Use of Artificial Intelligence in Health Care (utilization review)

HB 26-1139

Artificial intelligence · Health

From January 1, 2027, AI used in health coverage utilization review must base decisions on the individual's clinical data, not solely group data, and any medical-necessity denial must be reviewed by a qualified clinician. Entities must periodically review the AI for accuracy and ensure health data is not used beyond its stated purpose, and must disclose their AI use to regulators.

Where: Colorado
Citation: C.R.S. 10-16-112.7; 25.5-1-209
Status: Enacted, not yet in force
In force since: 2027-01-01
Enforced by: Colorado Division of Insurance; Department of Human Services; Department of Health Care Policy and Financing
People can sue: No
Penalties: Enforced through existing insurance and Medicaid regulatory authority.
Applies to: Health insurers (carriers), pharmacy benefit managers, private utilization review organizations, behavioral health administrative services organizations, and Medicaid managed care entities that use AI in utilization review

Practices it requires

Ensure AI utilization-review determinations rest on the individual's clinical circumstances, not solely group data, and that denials are reviewed by a competent licensed professional.C.R.S. 10-16-112.7 · From 2027-01-01
Periodically review the AI system for accuracy and reliability and ensure individuals' health data is not used beyond its intended or stated purpose.C.R.S. 10-16-112.7 · From 2027-01-01

Registration

Disclose to the regulator the utilization review functions using AI, human oversight of adverse determinations, and audit processes.C.R.S. 10-16-112.7; 25.5-1-209 · From 2027-01-01

Sources

Checked against these sources on 2026-09-25 by research agent (Claude), primary sources.

Unverified: Obligation details were taken from the legislature's enacted-bill summary; subsection-level cites were not verified.

Research reference, not legal advice.