89R5922 SCL-F
By: Schwertner S.B. No. 815
A BILL TO BE ENTITLED
AN ACT
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.