WHAT THIS BILL REGULATES · 2 REQUIREMENT TYPES
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) This section shall be known and may be cited as the use of artificial intelligenceArtificial intelligence"Artificial intelligence" means an engineered or machine-based system that varies in level of autonomy and can, for explicit or implicit objectives, infer from the input that such system receives how to generate outputs that can influence physical or virtual environments.Section 1(b)(2) in medical decisions transparency actAct"Act" means the use of artificial intelligence in medical decisions transparency act.Section 1(b)(1).
(a)(2) This actAct"Act" means the use of artificial intelligence in medical decisions transparency act.Section 1(b)(1) shall apply to every health insurerHealth insurer"Health insurer" means the same as defined in K.S.A. 40-4602, and amendments thereto.Section 1(b)(5) and utilization review organizationUtilization review organization"Utilization review organization" means the same as defined in K.S.A. 40-22a03, and amendments thereto.Section 1(b)(9) that uses an artificial intelligenceArtificial intelligence"Artificial intelligence" means an engineered or machine-based system that varies in level of autonomy and can, for explicit or implicit objectives, infer from the input that such system receives how to generate outputs that can influence physical or virtual environments.Section 1(b)(2), algorithm or other software tool for the purpose of utilization reviewUtilization review"Utilization review" means the same as defined in K.S.A. 40-22a03, and amendments thereto.Section 1(b)(8) or utilization management functions based in whole or in part on medical necessity or that contracts with or otherwise works through an entity that uses an artificial intelligenceArtificial intelligence"Artificial intelligence" means an engineered or machine-based system that varies in level of autonomy and can, for explicit or implicit objectives, infer from the input that such system receives how to generate outputs that can influence physical or virtual environments.Section 1(b)(2), algorithm or other software tool for the purpose of utilization reviewUtilization review"Utilization review" means the same as defined in K.S.A. 40-22a03, and amendments thereto.Section 1(b)(8) or utilization management functions based in whole or in part on medical necessity.
Subsection (a) establishes the act's short title and defines its scope. The act applies to every health insurer and utilization review organization that uses — or contracts with an entity that uses — an artificial intelligence, algorithm, or other software tool for utilization review or utilization management functions based in whole or in part on medical necessity.
(b)(1)–(9) As used in this actAct"Act" means the use of artificial intelligence in medical decisions transparency act.Section 1(b)(1): (1) "ActAct"Act" means the use of artificial intelligence in medical decisions transparency act.Section 1(b)(1)" means the use of artificial intelligenceArtificial intelligence"Artificial intelligence" means an engineered or machine-based system that varies in level of autonomy and can, for explicit or implicit objectives, infer from the input that such system receives how to generate outputs that can influence physical or virtual environments.Section 1(b)(2) in medical decisions transparency actAct"Act" means the use of artificial intelligence in medical decisions transparency act.Section 1(b)(1). (2) "Artificial intelligenceArtificial intelligence"Artificial intelligence" means an engineered or machine-based system that varies in level of autonomy and can, for explicit or implicit objectives, infer from the input that such system receives how to generate outputs that can influence physical or virtual environments.Section 1(b)(2)" means an engineered or machine-based system that varies in level of autonomy and can, for explicit or implicit objectives, infer from the input that such system receives how to generate outputs that can influence physical or virtual environments. (3) "DepartmentDepartment"Department" means the Kansas department of insurance.Section 1(b)(3)" means the Kansas department of insurance. (4) "Health benefit planHealth benefit plan"Health benefit plan" means the same as defined in K.S.A. 40-4602, and amendments thereto.Section 1(b)(4)" means the same as defined in K.S.A. 40-4602, and amendments thereto. (5) "Health insurerHealth insurer"Health insurer" means the same as defined in K.S.A. 40-4602, and amendments thereto.Section 1(b)(5)" means the same as defined in K.S.A. 40-4602, and amendments thereto. (6) "Healthcare providerHealthcare provider"Healthcare provider" or "provider" means the same as defined in K.S.A. 40-22a03, and amendments thereto.Section 1(b)(6)" or "provider" means the same as defined in K.S.A. 40-22a03, and amendments thereto. (7) "PhysicianPhysician"Physician" means the same as defined in K.S.A. 65-5502, and amendments thereto.Section 1(b)(7)" means the same as defined in K.S.A. 65-5502, and amendments thereto. (8) "Utilization reviewUtilization review"Utilization review" means the same as defined in K.S.A. 40-22a03, and amendments thereto.Section 1(b)(8)" means the same as defined in K.S.A. 40-22a03, and amendments thereto. (9) "Utilization review organizationUtilization review organization"Utilization review organization" means the same as defined in K.S.A. 40-22a03, and amendments thereto.Section 1(b)(9)" means the same as defined in K.S.A. 40-22a03, and amendments thereto.
