Bill > HB4018

This bill adds a new section to the Texas Insurance Code that regulates the use of artificial intelligence (AI) in utilization review for health benefit plans. The bill defines AI as a machine-based system that can infer and generate outputs based on input, and establishes specific requirements for utilization review agents using AI algorithms or software tools. These requirements include ensuring that AI determinations are based on individual patient clinical information, do not rely solely on group datasets, comply with existing laws, do not override healthcare provider decisions, avoid discrimination, are applied fairly, are subject to periodic review and revision, protect patient information, and do not cause harm to patients. Critically, the bill prohibits using AI as the sole basis for denying, delaying, or modifying health care services, emphasizing that only a physician or licensed healthcare provider can ultimately determine medical necessity or appropriateness of health care services. The legislation is set to take effect on September 1, 2025, and aims to provide safeguards for patients by ensuring AI tools in healthcare are used responsibly and do not replace professional medical judgment.

Business and Industry

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB4018