IA SF562

Health carriers using artificial intelligence, algorithms, or software for utilization review must ensure these tools base determinations on individual patient medical history and clinical circumstances, comply with state and federal law, do not supplant provider decision-making, and do not discriminate against covered persons

AI tools cannot deny, delay, or modify health care services based on medical necessity—only a qualified health care provider can make medical necessity determinations after reviewing patient records and provider recommendations

Utilization review organizations must respond to prior authorization requests within 48 hours for urgent requests and 10 calendar days for non-urgent requests, and must annually review and eliminate prior authorization requirements for services that are routinely approved

Health carriers must publish prior authorization statistics on their websites by March 31 annually, including approval/denial rates, appeal outcomes, and average response times

All health carriers must implement a prior authorization exemption pilot program by January 15, 2026, exempting certain providers (including primary care providers) from authorization requirements, with a report on program results due to the commissioner of insurance by January 15, 2027