AI and algorithms in health plan utilization review (SB 1120, 'Physicians Make Decisions Act')
SB 1120Requires health plans and insurers that use AI or algorithms in utilization review to base decisions on the individual patient's clinical information rather than group data alone, to apply them fairly, and to leave medical-necessity denials to licensed clinicians.
Jurisdiction
California
Jurisdiction Type
state
Country
United States
Effective Date
1/1/2025
Enforcing Authority
Department of Managed Health Care; Department of Insurance
Fines Under This Regulation
0
Total Fine Amount (USD)
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