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A BILL TO BE ENTITLED
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AN ACT
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relating to the use of artificial intelligence-based algorithms in |
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utilization review conducted for certain 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. ARTIFICIAL INTELLIGENCE-BASED ALGORITHMS. |
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(a) An issuer of a health insurance policy or a health maintenance |
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organization that is the issuer of a health benefit plan shall |
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publish on a publicly accessible part of the issuer's Internet |
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website and provide in writing to each insured or enrollee, and any |
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physician or health care provider contracting with the issuer or |
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providing services to an insured or enrollee, a disclosure |
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regarding whether the issuer or the issuer's utilization review |
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agent uses artificial intelligence-based algorithms in conducting |
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utilization review. |
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(b) An issuer described by Subsection (a) or a utilization |
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review agent for an issuer described by Subsection (a) shall ensure |
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that any artificial intelligence-based algorithm used by the issuer |
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or agent in conducting utilization review and the training data |
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sets the algorithm uses: |
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(1) have minimized the risk of bias based on an |
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individual's race, color, religion, ancestry, age, sex, gender, |
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national origin, or disability; and |
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(2) comply with evidence-based clinical guidelines. |
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(c) Not later than December 31 of each year, an issuer |
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described by Subsection (a) or a utilization review agent for an |
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issuer described by Subsection (a) shall submit to the department |
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for review, in the form and manner prescribed by the commissioner, |
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any artificial intelligence-based algorithm used by the issuer or |
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agent in conducting utilization review and each training data set |
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the algorithm uses. The issuer or agent must include with the |
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submission an attestation to the department that the algorithm and |
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training data sets comply with Subsection (b). |
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SECTION 2. This Act takes effect September 1, 2025. |