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Relates to the use of artificial intelligence by insurers and clinical peer reviewers for utilization review; establishes additional notice requirements for adverse determinations.
The bill mandates insurers to disclose AI use in utilization reviews and submit quality assurance testing results semiannually.
If you are an insurer using AI for utilization reviews, you must notify stakeholders and disclose algorithm details or face fines up to $10,000 per violation.
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Affected Industries
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What This Means
This bill introduces significant regulations on the use of artificial intelligence in the insurance sector, particularly regarding utilization reviews. Insurers will be required to provide detailed notifications about their AI algorithms and submit quality assurance testing results semiannually. Compliance will involve transparency with both insured individuals and healthcare providers, impacting how insurers operate in New York.
Key Provisions
- Insurers must notify stakeholders about AI use in utilization reviews.
- Detailed disclosures about AI algorithms and data sets are required.
- Adverse determinations cannot be based solely on AI algorithms.
- Clinical peer reviewers must consider individual patient circumstances.
- Insurers must submit quality assurance testing results semiannually.
- Ongoing quality assurance testing of AI algorithms is mandated.
Latest Legislative Action
referred to insurance
Bill Sponsors
| Name | Role | District |
|---|---|---|
| David Weprin D | Sponsor | HD-024 |
Compliance Checklist
Who: Insurers
Deadline: Upon first adoption and once per policy period
Penalty: Fines up to $10,000 per violation
Who: Insurers
Deadline: As specified by the superintendent
Penalty: License suspension or fines
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