Regulon — 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 prohibits private review agents and utilization review entities from issuing adverse determinations to patients based solely on AI, AI systems, or other software tools. AI may be used to automate tasks and participate in decision-making, but no adverse determination may be issued until a natural person qualifying as a private review agent or utilization review entity conducts a utilization review with clinical peer participation. The judgment of the clinical peer may not be superseded by AI. The bill also requires that any AI tools used be part of a utilization review plan in accordance with existing chapter standards and Commissioner regulations. 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

2026-04-10 Senate Sent to Governor Senate Sent to Governor

2026-05-05 Senate Date Signed by Governor Senate Date Signed by Governor

2026-05-05 Act 411 Act 411

2026-05-05 Effective Date 2027-01-01 Effective Date 2027-01-01

Summary

Enforcement & Penalties

Enforcement Authority

Enforced by the Georgia Insurance Commissioner under existing authority over private review agents and utilization review entities under O.C.G.A. Chapter 46 of Title 33. The Commissioner has rulemaking and certification authority over private review agents. No private right of action is created by this provision. Enforcement is agency-initiated through the Commissioner's existing regulatory and certification powers.

Penalties

The bill does not specify monetary penalties, civil damages, or other remedies specific to violations of this new Code section. Enforcement remedies would be determined under the Commissioner's existing authority over private review agent certification under O.C.G.A. Chapter 46 of Title 33, which may include certification revocation or other administrative sanctions.

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

Private review agents and utilization review entities may use AI tools to assist with utilization review tasks, but AI may not issue an adverse determination to a patient on its own. Before any adverse determination is issued, a qualified natural person must conduct a utilization review with clinical peer participation. The clinical peer's judgment is supreme — AI may never override it. This effectively requires human-in-the-loop review with clinical peer sign-off for every adverse coverage decision, while permitting AI to support administrative and analytical functions short of the final adverse determination.

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

Any AI system or software tool used by a private review agent or utilization review entity must be incorporated into the entity's utilization review plan, and that plan must comply with the existing standards in Chapter 46 of Title 33 and Commissioner regulations. This is a compliance prerequisite — AI tools cannot be deployed on an ad hoc basis outside the formal utilization review framework. This conditions AI use on conformity with an existing regulatory structure but does not itself specify what those standards require.

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.