Assembly Bill A3991

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3991
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 30, 2025
                                ___________
 
 Introduced  by M. of A. FORREST -- read once and referred to the Commit-
   tee on Insurance
 
 AN ACT to amend the insurance law, in relation to requirements  for  the
   usage of artificial intelligence in utilization review and management
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subsection (a) of section  107  of  the  insurance  law  is
 amended by adding a new paragraph 56 to read as follows:
   (56)  "ARTIFICIAL  INTELLIGENCE"  MEANS AN ENGINEERED OR MACHINE-BASED
 SYSTEM THAT VARIES IN ITS LEVEL OF AUTONOMY AND THAT CAN,  FOR  EXPLICIT
 OR IMPLICIT OBJECTIVES, INFER FROM THE INPUT IT RECEIVES HOW TO GENERATE
 OUTPUTS THAT CAN INFLUENCE PHYSICAL OR VIRTUAL ENVIRONMENTS.
   §  2.  The  insurance law is amended by adding a new section 3224-e to
 read as follows:
   § 3224-E. REQUIREMENTS FOR USAGE OF ARTIFICIAL INTELLIGENCE IN  UTILI-
 ZATION REVIEW AND MANAGEMENT. (A) A HEALTH CARE SERVICE PLAN OR SPECIAL-
 IZED  HEALTH  CARE  SERVICE  PLAN  THAT USES AN ARTIFICIAL INTELLIGENCE,
 ALGORITHM, OR OTHER SOFTWARE TOOL FOR THE PURPOSE OF UTILIZATION  REVIEW
 OR UTILIZATION MANAGEMENT FUNCTIONS, OR THAT CONTRACTS WITH OR OTHERWISE
 WORKS THROUGH AN ENTITY THAT USES AN ARTIFICIAL INTELLIGENCE, ALGORITHM,
 OR OTHER SOFTWARE TOOL FOR THE PURPOSE OF UTILIZATION REVIEW OR UTILIZA-
 TION  MANAGEMENT  FUNCTIONS,  SHALL  COMPLY  WITH THIS SECTION AND SHALL
 ENSURE ALL OF THE FOLLOWING:
   (1) THE ARTIFICIAL INTELLIGENCE, ALGORITHM,  OR  OTHER  SOFTWARE  TOOL
 BASES ITS DETERMINATION ON THE FOLLOWING INFORMATION, AS APPLICABLE:
   (I) AN ENROLLEE'S MEDICAL OR DENTAL HISTORY;
   (II)  INDIVIDUAL CLINICAL CIRCUMSTANCES AS PRESENTED BY THE REQUESTING
 PROVIDER; AND
   (III) OTHER RELEVANT CLINICAL INFORMATION CONTAINED IN THE  ENROLLEE'S
 MEDICAL OR DENTAL RECORD.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07314-01-5
 A. 3991                             2
              

 
   (2)  THE  ARTIFICIAL  INTELLIGENCE,  ALGORITHM, OR OTHER SOFTWARE TOOL
 DOES NOT SUPPLANT HEALTH CARE PROVIDER DECISION MAKING.
   (3)  THE USE OF THE ARTIFICIAL INTELLIGENCE, ALGORITHM, OR OTHER SOFT-
 WARE TOOL DOES  NOT  ADVERSELY  DISCRIMINATE,  DIRECTLY  OR  INDIRECTLY,
 AGAINST  AN  INDIVIDUAL  ON THE BASIS OF RACE, COLOR, RELIGION, NATIONAL
 ORIGIN, ANCESTRY, AGE, SEX, GENDER, GENDER IDENTITY, GENDER  EXPRESSION,
 SEXUAL  ORIENTATION, PRESENT OR PREDICTED DISABILITY, EXPECTED LENGTH OF
 LIFE, DEGREE OF MEDICAL DEPENDENCY, QUALITY OF  LIFE,  OR  OTHER  HEALTH
 CONDITIONS.
   (4)  THE ARTIFICIAL INTELLIGENCE, ALGORITHM, OR OTHER SOFTWARE TOOL IS
 FAIRLY AND EQUITABLY APPLIED.
   (5) THE ARTIFICIAL INTELLIGENCE, ALGORITHM, OR OTHER SOFTWARE TOOL  IS
 OPEN TO INSPECTION.
   (6)  DISCLOSURES PERTAINING TO THE USE AND OVERSIGHT OF THE ARTIFICIAL
 INTELLIGENCE, ALGORITHM, OR OTHER SOFTWARE TOOL  ARE  CONTAINED  IN  THE
 WRITTEN POLICIES AND PROCEDURES.
   (7)  THE  ARTIFICIAL INTELLIGENCE, ALGORITHM, OR OTHER SOFTWARE TOOL'S
 PERFORMANCE, USE, AND OUTCOMES ARE PERIODICALLY REVIEWED AND REVISED  TO
 MAXIMIZE ACCURACY AND RELIABILITY.
   (8)  PATIENT  DATA IS NOT USED BEYOND ITS INTENDED AND STATED PURPOSE,
 CONSISTENT WITH APPLICABLE STATE LAWS AND THE FEDERAL  HEALTH  INSURANCE
 PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (PUBLIC LAW 104-191).
   (9)  THE  ARTIFICIAL  INTELLIGENCE,  ALGORITHM, OR OTHER SOFTWARE TOOL
 DOES NOT DIRECTLY OR INDIRECTLY CAUSE HARM TO THE ENROLLEE.
   (B) NOTWITHSTANDING SUBSECTION (A) OF THIS SECTION, A  DENIAL,  DELAY,
 OR MODIFICATION OF HEALTH CARE SERVICES BASED ON MEDICAL NECESSITY SHALL
 BE  MADE BY A LICENSED PHYSICIAN OR OTHER HEALTH CARE PROVIDER COMPETENT
 TO EVALUATE THE SPECIFIC CLINICAL ISSUES INVOLVED  IN  THE  HEALTH  CARE
 SERVICES REQUESTED BY THE PROVIDER BY CONSIDERING THE REQUESTING PROVID-
 ER'S  RECOMMENDATION AND BASED ON RECOMMENDATION, THE ENROLLEE'S MEDICAL
 OR DENTAL HISTORY, AS APPLICABLE, AND INDIVIDUAL CLINICAL CIRCUMSTANCES.
   § 3. This act shall take effect immediately.