Bill Text: NY A01456 | 2025-2026 | General Assembly | Introduced

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Bill Title: Provides for notice requirements where an insurer authorized to write accident and health insurance in this state, a corporation organized pursuant to article forty-three of this chapter, or a health maintenance organization certified pursuant to article forty-four of the public health law uses artificial intelligence-based algorithms in the utilization review process.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2025-01-09 - referred to insurance [A01456 Detail]

Download: New_York-2025-A01456-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          1456

                               2025-2026 Regular Sessions

                   IN ASSEMBLY

                                     January 9, 2025
                                       ___________

        Introduced by M. of A. HUNTER -- read once and referred to the Committee
          on Insurance

        AN  ACT to amend the insurance law, in relation to the use of artificial
          intelligence for utilization review

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section 1. The insurance law is amended by adding a new section 338 to
     2  read as follows:
     3    §  338.  Notification regarding the use of artificial intelligence for
     4  utilization review. (a) As used in this  section,  the  following  terms
     5  shall have the following meanings:
     6    (1)  "Adverse  determination" shall have the same meaning as such term
     7  is defined in section four thousand nine hundred of  the  public  health
     8  law.
     9    (2)  "Artificial  intelligence-based  algorithm"  means any artificial
    10  system that performs tasks under varying and unpredictable circumstances
    11  without significant human oversight or that can  learn  from  experience
    12  and improve performance when exposed to data sets.
    13    (3)  "Clinical peer reviewer" shall have the same meaning as such term
    14  is defined in section four thousand nine hundred of  the  public  health
    15  law.
    16    (4)  "Utilization  review" shall have the same meaning as such term is
    17  defined in section forty-nine hundred of the public health law.
    18    (b) The superintendent shall require all insurers authorized to  write
    19  accident  and  health  insurance  in  this state, corporations organized
    20  pursuant to article forty-three of this chapter, and  a  health  mainte-
    21  nance  organization  certified  pursuant  to  article  forty-four of the
    22  public health law to notify insureds and enrollees about the use or lack
    23  of use of artificial intelligence-based algorithms  in  the  utilization
    24  review  process  on  the  accessible  Internet  website  of such insurer
    25  authorized to write accident and health insurance in this state,  corpo-

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01878-01-5
        A. 1456                             2

     1  ration  organized  pursuant  to  article forty-three of this chapter, or
     2  health maintenance organization certified pursuant to article forty-four
     3  of the public health law.
     4    (c) Every insurer authorized to write accident and health insurance in
     5  this  state,  corporation  organized  pursuant to article forty-three of
     6  this chapter, and health maintenance organization certified pursuant  to
     7  article  forty-four of the public health law shall submit the artificial
     8  intelligence-based algorithms and training data sets that are being used
     9  or will be used in the utilization review process to the department. The
    10  department shall implement a  process  that  allows  the  department  to
    11  certify that these artificial intelligence-based algorithms and training
    12  data  sets have minimized the risk of bias based on the covered person's
    13  race, color, religious  creed,  ancestry,  age,  sex,  gender,  national
    14  origin,  handicap  or  disability  and adhere to evidence-based clinical
    15  guidelines.
    16    (d) A clinical peer reviewer who participates in a utilization  review
    17  process for an insurer authorized to write accident and health insurance
    18  in  this  state, a corporation organized pursuant to article forty-three
    19  of this chapter, and a health maintenance organization certified  pursu-
    20  ant  to  article forty-four of the public health law that initially uses
    21  artificial intelligence-based algorithms for a utilization review  shall
    22  open  and  document  the  utilization  review of the individual clinical
    23  records or data prior to issuing an adverse determination.
    24    (e) (1) A violation of the provisions of this section shall be subject
    25  to one or more of the following  penalties  at  the  discretion  of  the
    26  superintendent,  in consultation with the commissioner of health and the
    27  commissioner of education as applicable:
    28    (i) Where a violation is made by an insurer authorized to write  acci-
    29  dent  and health insurance in this state, a corporation organized pursu-
    30  ant to article forty-three of this  chapter,  or  a  health  maintenance
    31  organization  certified  pursuant  to  article  forty-four of the public
    32  health law:
    33    (A) Suspension or revocation of license;
    34    (B) Refusal, for a period not to exceed  one  year,  to  issue  a  new
    35  license;
    36    (C) A fine of not more than $5,000 for each violation of this section;
    37  or
    38    (D) A fine of not more than $10,000 for each willful violation of this
    39  section.
    40    Fines  imposed  pursuant  to  the provisions of this subparagraph on a
    41  single insurer authorized to write accident and health insurance in this
    42  state, a corporation organized pursuant to article forty-three  of  this
    43  chapter,  or  a  health  maintenance  organization certified pursuant to
    44  article forty-four of the  public  health  law  shall  not  exceed  five
    45  hundred thousand dollars in aggregate during a calendar year.
    46    (ii) Where a violation is made by a clinical peer reviewer:
    47    (A) Suspension or revocation of license;
    48    (B)  Refusal,  for  a  period  not  to exceed one year, to issue a new
    49  license;
    50    (C) A fine of not more than $5,000 for each violation of this section;
    51  or
    52    (D) A fine of not more than $10,000 for each willful violation of this
    53  section.
    54    Fines imposed pursuant to the provisions of  this  subparagraph  on  a
    55  single  clinical  peer  reviewer  shall  not exceed one hundred thousand
    56  dollars in aggregate during a calendar year.
        A. 1456                             3

     1    (2) Penalties pursuant to the provisions of this subsection  shall  be
     2  in addition to any other remedies or penalties that may be imposed under
     3  any other applicable law.
     4    (f)  The  superintendent  shall  promulgate  all rules and regulations
     5  necessary for the implementation of this section.
     6    § 2. This act shall take effect on the sixtieth  day  after  it  shall
     7  have become a law. Effective immediately, the addition, amendment and/or
     8  repeal  of  any  rule  or regulation necessary for the implementation of
     9  this act on its effective date are authorized to be made  and  completed
    10  on or before such effective date.