Bill > HB1866

This bill, known as the "Regulate Artificial Intelligence (AI) in Health Care Act," aims to establish guidelines for the use of AI in health insurance decisions. It defines "artificial intelligence" broadly as a machine-based system capable of making predictions, recommendations, or decisions, influencing environments, or learning from data, and also includes systems that solve tasks requiring human-like perception or cognition. The bill specifies that a "health insurance issuer" includes entities that provide health coverage, such as insurance companies, health maintenance organizations, and pharmacy benefits managers, and also encompasses state programs like TennCare and CoverKids. Crucially, the act mandates that health insurance issuers cannot deny, delay, or modify healthcare services based on medical necessity, as determined by AI or algorithms, unless the prior authorization request is reviewed by a licensed healthcare professional competent to evaluate the specific clinical issues. This review must consider the requesting provider's recommendation, the patient's medical history, and individual circumstances. Violations are considered unfair claims practices, subject to penalties, and individuals harmed by a violation can pursue private legal action to recover damages, punitive damages, and legal costs. The Department of Commerce and Insurance is authorized to create rules to implement this act, which will take effect for rule-making purposes immediately upon becoming law, and for all other purposes, on July 1, 2026, applying to conduct on or after that date.

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https://wapp.capitol.tn.gov/apps/Billinfo/default.aspx?BillNumber=HB1866&ga=114