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.