Bill > A08556

This bill prescribes 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 mandates that any AI or algorithmic tool used for reviewing health care services must base its determinations on individual patient clinical history, specific clinical circumstances, and relevant medical records, and cannot rely solely on group datasets. The bill requires that these tools do not replace healthcare provider decision-making, cannot discriminate against patients, must be applied fairly and equitably, and cannot directly or indirectly cause harm to patients. Critically, the bill stipulates that actual determinations of medical necessity must be made only by licensed physicians or healthcare professionals who review the specific clinical issues, provider recommendations, and individual patient circumstances. The legislation applies to prospective, retrospective, and concurrent reviews of health care services and requires that patient data be used only for its intended purpose, consistent with HIPAA regulations. Additionally, the bill provides for periodic review and revision of AI tools to maximize accuracy, mandates transparency through written policies, and allows for departmental inspection and audit. The goal is to ensure that AI technologies in healthcare are used responsibly, ethically, and with primary consideration of individual patient needs.

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https://www.nysenate.gov/legislation/bills/2025/A8556