HB515 Summary

• Requires health insurers using artificial intelligence in coverage determinations to employ a licensed physician or competent health care professional to make the final medical necessity decision, which may consider but cannot be solely based on AI recommendations.

• Mandates insurers using AI, algorithms, or software tools in utilization review must use relevant clinical information, patient's unique circumstances, avoid discrimination, and comply with applicable state and federal law.

• Requires insurers to make prominent written disclosure to plan enrollees and network providers that artificial intelligence is used in utilization management or utilization review processes.

• Allows injured persons to bring civil actions against insurers or contractors for compensatory or punitive damages, injunctive relief, and reasonable costs and attorney fees for violations.

• Becomes effective October 1, 2025.