Changes to Existing Law
SB169 — Place requirements on the use of artificial intelligence systems by health carriers in making determinations about the provision of health care services.
1 section modified+1537-0
View:
§ 58-17
New Section+1537
NEW SECTION added to Chapter 58-17
H: Any health carrier that makes determinations or provides advice about third-party payment for any health care services using an artificial intelligence, algorithm, or other software tool, for the purpose of utilization review and any health carrier that contracts with or otherwise works through an entity that uses an artificial intelligence, algorithm, or other software tool, for the purpose of utilization review, shall ensure the following: (1) The artificial intelligence, algorithm, or other software tool bases its determination on the following information, as applicable: (a) A patient’s medical or other clinical history; (b) Individual clinical circumstances, as presented by the requesting provider; and (c) Other relevant clinical information contained in the patient’s medical or other clinical record; (2) The artificial intelligence, algorithm, or other software tool does not base its determination solely on a group dataset; (3) The artificial intelligence, algorithm, or other software tool is applied equally for all patients, including in accordance with any applicable regulations and guidance issued by the United States Department of Health and Human Services; and (4) The artificial intelligence, algorithm, or other software tool is configured and applied in a standard consistent manner for all subscriber groups and individuals covered by a health benefit plan, as defined in § 58-17-66, so that the resulting decisions are the same for all patients with similar clinical presentations and considerations.