In one paragraph
Ohio's SB 164 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, including denials, delays or modifications based on medical necessity, based solely on AI results. Medical necessity determinations would require a licensed physician or qualified provider. It was introduced April 1, 2025 and referred to the Senate Financial Institutions, Insurance and Technology Committee April 2, 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 Senate Financial Institutions, Insurance and Technology Committee on April 2, 2025; pending
Latest legislative action
Apr 2, 2025. Referred to committee (Senate Financial Institutions, Insurance and Technology)
Sponsors (showing 5 of 40)
| Name | Role |
|---|---|
| Al Cutrona R | Primary |
| Frank LaRose | Primary |
| Jay Hottinger | Primary |
| Tim Schaffer R | Primary |
| Andrew Brenner R | 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