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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 to |
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any physician or health care provider contracting with the issuer |
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or providing services to an insured or enrollee, a written |
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disclosure regarding whether the issuer or the issuer's utilization |
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review agent uses artificial intelligence-based algorithms in |
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conducting 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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an artificial intelligence compliance statement. The statement |
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must: |
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(1) summarize the function and scope of an artificial |
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intelligence-based algorithm used for utilization review; |
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(2) provide a logic or decision tree of an artificial |
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intelligence-based algorithm used for utilization review; |
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(3) provide a description of each training data set |
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used by an artificial intelligence-based algorithm for utilization |
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review, including the source of the data; |
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(4) attest that the artificial intelligence-based |
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algorithm and the algorithm's training data sets comply with |
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Subsection (b); and |
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(5) describe the issuer's or agent's process for |
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overseeing and validating the artificial intelligence-based |
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algorithm's performance and compliance with Subsection (b). |
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(d) If the commissioner has reason to believe that an issuer |
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described by Subsection (a) or utilization review agent for an |
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issuer described by Subsection (a) is not in compliance with this |
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section, the commissioner may require additional documentation or |
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conduct an inspection of: |
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(1) any artificial intelligence-based algorithm used |
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by the issuer or agent in conducting utilization review; and |
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(2) each training data set the artificial |
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intelligence-based algorithm uses. |
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(e) Information submitted to the department under this |
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section is confidential and not subject to disclosure under Chapter |
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552, Government Code. |
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SECTION 2. This Act takes effect September 1, 2025. |
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