NY A08556

Prohibits AI, algorithms, or other software tools from denying, delaying, or modifying health care services based on medical necessity; requires all medical necessity determinations to be made by a licensed physician or qualified health care professional

Requires AI tools used in utilization review to base decisions on individual patient information including medical history, clinical circumstances presented by providers, and relevant clinical records, rather than solely on group datasets

Mandates that AI tools used by utilization review agents and disability insurers must not supplant health care provider decision-making, must not discriminate against enrollees or insureds, and must not directly or indirectly cause harm to patients

Requires insurers and utilization review agents to make AI tools open to state department inspection for audits, include disclosures about AI use in written policies, and periodically review AI performance for accuracy and reliability

Takes effect 90 days after becoming law and applies to prospective, retrospective, and concurrent utilization reviews of covered health care services