Bill > SB164

This bill regulates the use of artificial intelligence (AI) by health insurers in Ohio, requiring them to annually report detailed information about their AI algorithms to the state superintendent of insurance. The report must include specifics about providers in their network, the number of covered persons, and comprehensive details about AI algorithms used in utilization review processes, such as algorithm criteria, training data sets, outcomes, and the amount of time human reviewers spend examining adverse determinations. The bill prohibits health insurers from making care decisions solely based on AI results and mandates that medical necessity determinations must be made by a licensed physician or qualified provider who considers the patient's individual clinical circumstances and the requesting provider's recommendation. Furthermore, any decision to deny, delay, or modify health care services using an AI algorithm must be accompanied by a clear explanation of the rationale. The superintendent of insurance is granted the authority to audit health insurers' AI algorithms at any time, potentially using third-party contractors. These regulations will apply to health benefit plans issued, amended, or renewed after the bill's effective date, with the goal of ensuring transparency, human oversight, and patient-centered decision-making in health care service determinations.

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https://www.legislature.ohio.gov/legislation/136/sb164