SD SB169

Health carriers using AI, algorithms, or software tools for utilization review must base determinations on individual patient medical history, clinical circumstances presented by the requesting provider, and relevant clinical records—not solely on group datasets

AI systems are prohibited from denying, delaying, or modifying health care service determinations; adverse determinations may only be made by a licensed physician or healthcare professional competent in the specific clinical issues

Health carriers must apply AI tools equally and consistently across all patients and subscriber groups, ensuring identical decisions for patients with similar clinical presentations

Annual reports detailing AI use in utilization review and the degree of human oversight must be submitted to the Executive Board of the Legislative Research Council by December 1st each year

The Division of Insurance may inspect health carrier AI systems at any time for compliance, and noncompliance triggers notification to the attorney general who may issue cease and desist orders