SB1822 - Relating to the use of artificial intelligence-based algorithms in utilization review conducted for certain health benefit plans.

      By: Johnson S.B. No. 1822     A BILL TO BE ENTITLED   AN ACT   relating to the use of artificial intelligence-based algorithms in   utilization review conducted for certain 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.     ARTIFICIAL INTELLIGENCE-BASED ALGORITHMS.   (a) An issuer of a health insurance policy or a health maintenance   organization that is the issuer of a health benefit plan shall   publish on a publicly accessible part of the issuer's Internet   website and provide in writing to each insured or enrollee, and to   any physician or health care provider contracting with the issuer   or providing services to an insured or enrollee, a written   disclosure regarding whether the issuer or the issuer's utilization   review agent uses artificial intelligence-based algorithms in   conducting utilization review.           (b)     An issuer described by Subsection (a) or a utilization   review agent for an issuer described by Subsection (a) shall ensure   that any artificial intelligence-based algorithm used by the issuer   or agent in conducting utilization review and the training data   sets the algorithm uses:                 (1)     have minimized the risk of bias based on an   individual's race, color, religion, ancestry, age, sex, gender,   national origin, or disability; and                 (2)  comply with evidence-based clinical guidelines.           (c)     Not later than December 31 of each year, an issuer   described by Subsection (a) or a utilization review agent for an   issuer described by Subsection (a) shall submit to the department   for review, in the form and manner prescribed by the commissioner,   an artificial intelligence compliance statement. The statement   must:                 (1)     summarize the function and scope of an artificial   intelligence-based algorithm used for utilization review;                 (2)     provide a logic or decision tree of an artificial   intelligence-based algorithm used for utilization review;                 (3)     provide a description of each training data set   used by an artificial intelligence-based algorithm for utilization   review, including the source of the data;                 (4)     attest that the artificial intelligence-based   algorithm and the algorithm's training data sets comply with   Subsection (b); and                 (5)     describe the issuer's or agent's process for   overseeing and validating the artificial intelligence-based   algorithm's performance and compliance with Subsection (b).           (d)     If the commissioner has reason to believe that an issuer   described by Subsection (a) or utilization review agent for an   issuer described by Subsection (a) is not in compliance with this   section, the commissioner may require additional documentation or   conduct an inspection of:                 (1)     any artificial intelligence-based algorithm used   by the issuer or agent in conducting utilization review; and                 (2)     each training data set the artificial   intelligence-based algorithm uses.           (e)     Information submitted to the department under this   section is confidential and not subject to disclosure under Chapter   552, Government Code.          SECTION 2.  This Act takes effect September 1, 2025.