In one paragraph
Tennessee's HB 1382 (114th General Assembly) would have required a health insurance issuer that uses AI, an algorithm or other software tool for utilization review or management based on medical necessity to ensure the tool bases decisions on the enrollee's clinical history and circumstances, does not rely solely on a group dataset, does not supplant provider decision-making, and does not discriminate or cause harm. Companion: SB 1261. Not passed before the session ended in April 2026; last action: Assigned to s/c Insurance Subcommittee (February 12, 2025).
Plain-English summary, written with AI assistance. The official text controls.
What it means for business
Not law. If enacted, insurers and other health plans using AI or algorithms for utilization review would have had to meet clinical-basis, anti-discrimination and oversight standards and disclose the tools' use and oversight in written policies.
Key provisions
- Applies to health insurance issuers (including TennCare and other state plans) that use AI, algorithms or other software for utilization review or management based on medical necessity, or work through an entity that does
- The tool would have to base determinations, as applicable, on the enrollee's medical or other clinical history, the clinical circumstances presented by the requesting provider and other relevant clinical record information
- The tool could not base determinations solely on a group dataset or supplant healthcare provider decision-making, and its criteria would have to comply with state insurance law and other applicable law
- The tool could not discriminate, directly or indirectly, against an enrollee in violation of state or federal law, and could not directly or indirectly cause harm to an enrollee
- The issuer would have to disclose the tool's use and oversight in its written policies and procedures, periodically review its use, performance and outcomes, and keep patient data within its intended and stated purpose consistent with HIPAA, as applicable
- Status: assigned to the House Insurance Subcommittee on February 12, 2025 (companion SB 1261); no later action before the 114th General Assembly ended in April 2026
Latest legislative action
Feb 12, 2025. Assigned to s/c Insurance Subcommittee
Sponsors (showing 5 of 7)
| Name | Role |
|---|---|
| Bailey | Primary |
| Haile | Primary |
| Harris | Primary |
| Jernigan | Primary |
| Ragan | 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