Bill > HB1385

This bill requires that when health insurance companies, or entities they contract with, use artificial intelligence (AI), algorithms, or other software tools for utilization review—which is the process of determining if a requested medical service is medically necessary and appropriate—these tools must undergo specific human oversight. Specifically, any audits or compliance checks of these AI tools must include an evaluation by a licensed healthcare professional who can review patient medical records, consider individual circumstances, and has the authority to question, change, or reject the AI's initial determination. Furthermore, the ongoing review and revision of how these AI tools perform, are used, and their outcomes must also involve a human evaluation of real-world health results, with the findings from this human review being used to make the AI tools safer, more accurate, and better suited to patient needs. This bill defines artificial intelligence as a system that can infer from its input how to generate outputs that can affect environments, and it applies to various entities that provide health benefit plans or manage pharmacy benefits.