Health insurance
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Overview
This bill aims to regulate how health insurers in South Carolina use artificial intelligence (AI) when making decisions about prior authorizations for healthcare services. It requires insurers to consider a patient’s medical history and clinical circumstances when using AI, and mandates specific disclosures to enrollees about AI’s use in coverage decisions. The bill also establishes disciplinary actions for insurers that violate these guidelines.
Key provisions
- Requires insurers to consider a patient’s medical history and clinical circumstances when using AI for prior authorization decisions.
- Mandates specific disclosures to enrollees about the use of AI in coverage decisions.
- Establishes disciplinary actions for insurers that violate the bill’s provisions.
- Requires insurers to certify annually that their AI tools comply with fairness and non-discrimination standards.
- Requires insurers to review and improve the accuracy and reliability of their AI tools.
- Requires insurers to make data usage consistent with HIPAA regulations.
- Requires a licensed physician to review AI-generated recommendations.
- Allows the Department of Insurance to investigate and take corrective action against insurers.
Who is affected
- Health insurance companies
- Healthcare providers
- Enrollees in health benefit plans
- The Department of Insurance
Bill text
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