Bill > S07896

This bill establishes comprehensive requirements and safeguards for the use of artificial intelligence (AI), algorithms, or software tools in utilization review for health and accident insurance in New York. The legislation requires that any AI tool used for reviewing healthcare services must base its determinations on individual patient medical history, specific clinical circumstances, and relevant medical records, and cannot rely solely on group datasets. The bill mandates that these AI tools cannot replace healthcare provider decision-making, must not discriminate against patients, and must be applied fairly and equitably. Importantly, the bill stipulates that final determinations of medical necessity must be made by a licensed physician or qualified healthcare professional, not by the AI tool itself. The legislation also requires periodic review of the AI tool's performance, ensures patient data privacy consistent with HIPAA regulations, and mandates that the tools do not cause direct or indirect harm to patients. The bill applies to prospective, retrospective, and concurrent healthcare service reviews and requires compliance with federal guidelines. Additionally, it provides the department flexibility in implementing these regulations, including the ability to enter into contracts and issue guidance without being subject to typical administrative procedures. The law will take effect 90 days after becoming official.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/S7896