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Establishes requirements for the use of artificial intelligence, algorithm, or other software tools in utilization review and management; defines artificial intelligence.
In one paragraph
New York's A 3991 would add Insurance Law § 3224-e and define artificial intelligence in Insurance Law § 107(a). A health care service plan using an AI, algorithm or other software tool for utilization review or management would have to ensure it bases determinations on the enrollee's history and clinical circumstances, does not supplant provider decision making, does not discriminate, and is open to inspection. Medical necessity denials, delays or modifications would have to be made by a licensed physician or other competent provider. Would take effect immediately. Referred to Insurance January 30, 2025 and January 7, 2026; it has not passed either chamber.
Plain-English summary, written with AI assistance. The official text controls.
What it means for business
None yet: the bill is pending. If enacted, health plans using AI in utilization review would have to meet fairness and oversight conditions and have a qualified clinician make any medical-necessity denial.
Key provisions
- Adds Insurance Law § 107(a)(56) defining AI as an engineered or machine-based system that infers from input how to generate outputs that can influence physical or virtual environments
- § 3224-e applies to plans that use, or contract with an entity that uses, AI, algorithms or software tools for utilization review or management
- Plans must ensure the tool bases determinations on medical or dental history, clinical circumstances presented by the requesting provider and other clinical information, and does not supplant provider decision making
- The tool must not adversely discriminate (including on present or predicted disability, expected length of life and quality of life), must be fairly applied and open to inspection, and be periodically reviewed
- Denials, delays or modifications based on medical necessity must be made by a licensed physician or other provider competent to evaluate the clinical issues
- The text states no penalties or enforcement mechanism; would take effect immediately
Latest legislative action
Jan 7, 2026. referred to insurance
Sponsors
| Name | Role |
|---|---|
| Amy Paulin D | Primary |
| COLTON | Primary |
| Phara Souffrant Forrest D | Primary |
| PRETLOW | Primary |
| Jo Anne Simon D | Cosponsor |
Topics and industries
Related topics
Affected industries
This page is general information, not legal advice. Summaries are AI-assisted and may contain errors; read the statute for the controlling text and talk to a lawyer about your situation. Full disclaimer · Report an error