Bill > SB63

This bill establishes regulations for health care plans in Alabama that use artificial intelligence (AI) for making decisions about coverage, specifically for requests requiring prior authorization, which is a process where a health plan provider must approve a medical service before it's rendered to ensure it's medically necessary and covered. The bill defines AI broadly as a machine-based system that can perform tasks requiring human-like perception and learning, and it mandates that when AI is used for medical necessity determinations, it must consider the enrollee's individual medical history, unique clinical circumstances, and other relevant information from their medical record. Health benefit plan providers must annually certify to the Department of Insurance that their AI systems do not rely on group data for individual decisions, are applied fairly and equitably, and do not discriminate. Crucially, any decision to deny, delay, or modify a prior authorization request based on medical necessity must ultimately be made or reviewed by a licensed physician or qualified health care professional. The bill also requires health plans to disclose their use of AI in utilization review (the process of determining if a requested service meets the plan's criteria), periodically review AI outcomes for accuracy, and ensure patient data is used only for its intended purpose in compliance with HIPAA. The Department of Insurance is empowered to investigate violations, hold hearings, and impose corrective plans, administrative fines, or even suspend or revoke a provider's certificate of authority for repeat offenses, and providers will be required to reimburse the department for investigation expenses. The bill will become effective on October 1, 2026.

Business and Industry, Health and Social Services

https://alison.legislature.state.al.us/bill-search