TX HB4018

Prohibits utilization review agents from using AI-based algorithms or software tools as the sole basis for denying, delaying, or modifying health care services; only physicians or licensed health care providers may make medical necessity determinations

Requires AI tools used in utilization review to base determinations on individual patient information including medical history, clinical circumstances from the provider, and relevant clinical records rather than solely on group datasets

Mandates that AI algorithms comply with state and federal law, do not override physician decision-making, and do not discriminate against enrollees directly or indirectly

Requires utilization review agents to make AI algorithms available for regulatory inspection, disclose their use and oversight procedures to enrollees in writing, and periodically review the tools for accuracy and reliability

Takes effect September 1, 2025