Health insurance
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Senate
- Passed House
- To Governor
- Became Law
Overview
This bill aims to regulate how health insurers in South Carolina use artificial intelligence (AI) for prior authorization decisions. It requires insurers to consider a patient’s medical history, clinical circumstances, and relevant medical information when using AI, and mandates specific disclosures to enrollees about AI’s use in coverage determinations. The bill also establishes disciplinary actions for insurers who violate these guidelines, ensuring fairness and transparency in the process.
Key provisions
- Requires insurers to base prior authorization decisions on a patient's medical history, clinical circumstances, and relevant medical information.
- Mandates specific disclosures to enrollees about the use of AI in coverage determinations.
- Establishes disciplinary actions for insurers who violate the provisions of the bill.
- Requires insurers to certify annually that their AI systems comply with fairness and non-discrimination standards.
- Requires insurers to review and improve the accuracy and reliability of their AI systems.
- Requires insurers to make data used in utilization review available for inspection.
- Ensures patient data is used only for its intended purpose, complying with HIPAA regulations.
- Requires a licensed physician to review AI-generated recommendations for denials or modifications.
Who is affected
- Health insurance companies
Bill text
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