Bill > H5206

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 consider an enrollee's medical history, unique clinical circumstances provided by a healthcare provider, and other relevant information from the enrollee's medical record. Additionally, insurers must annually certify to the Department of Insurance that their AI tools do not solely rely on group data, are applied fairly to all enrollees, 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 clearly inform 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 used in compliance with HIPAA. If an insurer violates these provisions, the Department of Insurance can require corrective actions or impose disciplinary measures for repeat offenses.

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https://www.scstatehouse.gov/billsearch.php?billnumbers=5206&session=126&summary=B