Usage of artificial intelligence in the utilization review process prohibition provision
Summary
SF1856 would prohibit the use of artificial intelligence in the health insurance utilization review process. It amends Minnesota’s utilization review statutes to define artificial intelligence by reference to federal law, require that adverse clinical determinations be made by a physician, and require the physician to attest in writing that AI was not used in the review process. The bill also creates a new section expressly banning AI in any part of utilization review, including review, evaluation, determination, and appeals.
The bill provides that any adverse determination made in violation of these requirements is null and void. It also authorizes enforcement by the Minnesota Attorney General under the state’s consumer protection enforcement statute. The measure excludes outpatient mental health and substance use disorder services governed by a separate subdivision, and it preserves existing special rules for prescription drug reviews and certain health plan companies.
Impact
The bill would add a new prohibition to Minnesota Statutes chapter 62M governing utilization review by health plan companies and utilization review organizations. It would require human clinical decision-making in adverse determinations and bar AI from being used anywhere in the utilization review or appeals process, with violations rendering the resulting adverse determinations void. It also expands potential enforcement tools by allowing the attorney general to act under section 8.31, which can support consumer protection-style enforcement actions.
Sentiment
No committee transcript or vote record is provided, so there is no direct evidence of debate, support, or opposition in the materials supplied. Based on the bill text and caption, the measure appears aimed at ensuring human oversight in insurance coverage decisions and limiting automated decision-making in health care coverage reviews. The absence of recorded votes or hearing discussion means the overall sentiment cannot be assessed from the available context.
Contention
The main likely point of contention is whether banning AI in utilization review is necessary to protect patients and ensure individualized medical judgment, versus whether it could reduce efficiency, increase administrative burden, or limit insurers’ ability to use technology in coverage decisions. Another possible issue is the breadth of the prohibition, since it applies to any part of the review and appeals process, while still leaving some existing statutory exceptions in place for mental health/substance use services and certain prescription drug reviews. No specific objections or supporters are identified in the provided record.
Relates to the use of artificial intelligence by insurers and clinical peer reviewers for utilization review; establishes additional notice requirements for adverse determinations.
Relates to the use of artificial intelligence by insurers and clinical peer reviewers for utilization review; establishes additional notice requirements for adverse determinations.