Subsection (b) defines key terms used throughout the act. Most definitions incorporate by reference existing Kansas statutes governing health insurance and utilization review. The definition of artificial intelligence tracks the NIST-derived definition used in recent federal and state AI legislation. No new compliance obligations are imposed in this subsection.
(c)(1)(A)–(H) 1 Each health insurerHealth insurer"Health insurer" means the same as defined in K.S.A. 40-4602, and amendments thereto.Section 1(b)(5) and utilization review organizationUtilization review organization"Utilization review organization" means the same as defined in K.S.A. 40-22a03, and amendments thereto.Section 1(b)(9) shall ensure that the artificial intelligenceArtificial intelligence"Artificial intelligence" means an engineered or machine-based system that varies in level of autonomy and can, for explicit or implicit objectives, infer from the input that such system receives how to generate outputs that can influence physical or virtual environments.Section 1(b)(2), algorithm or other software tool used to review and approve, modify and delay or deny requests by providers: (A) Makes a determination based on the following information, as applicable: (i) An enrollee's medical or other clinical history; (ii) individual clinical circumstances as presented by the requesting healthcare providerHealthcare provider"Healthcare provider" or "provider" means the same as defined in K.S.A. 40-22a03, and amendments thereto.Section 1(b)(6); and (iii) other relevant clinical information contained in the enrollee's medical or other clinical record; (B) does not make a determination based solely on a group dataset; (C) does not supplant healthcare providerHealthcare provider"Healthcare provider" or "provider" means the same as defined in K.S.A. 40-22a03, and amendments thereto.Section 1(b)(6) decision-making; (D) does not discriminate, directly or indirectly, against enrollees in violation of state or federal law; (E) is fairly and equitably applied, in accordance with any applicable regulations or guidance issued by the United States department of health and human services; (F) is periodically reviewed and revised to maximize accuracy and reliability; (G) uses patient data in compliance with the health insurance portability and accountability actAct"Act" means the use of artificial intelligence in medical decisions transparency act.Section 1(b)(1) of 1996, public law 104-191; and (H) does not directly or indirectly cause harm to the enrollee.
(c)(2) 2 Notwithstanding the provisions of paragraph (1), the artificial intelligenceArtificial intelligence"Artificial intelligence" means an engineered or machine-based system that varies in level of autonomy and can, for explicit or implicit objectives, infer from the input that such system receives how to generate outputs that can influence physical or virtual environments.Section 1(b)(2), algorithm or other software tool shall not deny, delay or modify healthcare services based in whole or in part on medical necessity. A determination of medical necessity shall be made only by a licensed physicianPhysician"Physician" means the same as defined in K.S.A. 65-5502, and amendments thereto.Section 1(b)(7) or a licensed healthcare professional who is competent to evaluate the specific clinical issues involved in the healthcare services requested by the healthcare providerHealthcare provider"Healthcare provider" or "provider" means the same as defined in K.S.A. 40-22a03, and amendments thereto.Section 1(b)(6) by reviewing and considering such healthcare providerHealthcare provider"Healthcare provider" or "provider" means the same as defined in K.S.A. 40-22a03, and amendments thereto.Section 1(b)(6)'s recommendation, the enrollee's medical or other clinical history, as applicable, and individual clinical circumstances.
Subsection (c) is the core operative section. Paragraph (1) imposes eight affirmative requirements on AI tools used in utilization review, including individualized-data mandates, prohibitions on group-dataset-only determinations, nondiscrimination rules, HIPAA compliance, periodic review, and a general prohibition on causing enrollee harm. Paragraph (2) overrides paragraph (1) on the critical question of medical necessity: no AI tool may deny, delay, or modify healthcare services based on medical necessity — that determination must be made only by a licensed physician or competent healthcare professional who considers the provider's recommendation and the enrollee's individual clinical circumstances.
