This bill establishes new regulations regarding the use of automated systems in health insurance utilization reviews in Oklahoma. It defines key terms such as "adverse determination," "algorithm," "artificial intelligence system," and "automated decision system." The bill prohibits utilization review agents from making adverse determinations solely through automated systems, mandating that such decisions must be reviewed by a qualified human professional before finalization. Additionally, it grants the Insurance Commissioner the authority to audit and inspect the use of these automated systems by utilization review agents. However, the bill clarifies that the use of automated systems for administrative support or fraud detection is still permitted.

Furthermore, the bill requires that any notice of an adverse determination must include specific information, such as the reasons for the determination, the clinical basis, the criteria used, and details about the complaint and appeal process. This aims to ensure transparency and provide enrollees with clear avenues for recourse. The act is set to take effect on November 1, 2026.