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Prescribes requirements and safeguards for the use of an artificial intelligence, algorithm, or other software tool for the purpose of utilization review for health and accident insurance.
In one paragraph
New York's A 8556 would add Public Health Law § 4905-a and Insurance Law § 4905-a. A utilization review agent or disability insurer using AI, an algorithm or another software tool for utilization review based on medical necessity would have to base determinations on the enrollee's clinical history, not solely a group dataset, and the tool could not "deny, delay, or modify health care services" on medical necessity; only a licensed health care professional could. Would take effect on the ninetieth day after it becomes law. Referred to the Insurance Committee May 20, 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, insurers and utilization review agents using AI tools could not let them deny, delay or modify care on medical necessity; a licensed professional would decide.
Key provisions
- Adds § 4905-a to both the Public Health Law (utilization review agents) and the Insurance Law (disability insurers, including specialized health insurers)
- Tool must base determinations on the enrollee's medical or clinical history and the requesting provider's clinical circumstances, not solely on a group dataset, and must not supplant health care provider decision-making or discriminate in violation of state or federal law
- Tool must be open to Department inspection for audit or compliance reviews, periodically reviewed and revised for accuracy and reliability, and must not use patient data beyond its intended and stated purpose
- Tool "shall not deny, delay, or modify health care services" based in whole or part on medical necessity; only a licensed physician or licensed health care professional competent to evaluate the clinical issues may make such a determination
- "Artificial intelligence" means an engineered or machine-based system that varies in autonomy and can infer from input how to generate outputs that can influence physical or virtual environments
- Department may issue guidance within one year of federal rules or guidance (exempt from the State Administrative Procedure Act)
- Would take effect on the ninetieth day after it becomes law; introduced May 20, 2025, referred to Insurance, no further action
Latest legislative action
Jan 7, 2026. referred to insurance
Sponsors
| Name | Role |
|---|---|
| BRONSON | Primary |
| Karines Reyes D | Primary |
| KAVANAGH | Primary |
| MOSLEY | Primary |
| Pamela J. Hunter D | Primary |
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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