Bill > HB3675

This bill, effective November 1, 2026, requires that any decision by a health insurance utilization review agent to deny coverage for medical services, known as an "adverse determination" (meaning services are deemed not medically necessary, appropriate, or are experimental/investigational), must be reviewed by a qualified human professional before it is finalized, even if an "algorithm" (a set of computerized steps), "artificial intelligence system" (a machine learning system that generates outputs like decisions or recommendations), or "automated decision system" (any algorithm, including AI, that uses data to make or suggest determinations) was used in the initial review. The Insurance Commissioner is granted the authority to audit how these automated systems are used for utilization review, but the bill clarifies that these systems can still be used for administrative support or to detect fraud. Additionally, any notice of an adverse determination must clearly state the reasons for the denial, the clinical basis, the screening criteria used, and provide detailed information about the complaint and appeal process, including the right to appeal to an independent review organization.

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http://www.oklegislature.gov/BillInfo.aspx?Bill=hb3675&Session=2600