AI and algorithms in health plan utilization review (SB 1120, 'Physicians Make Decisions Act')

SB 1120
active

Requires 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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