Bill > SB444

This bill, effective January 1, 2027, amends Georgia law concerning private review agents, which are entities that review healthcare services to determine if they are medically necessary and appropriate for insurance coverage. The key provision is that while private review agents and utilization review entities can use artificial intelligence (AI) systems, AI, or other software tools to assist in their processes, these tools cannot be the sole basis for making decisions about insurance coverage for healthcare services. The bill defines "artificial intelligence" as a machine-based system that makes predictions, recommendations, or decisions based on human-defined objectives, and "artificial intelligence system" as a system that emulates human cognitive processes like learning and reasoning. Importantly, these AI tools can automate tasks and aid in decision-making, but they are prohibited from issuing a final denial of coverage (an adverse determination) to a patient unless a human reviewer, who is a qualified private review agent or utilization review entity and includes a participating clinical peer, has conducted a review. Furthermore, the judgment of this clinical peer must always take precedence over any AI system's recommendation.