TX SB815

Prohibits utilization review agents from using automated decision systems (including AI and algorithms) to make adverse determinations—wholly or partly—on health benefit claims regarding medical necessity or appropriateness

Defines key terms including "algorithm," "artificial intelligence system," and "automated decision system" in the Texas Insurance Code for utilization review purposes

Grants the Insurance Commissioner authority to audit and inspect utilization review agents' use of automated decision systems at any time

Allows continued use of algorithms and AI for administrative support and fraud-detection functions, exempting these uses from the prohibition

Requires adverse determination notices to include both a description and the source of screening criteria and review procedures used; applies to health benefit plans delivered, issued, or renewed on or after January 1, 2026