(d) 3 No individual, other than a licensed physicianPhysician"Physician" means the same as defined in K.S.A. 65-5502, and amendments thereto.Section 1(b)(7) or a licensed healthcare professional who is competent to evaluate the specific clinical issues involved in the healthcare services requested by the provider, shall deny or modify requests for authorization of healthcare services for an enrollee for reasons of medical necessity.
Subsection (d) reinforces the medical necessity human-override requirement from (c)(2) by framing it as a prohibition applicable to any individual — not just AI tools. No individual other than a licensed physician or competent healthcare professional may deny or modify requests for authorization of healthcare services for reasons of medical necessity. This is an entity-level prohibition, not merely a tool-level restriction.
(e)(1)–(2) 4 Each health insurerHealth insurer"Health insurer" means the same as defined in K.S.A. 40-4602, and amendments thereto.Section 1(b)(5) subject to this actAct"Act" means the use of artificial intelligence in medical decisions transparency act.Section 1(b)(1) shall establish written policies and procedures that: (1) Describe the process by which the health benefit planHealth benefit plan"Health benefit plan" means the same as defined in K.S.A. 40-4602, and amendments thereto.Section 1(b)(4) prospectively, retrospectively or concurrently reviews and approves, modifies and delays or denies requests, based in whole or in part on medical necessity, by healthcare providers of healthcare services for health benefit planHealth benefit plan"Health benefit plan" means the same as defined in K.S.A. 40-4602, and amendments thereto.Section 1(b)(4) enrollees; and (2) require decisions to be based on the medical necessity of proposed healthcare services are consistent with criteria or guidelines that are supported by clinical principles and processes.
Subsection (e) requires each health insurer to establish written policies and procedures describing its utilization review process and ensuring that medical necessity decisions are consistent with clinical principles and processes. This is a governance documentation requirement that creates the internal framework health insurers must maintain for their AI-assisted utilization review operations.
(f)(1)–(2) 5 Each health insurerHealth insurer"Health insurer" means the same as defined in K.S.A. 40-4602, and amendments thereto.Section 1(b)(5) subject to this actAct"Act" means the use of artificial intelligence in medical decisions transparency act.Section 1(b)(1) shall file with the departmentDepartment"Department" means the Kansas department of insurance.Section 1(b)(3) such health insurerHealth insurer"Health insurer" means the same as defined in K.S.A. 40-4602, and amendments thereto.Section 1(b)(5)'s policies and procedures establishing the process by which such health insurerHealth insurer"Health insurer" means the same as defined in K.S.A. 40-4602, and amendments thereto.Section 1(b)(5) prospectively, retrospectively or concurrently reviews and approves, modifies and delays or denies requests, based in whole or in part on medical necessity, by providers of healthcare services for health benefit planHealth benefit plan"Health benefit plan" means the same as defined in K.S.A. 40-4602, and amendments thereto.Section 1(b)(4) enrollees. (2) Pursuant to paragraph (1), such policies and procedures shall ensure that healthcare decisions based on the medical necessity of proposed healthcare services are consistent with criteria or guidelines that are supported by clinical principles and processes.
(f)(3) 6 Each health insurerHealth insurer"Health insurer" means the same as defined in K.S.A. 40-4602, and amendments thereto.Section 1(b)(5) shall disclose such policies and procedures to insureds, healthcare providersHealthcare provider"Healthcare provider" or "provider" means the same as defined in K.S.A. 40-22a03, and amendments thereto.Section 1(b)(6) and the public upon request.
Subsection (f) imposes two distinct obligations on health insurers: (1) filing their utilization review policies and procedures with the Kansas Department of Insurance, and (2) disclosing those policies to insureds, healthcare providers, and the public upon request. The filing requirement creates a regulatory submission obligation; the disclosure requirement creates a transparency obligation to affected parties.
This actAct"Act" means the use of artificial intelligence in medical decisions transparency act.Section 1(b)(1) shall take effect and be in force from and after its publication in the statute book.
Section 2 provides that the act takes effect upon publication in the Kansas statute book, which is the standard Kansas effective-date mechanism for legislation that does not specify a fixed calendar date.