Bill > SB169

This bill requires health carriers, which are insurance companies that provide health coverage, to follow specific rules when using artificial intelligence (AI), algorithms, or other software tools to make decisions about paying for healthcare services, a process known as utilization review. These tools must base their decisions on a patient's individual medical history, their specific clinical circumstances as provided by a doctor, and other relevant information from their medical records, rather than solely on general group data. The AI must be applied consistently to all patients and all groups covered by a health plan, ensuring that similar clinical situations lead to the same outcomes. Crucially, these AI tools cannot be the sole authority for denying, delaying, or changing a decision to provide healthcare services; any adverse determination must be made by a licensed physician or healthcare professional who has reviewed the patient's case and the requesting provider's recommendation. Health carriers using these AI tools must also produce an annual report detailing how the AI was used in utilization review and the extent of human oversight involved, which must be submitted to the Legislative Research Council. The Division of Insurance is empowered to inspect these automated systems for compliance, and if non-compliance is found, the Attorney General can order the health carrier to stop the non-compliant activities.

Health and Social Services

https://sdlegislature.gov/#/Session/Bill/26550