Bill > SB815

This bill amends the Texas Insurance Code to regulate the use of automated systems in health benefit claim determinations. The bill introduces new definitions for key technological terms, including "algorithm" (a computerized procedure with set steps), "artificial intelligence system" (a machine learning-based system that generates outputs based on inputs), and "automated decision system" (an algorithm that uses data analytics to make or recommend determinations). The legislation prohibits utilization review agents from using automated decision systems to make adverse determinations about health care services, which are decisions that deem services as not medically necessary or appropriate. The bill requires that adverse determination notices include more detailed information, such as the principal reasons for the determination, the clinical basis, and the specific screening criteria used. The insurance commissioner is granted the authority to audit and inspect how utilization review agents use automated decision systems. Importantly, the bill does not prevent the use of algorithms or AI for administrative support or fraud detection. The provisions will apply to health benefit plans delivered, issued, or renewed on or after January 1, 2026, and the act itself will take effect on September 1, 2025. This legislation aims to ensure more transparent and human-involved decision-making in health care service evaluations.

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https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=SB815