In one paragraph
Ohio's HB 579, the House companion to SB 164 with identical text, would add section 3902.80 requiring health plan issuers to report annually to the superintendent of insurance on their use of AI-based algorithms in utilization review, and barring decisions about a covered person's care based solely on AI results. Medical necessity determinations would require a licensed physician or qualified provider. Introduced November 5, 2025; referred to the House Insurance Committee November 12, 2025.
Plain-English summary, written with AI assistance. The official text controls.
What it means for business
None unless enacted: the bill is in committee. If enacted, health plan issuers using AI in utilization review would have to file annual reports and have a licensed physician or qualified provider decide medical necessity.
Key provisions
- Would require each health plan issuer to file an annual report by March 1 with the superintendent of insurance on whether it uses AI-based algorithms in utilization review, including algorithm criteria, training data sets, the algorithm itself and outcomes
- Would require the report to include data on how long a human reviewer spends on each adverse determination, verified by an officer of the issuer
- Would bar a health plan issuer from deciding care, including denying, delaying or modifying services on medical necessity, based solely on the results of AI
- Would require medical necessity determinations to be made by a licensed physician or qualified provider who considers the requesting provider's recommendation and the patient's history and circumstances
- Would require any denial, delay or modification that used an AI-based algorithm to come with a plain-language explanation of the rationale
- Would let the superintendent audit an issuer's use of AI-based algorithms at any time; applies to plans issued, amended or renewed on or after the section's effective date
- Status: referred to House Insurance Committee on November 12, 2025; pending
Latest legislative action
Nov 12, 2025. Referred to committee (House Insurance)
Sponsors (showing 5 of 37)
| Name | Role |
|---|---|
| C. Russo | Primary |
| Cindy Abrams R | Primary |
| Dan Ramos | Primary |
| Jean Schmidt R | Primary |
| Sean Brennan D | 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