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A BILL TO BE ENTITLED
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AN ACT
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relating to use of artificial intelligence in utilization review |
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conducted for health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter D, Chapter 4201, Insurance Code, is |
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amended by adding Section 4201.156 to read as follows: |
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Sec. 4201.156. USE OF ARTIFICIAL INTELLIGENCE-BASED |
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ALGORITHMS. (a) A utilization review agent may not use an |
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artificial intelligence-based algorithm as the sole basis of a |
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decision to wholly or partly deny, delay, or modify health care |
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services for an enrollee on the basis of medical necessity or |
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appropriateness of health care items and services. Only a |
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physician or licensed health care provider acting in accordance |
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with this chapter may determine medical necessity or |
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appropriateness of health care items and services. |
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(b) The commissioner may audit and inspect at any time a |
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utilization review agent's use of artificial intelligence for |
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utilization review. |
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SECTION 2. This Act takes effect September 1, 2025. |