| 89R5922 SCL-F | ||
| By: Spiller | H.B. No. 2922 | |
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A BILL TO BE ENTITLED
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AN ACT
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| relating to use of artificial intelligence in utilization review | ||
| conducted for health benefit plans. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Subchapter D, Chapter 4201, Insurance Code, is | ||
| amended by adding Section 4201.156 to read as follows: | ||
| Sec. 4201.156. USE OF ARTIFICIAL INTELLIGENCE-BASED | ||
| ALGORITHMS. (a) A utilization review agent may not use an | ||
| artificial intelligence-based algorithm as the sole basis of a | ||
| decision to wholly or partly deny, delay, or modify health care | ||
| services for an enrollee on the basis of medical necessity or | ||
| appropriateness of health care items and services. Only a | ||
| physician or licensed health care provider acting in accordance | ||
| with this chapter may determine medical necessity or | ||
| appropriateness of health care items and services. | ||
| (b) The commissioner may audit and inspect at any time a | ||
| utilization review agent's use of artificial intelligence for | ||
| utilization review. | ||
| SECTION 2. This Act takes effect September 1, 2025. | ||