The law requires carriers, pharmacy benefit managers, and private review agents to ensure AI decisions are based on an individual's clinical information.
The law requires carriers, pharmacy benefit managers, and private review agents to ensure AI decisions are based on an individual's clinical information.
If passed with this recent amendment, the bill would prevent the enforcement of laws on AI models and automated decision systems.
The bill would create new regulations and establish an Advisory Committee to oversee compliance, authorizing penalties of fines or license revocation.
House Bill 5918 would prohibit using AI or predictive models as the sole basis for denying, reducing, or terminating coverage.
While the bulletin outlines ways carriers can demonstrate compliance with state laws, it does not mandate specific practices or documentation.
AI-enabled social engineering and AI-enhanced cybersecurity attacks are some of the many topics addressed in the guidance.
Providers will have final approval of UR decisions when AI is used, and patients must receive notice if AI is used to generate claims communications.
Regulators endorsed the Principles of Artificial Intelligence adopted by the NAIC as a framework for insurers.
