Bill > S0920

This bill requires health insurers in South Carolina to consider specific factors when using artificial intelligence (AI), which is defined as a machine-based system that can learn and perform tasks requiring human-like perception or cognition, to make decisions about prior authorizations, a process where an insurer determines if a requested healthcare service is covered. Insurers must ensure their AI tools take into account an enrollee's medical history, unique clinical circumstances provided by a healthcare provider, and other relevant information from the enrollee's medical record. Furthermore, insurers must annually certify to the Department of Insurance that their AI tools are used fairly, do not rely solely on group data, and do not discriminate. Any decision to deny, reduce, or defer a prior authorization request must ultimately be made by a licensed physician or qualified healthcare professional. The bill also mandates that insurers disclose to enrollees when AI is used in utilization review, which is the process of determining coverage, and provide data on denial rates upon request, while ensuring patient data is handled in compliance with HIPAA. The Department of Insurance is empowered to investigate violations and can require insurers to correct their procedures or impose disciplinary actions for repeat offenses.

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https://www.scstatehouse.gov/billsearch.php?billnumbers=0920&session=126&summary=B