Illinois 2023-2024 Regular Session

Illinois House Bill HB5918 Compare Versions

Only one version of the bill is available at this time.

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1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5918 Introduced , by Rep. Bob Morgan SYNOPSIS AS INTRODUCED: New Act5 ILCS 100/5-45.65 new Creates the Artificial Intelligence Systems Use in Health Insurance Act. Provides that the Department of Insurance's regulatory oversight of insurers includes oversight of an insurer's use of AI systems to make or support adverse determinations that affect consumers. Provides that any insurer authorized to operate in the State is subject to review by the Department in an investigation or market conduct action regarding the development, implementation, and use of AI systems or predictive models and the outcomes from the use of those AI systems or predictive models. Provides that an insurer authorized to do business in Illinois shall not issue an adverse consumer outcome with regard to the denial, reduction, or termination of insurance plans or benefits that result solely from the use or application of any AI system or predictive model. Provides that any decision-making process for the denial, reduction, or termination of insurance plans or benefits that results from the use of AI systems or predictive models shall be meaningfully reviewed, in accordance with review procedures determined by Department rules, by an individual with authority to override the AI systems and determinations. Authorizes the Department to adopt emergency rules to implement the Act and to adopt rules concerning standards for full and fair disclosure of an insurer's use of AI systems. Makes a conforming change in the Illinois Administrative Procedure Act. LRB103 43349 RPS 76666 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5918 Introduced , by Rep. Bob Morgan SYNOPSIS AS INTRODUCED: New Act5 ILCS 100/5-45.65 new New Act 5 ILCS 100/5-45.65 new Creates the Artificial Intelligence Systems Use in Health Insurance Act. Provides that the Department of Insurance's regulatory oversight of insurers includes oversight of an insurer's use of AI systems to make or support adverse determinations that affect consumers. Provides that any insurer authorized to operate in the State is subject to review by the Department in an investigation or market conduct action regarding the development, implementation, and use of AI systems or predictive models and the outcomes from the use of those AI systems or predictive models. Provides that an insurer authorized to do business in Illinois shall not issue an adverse consumer outcome with regard to the denial, reduction, or termination of insurance plans or benefits that result solely from the use or application of any AI system or predictive model. Provides that any decision-making process for the denial, reduction, or termination of insurance plans or benefits that results from the use of AI systems or predictive models shall be meaningfully reviewed, in accordance with review procedures determined by Department rules, by an individual with authority to override the AI systems and determinations. Authorizes the Department to adopt emergency rules to implement the Act and to adopt rules concerning standards for full and fair disclosure of an insurer's use of AI systems. Makes a conforming change in the Illinois Administrative Procedure Act. LRB103 43349 RPS 76666 b LRB103 43349 RPS 76666 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5918 Introduced , by Rep. Bob Morgan SYNOPSIS AS INTRODUCED:
3	3	New Act5 ILCS 100/5-45.65 new New Act 5 ILCS 100/5-45.65 new
4	4	New Act
5	5	5 ILCS 100/5-45.65 new
6	6	Creates the Artificial Intelligence Systems Use in Health Insurance Act. Provides that the Department of Insurance's regulatory oversight of insurers includes oversight of an insurer's use of AI systems to make or support adverse determinations that affect consumers. Provides that any insurer authorized to operate in the State is subject to review by the Department in an investigation or market conduct action regarding the development, implementation, and use of AI systems or predictive models and the outcomes from the use of those AI systems or predictive models. Provides that an insurer authorized to do business in Illinois shall not issue an adverse consumer outcome with regard to the denial, reduction, or termination of insurance plans or benefits that result solely from the use or application of any AI system or predictive model. Provides that any decision-making process for the denial, reduction, or termination of insurance plans or benefits that results from the use of AI systems or predictive models shall be meaningfully reviewed, in accordance with review procedures determined by Department rules, by an individual with authority to override the AI systems and determinations. Authorizes the Department to adopt emergency rules to implement the Act and to adopt rules concerning standards for full and fair disclosure of an insurer's use of AI systems. Makes a conforming change in the Illinois Administrative Procedure Act.
7	7	LRB103 43349 RPS 76666 b LRB103 43349 RPS 76666 b
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12	12	1 AN ACT concerning regulation.
13	13	2 Be it enacted by the People of the State of Illinois,
14	14	3 represented in the General Assembly:
15	15	4 Section 1. Short title. This Act may be cited as the
16	16	5 Artificial Intelligence Systems Use in Health Insurance Act.
17	17	6 Section 5. Definitions. In this Act:
18	18	7 "Adverse consumer outcome" means a decision by an insurer
19	19	8 that is subject to insurance regulatory standards enforced by
20	20	9 the Department that adversely impacts the consumer in a manner
21	21	10 that violates those standards or any claim denial as
22	22	11 determined by the use of an AI System.
23	23	12 "AI system" means a machine-based system that can, with
24	24	13 varying levels of autonomy, for a given set of objectives,
25	25	14 generate outputs such as predictions, recommendations, content
26	26	15 (such as text, images, videos, or sounds), or other outputs
27	27	16 influencing decisions made in real or virtual environments.
28	28	17 "AI systems program" means a written program for the
29	29	18 responsible use of AI systems that makes or supports decisions
30	30	19 related to regulated insurance practices to be developed,
31	31	20 implemented, and maintained by all insurers authorized to do
32	32	21 business in the State.
33	33	22 "Algorithm" means a clearly specified mathematical process
34	34	23 for computation and a set of rules that, if followed, will give
