Bill > HB1382

This bill establishes comprehensive regulations for health insurance issuers using artificial intelligence (AI), algorithms, or software tools in utilization review and management functions. The legislation defines AI broadly and applies to various health insurance entities, including TennCare and other state health programs. Key provisions require that AI tools base determinations on individual patient clinical history, individual clinical circumstances, and relevant medical records, and prohibit decisions made solely on group datasets. The bill mandates that these tools cannot replace healthcare provider decision-making, must avoid discrimination, and cannot directly or indirectly harm enrollees. Health insurance issuers must develop written policies disclosing AI use, periodically review the performance and outcomes of these tools, and ensure patient data is used only for its intended purpose and in compliance with HIPAA. Critically, the bill stipulates that medical necessity determinations must be made exclusively by licensed physicians or healthcare professionals, not by AI systems. The legislation provides enforcement mechanisms, including the possibility of private legal action with potential awards for actual and punitive damages, and treats violations as unfair claims practices. The bill will take effect on July 1, 2025, with rules implementation beginning immediately upon becoming law, and includes a provision that exempts requirements that would result in loss of federal funding.

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https://wapp.capitol.tn.gov/apps/Billinfo/default.aspx?BillNumber=HB1382&ga=114