OH HB579

Health insurers prohibited from making care decisions—including denials, delays, or modifications based on medical necessity—solely on artificial intelligence results; all medical necessity determinations must be made by a licensed physician or qualified provider who considers the patient's individual clinical circumstances and history

Health insurers must file annual reports by March 1 with the Superintendent of Insurance disclosing their use of AI-based algorithms in utilization review, including algorithm criteria, training data sets, the algorithm itself, software outcomes, and time spent by human reviewers on adverse determinations

Medical necessity and utilization review decisions require physicians to open and document their review of individual clinical records before making a decision; AI-assisted denials must include a plain language explanation of the rationale

The Superintendent of Insurance may audit insurers' AI algorithm use at any time and may contract with third parties to conduct audits; reports must be published on both the Department of Insurance website and the insurer's public website

Applies to health benefit plans issued, amended, or renewed on or after the effective date