Regulon.AI — GA-SB-444 · GA SB 444 (Healthcare AI Utilization Review)

SB-444

GA · State · USA

USA

● Passed

Proposed Effective Date

2027-01-01

Georgia SB 444 — An Act to amend Chapter 46 of Title 33 of the Official Code of Georgia Annotated, relating to certification of private review agents, so as to provide that certain decisions with regard to the provision of insurance coverage for healthcare services shall not be based solely on artificial intelligence systems, artificial intelligence, or other software tools

Georgia SB 444 restricts the use of AI, AI systems, and software tools in healthcare utilization review and coverage determinations by private review agents and utilization review entities. While these entities may use AI tools as part of a utilization review plan that complies with existing standards and Commissioner rules, they may not issue an adverse determination to a patient until a natural person qualifying as a private review agent or utilization review entity conducts a utilization review with clinical peer participation. AI may never supersede the judgment of the clinical peer. The bill is enforced through the Georgia Insurance Commissioner's existing regulatory authority over private review agents under O.C.G.A. Chapter 46 of Title 33. Effective January 1, 2027.

2026-02-02 other Senate Hopper

2026-02-03 other Senate Read and Referred

2026-02-06 other Senate Committee Favorably Reported

2026-02-09 other Senate Read Second Time

2026-02-11 other Senate Third Read

2026-02-11 other Senate Passed/Adopted

2026-02-12 other House First Readers

2026-02-17 other House Second Readers

2026-03-18 other House Committee Favorably Reported By Substitute

2026-03-19 other House Third Readers

2026-03-19 other House Passed/Adopted By Substitute

2026-03-25 other Senate Agreed House Amend or Sub

Summary

Enforcement & Penalties

Enforcement Authority

Enforcement falls under the Georgia Insurance Commissioner's existing authority over private review agents and utilization review entities under Chapter 46 of Title 33. The statute does not create a private right of action or designate a new enforcement mechanism; enforcement is through the Commissioner's existing regulatory and certification authority over private review agents.

Penalties

The statute does not specify monetary penalties, civil penalties, or remedies specific to violations of this provision. Enforcement remedies would be those available to the Commissioner under existing Chapter 46 authority, which may include certification actions against private review agents.

Who Is Covered

Compliance Obligations 2 obligations · click obligation ID to open requirement page

HC-01 Healthcare AI Decision Restrictions · HC-01.1 HC-01.2 · Deployer · Healthcare

O.C.G.A. § 33-46-7.1(c)

Plain Language

AI tools may participate in utilization review processes — including automating tasks and reducing administrative burdens — but may not issue an adverse determination to a patient on their own. Before any adverse determination is issued, a natural person qualifying as a private review agent or utilization review entity must conduct the utilization review, and a clinical peer must participate in that review. The clinical peer's judgment is supreme: AI may never override or supersede it. This effectively requires human-in-the-loop review with clinical peer participation for every adverse coverage decision, while permitting AI to support non-adverse and administrative functions.

Statutory Text

Artificial intelligence systems, artificial intelligence, 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 systems, artificial intelligence, or other software tools supersede the judgment of such clinical peer.

HC-01 Healthcare AI Decision Restrictions · Deployer · Healthcare

O.C.G.A. § 33-46-7.1(b)

Plain Language

Private review agents and utilization review entities are permitted to use AI tools, but only if those tools are incorporated into a utilization review plan that complies with the existing standards in Chapter 46 and rules adopted by the Insurance Commissioner. This provision functions as a conditional authorization — it confirms AI use is lawful but imposes a compliance prerequisite that the AI tools must be part of a plan meeting existing regulatory standards. In practice, this means entities must ensure their AI tools are documented within and governed by their utilization review plans, which are subject to Commissioner oversight.

Statutory Text

Private review agents and utilization review entities may use artificial intelligence systems, artificial intelligence, 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.