OH SB164

Health insurers are prohibited from making care decisions—including denying, delaying, or modifying services based on medical necessity—solely on artificial intelligence results

Medical necessity determinations must be made by a licensed physician or qualified provider who considers the requesting provider's recommendation, the patient's clinical history, and individual circumstances

Health plan issuers must file annual reports by March 1 with the Superintendent of Insurance detailing AI algorithm use, including the algorithm criteria, training data sets, software outcomes, and time spent by human reviewers on adverse determinations

Reports on AI use must be published on both the Department of Insurance website and the insurer's public website, with report contents verified by a company officer

The Superintendent of Insurance may audit any health insurer's AI algorithm use at any time, including through third-party contractors