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Digest
HB 4018 regulates the use of artificial intelligence (AI) in health insurance utilization review processes. It requires that AI-based algorithms or software tools used for utilization reviews consider an enrollee’s medical history, clinical circumstances, and other relevant medical data rather than relying solely on group datasets. The bill also mandates compliance with state and federal laws, prohibits AI from overriding a physician’s decisions, and requires AI systems to be transparent, nondiscriminatory, and periodically reviewed for accuracy. AI cannot be used as the sole basis for denying, delaying, or modifying health care services.
Author (1)
Suleman Lalani