Texas HB4018 regulates the use of artificial intelligence in health benefit plans' utilization reviews.

HB4018 amends the Texas Insurance Code to establish guidelines for using artificial intelligence in utilization reviews for health benefit plans. It prohibits using AI-based algorithms or software tools as the sole basis for decisions to deny, delay, or modify health care services. Only physicians or licensed health care providers can determine medical necessity or appropriateness. The bill mandates that AI tools must base decisions on individual clinical information, comply with state and federal laws, and not override provider decisions.

Texas HB4018 regulates the use of artificial intelligence in health benefit plans' utilization reviews.

HB4018 amends the Texas Insurance Code to establish guidelines for using artificial intelligence in utilization reviews for health benefit plans. It prohibits using AI-based algorithms or software tools as the sole basis for decisions to deny, delay, or modify health care services. Only physicians or licensed health care providers can determine medical necessity or appropriateness. The bill mandates that AI tools must base decisions on individual clinical information, comply with state and federal laws, and not override provider decisions.