NY A03991

Defines "artificial intelligence" in insurance law as an engineered or machine-based system with varying autonomy that can generate outputs influencing physical or virtual environments based on inputs received

Requires health care service plans using AI, algorithms, or software tools for utilization review to base determinations on the enrollee's medical/dental history, clinical circumstances presented by the provider, and relevant clinical information from medical records

Prohibits AI tools from supplanting health care provider decision making and mandates that any denial, delay, or modification of services based on medical necessity must be made by a licensed physician or competent health care provider

Bans AI tools from discriminating based on race, color, religion, national origin, age, sex, gender identity, sexual orientation, disability, expected length of life, quality of life, or other health conditions

Requires AI tools used in utilization review to be open to inspection, periodically reviewed for accuracy and reliability, and compliant with HIPAA and state patient data protection laws