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SC H5206
Bill
Status
Introduced
2/18/2026
Primary Sponsor
Brandon Guffey
Click for details
AI Summary
- Requires health insurers using artificial intelligence for prior authorization decisions to base determinations on the enrollee's individual medical history, unique clinical circumstances, and medical record information
- Mandates that any denial, reduction, or deferral of prior authorization must be made by a licensed physician or qualified healthcare professional, not solely by AI
- Requires insurers to annually certify to the Department of Insurance that their AI tools do not rely solely on group datasets and do not discriminate against enrollees
- Obligates insurers to disclose to enrollees when AI is used in utilization review and to make denial statistics available upon request to the department, providers, and enrollees
- Authorizes the Department of Insurance to investigate violations, hold hearings, and impose corrective plans or disciplinary measures for repeat violations
Legislative Description
Health insurance
Last Action
Referred to Committee on Labor, Commerce and Industry
2/18/2026
Committee Referrals
Labor, Commerce and Industry2/18/2026
Full Bill Text
No bill text available