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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 S 7896 would add Public Health Law § 4905-a and Insurance Law § 4905-a. A utilization review agent using AI, an algorithm or another software tool based on medical necessity must base determinations on the enrollee's clinical history, may not rely solely on a group dataset, and must not let the tool supplant provider decision-making. The tool could not deny, delay or modify services on medical necessity grounds; only a licensed physician or health professional could. Referred to Health 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 insurers and utilization review agents using AI could not let it decide medical necessity denials and would need the listed safeguards.
Key provisions
- Utilization review agents using AI must meet eleven conditions (A)-(K), including individualized clinical inputs, no sole reliance on a group dataset, no discrimination, Department inspection access, periodic review for accuracy, and no direct or indirect harm to the enrollee
- The tool "shall not deny, delay, or modify health care services" based on medical necessity; only a licensed physician or competent licensed health professional may make that determination
- Applies to prospective, retrospective and concurrent review; the Insurance Law version covers disability insurers and utilization management for insureds
- "Artificial intelligence" means an engineered or machine-based system with variable autonomy that infers outputs from inputs
- The Public Health Law section applies only to the extent the Department obtains needed federal approvals; no penalty, private right of action or exception is stated
- Takes effect the ninetieth day after becoming law; Assembly same-as A8556
Latest legislative action
Jan 7, 2026. referred to health
Sponsors (showing 5 of 11)
| Name | Role |
|---|---|
| AVELLA | Primary |
| CLEARE | Primary |
| Kevin S. Parker D | Primary |
| Kristen Gonzalez D | Primary |
| MARTINEZ | Primary |
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