WHAT THIS BILL REGULATES · 1 REQUIREMENT TYPE
How Is This Bill Enforced
Verbatim statutory text on the left; plain-language analysis and a per-section checklist on the right. Numbered markers cross-link to the matching checklist row.
(a)(1) 'Artificial intelligenceArtificial intelligence'Artificial intelligence' means a machine based system that can, for a given set of human defined objectives, make predictions, recommendations, or decisions influencing real or virtual environments.O.C.G.A. § 33-46-7.1(a)(1)' means a machine based system that can, for a given set of human defined objectives, make predictions, recommendations, or decisions influencing real or virtual environments.
(a)(2) 'Artificial intelligence systemArtificial intelligence system'Artificial intelligence system' means an engineered or machine based system that emulates the capability of a person to receive audio, visual, text, or any other form of information and use such information to emulate a human cognitive process, including, but not limited to, learning, generalizing, reasoning, planning, predicting, acting, or communicating; provided, however, that artificial intelligence systems may vary in the forms of information they can receive and in the human cognitive processes they can emulate.O.C.G.A. § 33-46-7.1(a)(2)' means an engineered or machine based system that emulates the capability of a person to receive audio, visual, text, or any other form of information and use such information to emulate a human cognitive process, including, but not limited to, learning, generalizing, reasoning, planning, predicting, acting, or communicating; provided, however, that artificial intelligence systemsArtificial intelligence system'Artificial intelligence system' means an engineered or machine based system that emulates the capability of a person to receive audio, visual, text, or any other form of information and use such information to emulate a human cognitive process, including, but not limited to, learning, generalizing, reasoning, planning, predicting, acting, or communicating; provided, however, that artificial intelligence systems may vary in the forms of information they can receive and in the human cognitive processes they can emulate.O.C.G.A. § 33-46-7.1(a)(2) may vary in the forms of information they can receive and in the human cognitive processes they can emulate.
Subsection (a) defines two key terms — artificial intelligence and artificial intelligence system — that scope the operative provisions of the new Code section. The AI definition tracks common federal formulations (similar to the National AI Initiative Act definition), while the AI system definition is broader, encompassing engineered or machine-based systems that emulate human cognitive processes across multiple modalities.
(b) 1 Private review agents and utilization review entities may use artificial intelligence systemsArtificial intelligence system'Artificial intelligence system' means an engineered or machine based system that emulates the capability of a person to receive audio, visual, text, or any other form of information and use such information to emulate a human cognitive process, including, but not limited to, learning, generalizing, reasoning, planning, predicting, acting, or communicating; provided, however, that artificial intelligence systems may vary in the forms of information they can receive and in the human cognitive processes they can emulate.O.C.G.A. § 33-46-7.1(a)(2), artificial intelligenceArtificial intelligence'Artificial intelligence' means a machine based system that can, for a given set of human defined objectives, make predictions, recommendations, or decisions influencing real or virtual environments.O.C.G.A. § 33-46-7.1(a)(1), or other software tools, provided that such systems or tools are a part of a utilization review plan that is in accordance with the standards set forth in this chapter and the rules and regulations adopted by the Commissioner.
Subsection (b) establishes a conditional permission: private review agents and utilization review entities may use AI systems and other software tools, but only if those tools are integrated into a utilization review plan that complies with existing Chapter 46 standards and Commissioner regulations. This creates a compliance prerequisite — AI use in utilization review is lawful only when embedded within an approved plan framework.
(c) 2 Artificial intelligence systemsArtificial intelligence system'Artificial intelligence system' means an engineered or machine based system that emulates the capability of a person to receive audio, visual, text, or any other form of information and use such information to emulate a human cognitive process, including, but not limited to, learning, generalizing, reasoning, planning, predicting, acting, or communicating; provided, however, that artificial intelligence systems may vary in the forms of information they can receive and in the human cognitive processes they can emulate.O.C.G.A. § 33-46-7.1(a)(2), artificial intelligenceArtificial intelligence'Artificial intelligence' means a machine based system that can, for a given set of human defined objectives, make predictions, recommendations, or decisions influencing real or virtual environments.O.C.G.A. § 33-46-7.1(a)(1), and other software tools may be used to automate tasks, reduce administrative burdens, participate in decision-making processes, and perform other lawful functions; provided, however, that such systems shall not issue an adverse determination to a patient until a natural person qualifying as a private review agent or a utilization review entity conducts a utilization review in which a clinical peer participates. In no event shall artificial intelligence systemsArtificial intelligence system'Artificial intelligence system' means an engineered or machine based system that emulates the capability of a person to receive audio, visual, text, or any other form of information and use such information to emulate a human cognitive process, including, but not limited to, learning, generalizing, reasoning, planning, predicting, acting, or communicating; provided, however, that artificial intelligence systems may vary in the forms of information they can receive and in the human cognitive processes they can emulate.O.C.G.A. § 33-46-7.1(a)(2), artificial intelligenceArtificial intelligence'Artificial intelligence' means a machine based system that can, for a given set of human defined objectives, make predictions, recommendations, or decisions influencing real or virtual environments.O.C.G.A. § 33-46-7.1(a)(1), or other software tools supersede the judgment of such clinical peer.
Subsection (c) is the bill's core substantive obligation. It permits AI tools for administrative and decision-support functions but draws a hard line: no adverse determination may issue to a patient unless a natural person qualifying as a private review agent or utilization review entity has conducted a utilization review with clinical peer participation. The final sentence reinforces this by providing that AI may never supersede the clinical peer's judgment. Together, these provisions ensure that AI remains a decision-support tool and cannot serve as the sole basis for denying, delaying, or modifying coverage.