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38	38	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5918 Introduced , by Rep. Bob Morgan SYNOPSIS AS INTRODUCED:
39	39	New Act5 ILCS 100/5-45.65 new New Act 5 ILCS 100/5-45.65 new
40	40	New Act
41	41	5 ILCS 100/5-45.65 new
42	42	Creates the Artificial Intelligence Systems Use in Health Insurance Act. Provides that the Department of Insurance's regulatory oversight of insurers includes oversight of an insurer's use of AI systems to make or support adverse determinations that affect consumers. Provides that any insurer authorized to operate in the State is subject to review by the Department in an investigation or market conduct action regarding the development, implementation, and use of AI systems or predictive models and the outcomes from the use of those AI systems or predictive models. Provides that an insurer authorized to do business in Illinois shall not issue an adverse consumer outcome with regard to the denial, reduction, or termination of insurance plans or benefits that result solely from the use or application of any AI system or predictive model. Provides that any decision-making process for the denial, reduction, or termination of insurance plans or benefits that results from the use of AI systems or predictive models shall be meaningfully reviewed, in accordance with review procedures determined by Department rules, by an individual with authority to override the AI systems and determinations. Authorizes the Department to adopt emergency rules to implement the Act and to adopt rules concerning standards for full and fair disclosure of an insurer's use of AI systems. Makes a conforming change in the Illinois Administrative Procedure Act.
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45	45	A BILL FOR
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71	71	1 a prescribed result.
72	72	2 "Artificial intelligence" or "AI" means a branch of
73	73	3 computer science that uses data processing systems that
74	74	4 perform functions normally associated with human intelligence,
75	75	5 such as reasoning, learning, and self-improvement, or the
76	76	6 capability of a device to perform functions that are normally
77	77	7 associated with human intelligence, such as reasoning,
78	78	8 learning, and self-improvement. "Artificial intelligence" or
79	79	9 "AI" includes machine learning.
80	80	10 "Department" means the Department of Insurance.
81	81	11 "Machine learning" means a field within artificial
82	82	12 intelligence that focuses on the ability of computers to learn
83	83	13 from provided data without being explicitly programmed.
84	84	14 "Predictive model" means the processing of historic data
85	85	15 using algorithms or machine learning to identify patterns and
86	86	16 predict outcomes that can be used to make decisions or support
87	87	17 decision-making.
88	88	18 "Third party" means an organization other than the insurer
89	89	19 that provides services, data, or other resources related to
90	90	20 AI.
91	91	21 Section 10. Regulatory oversight of the use of AI systems.
92	92	22 (a) The Department's regulatory oversight of insurers
93	93	23 includes oversight of an insurer's use of AI systems to make or
94	94	24 support adverse determinations that affect consumers. Any
95	95	25 insurer authorized to operate in the State is subject to
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106	106	1 review by the Department in an investigation or market conduct
107	107	2 action regarding the development, implementation, and use of
108	108	3 AI systems or predictive models and the outcomes from the use
109	109	4 of those AI systems or predictive models. The Department may
110	110	5 also request other information or documentation relevant to an
111	111	6 investigation or market conduct action, and an insurer must
112	112	7 comply with that request. The Department's inquiries may
113	113	8 include, but are not limited to, questions regarding any
114	114	9 specific model, AI system, or application of a model or AI
115	115	10 system. The Department may also make requests for information
116	116	11 and documentation relating to AI systems governance, risk
117	117	12 management, and use protocols; information and documentation
118	118	13 relating to the insurer's preacquisition and preutilization
119	119	14 diligence, monitoring, and auditing of data or AI systems
120	120	15 developed by a third party; and information and documentation
121	121	16 relating to implementation and compliance with the insurer's
122	122	17 AI systems program.
123	123	18 (b) An insurer authorized to do business in this State
124	124	19 shall not issue an adverse consumer outcome with regard to the
125	125	20 denial, reduction, or termination of insurance plans or
126	126	21 benefits that result solely from the use or application of any
127	127	22 AI system or predictive model. Any decision-making process
128	128	23 concerning the denial, reduction, or termination of insurance
129	129	24 plans or benefits that results from the use of AI systems or
130	130	25 predictive models shall be meaningfully reviewed, in
131	131	26 accordance with review procedures established by Department
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142	142	1 rules, by an individual with authority to override the AI
143	143	2 systems and their determinations.
144	144	3 Section 15. Disclosure of AI System utilization. The
145	145	4 Department of Insurance may adopt rules that include standards
146	146	5 for the full and fair disclosure of an insurer's use of AI
147	147	6 systems that set forth the manner, content, and required
148	148	7 disclosures.
149	149	8 Section 20. Compliance with Act. All insurers authorized
150	150	9 to do business in Illinois shall comply with this Act
151	151	10 regarding any decisions impacting consumers that are made or
152	152	11 supported by advanced analytical and computational
153	153	12 technologies, including AI systems and machine learning, and
154	154	13 must comply with all applicable insurance laws and
155	155	14 regulations, including laws addressing unfair trade practices
156	156	15 and unfair discrimination. All decisions made and actions
157	157	16 taken by authorized insurers using AI systems must comply with
158	158	17 applicable federal and State laws, regulations, and rules.
159	159	18 Section 25. Rulemaking. The Department may adopt rules,
160	160	19 including emergency rules, to implement and administer this
161	161	20 Act.
162	162	21 Section 90. The Illinois Administrative Procedure Act is
163	163	22 amended by adding Section 5-45.65 as follows:
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