Bill > SB2768

This bill aims to regulate the use of artificial intelligence (AI), algorithms (defined as computerized procedures with analytical steps), and other software tools by health insurance carriers and utilization review organizations when making decisions about healthcare coverage. Specifically, it mandates that these tools must base their determinations on an individual's medical history, clinical circumstances, and other relevant medical records, rather than solely on group data. The bill also requires that these tools be applied fairly, consistently for all patients with similar conditions, and be open for inspection by the insurance commissioner. Furthermore, it prohibits the use of AI or algorithms to directly deny, delay, or modify a decision to provide health care services. Crucially, before a health carrier can issue an "adverse action" (meaning a denial of a request for prior authorization or similar negative decision), a licensed health care provider, such as a physician or nurse, must conduct an independent review of the claim, exercising their own medical judgment and not relying solely on automated recommendations. The bill also clarifies that "prior authorization" refers to the process of obtaining approval from an insurer before receiving certain medical services.

Health and Social Services

https://www.capitol.hawaii.gov/session/measure_indiv.aspx?billtype=SB&billnumber=2768&year=2026