The bill, S.B. No. 815, introduces regulations regarding the use of artificial intelligence in the utilization review process for health benefit plans in Texas. It specifically prohibits utilization review agents from relying solely on artificial intelligence-based algorithms to make decisions that could deny, delay, or modify health care services based on medical necessity or appropriateness. Instead, such determinations must be made by a physician or licensed health care provider in accordance with existing laws. Additionally, the bill grants the commissioner the authority to audit and inspect the use of artificial intelligence by utilization review agents at any time.

This legislation aims to ensure that critical health care decisions are made by qualified professionals rather than automated systems, thereby safeguarding the quality of care for enrollees. The new provisions will take effect on September 1, 2025, allowing time for health benefit plans and utilization review agents to adjust to these requirements.

Statutes affected:
Introduced: ()