage third parties for this purpose. The provisions of this section apply to health benefit plans issued or renewed after the effective date of the bill.

Statutes affected:
As Introduced: 3902.50