Laws & Statutes › KS › KS-SB-467
SB-467
KS · State · USA
KS
USA
● Pending
Proposed Effective Date
2026-01-01
Kansas SB 467 — Use of Artificial Intelligence in Medical Decisions Transparency Act
Imposes requirements on Kansas health insurers and utilization review organizations that use AI, algorithms, or software tools in utilization review or management functions based on medical necessity. Prohibits AI tools from serving as the basis for denying, delaying, or modifying healthcare services on medical necessity grounds — all such determinations must be made by a licensed physician or competent healthcare professional who reviews individual clinical circumstances. Requires AI tools to base determinations on individualized enrollee clinical data rather than solely on group datasets, to be periodically reviewed for accuracy and reliability, and to comply with HIPAA. Health insurers must establish written policies and procedures, file them with the Kansas Department of Insurance, and disclose them to insureds, providers, and the public upon request.
Passage Likelihood
Low
Chamber No passage
Committee No action
Majority party No
Bipartisan No
Prior session None
Legislative History
2026-02-03 introduced Senate Introduced
2026-02-04 committee referral Senate Referred to Committee on Financial Institutions and Insurance
Mapped Requirements
HC-01 Healthcare AI Decision Restrictions H-02 Non-Discrimination & Bias Assessment
Official Sources
Full Text ↗
Entry Last Reviewed
2026-03-28
AI generated
Summary

Imposes requirements on Kansas health insurers and utilization review organizations that use AI, algorithms, or software tools in utilization review or management functions based on medical necessity. Prohibits AI tools from serving as the basis for denying, delaying, or modifying healthcare services on medical necessity grounds — all such determinations must be made by a licensed physician or competent healthcare professional who reviews individual clinical circumstances. Requires AI tools to base determinations on individualized enrollee clinical data rather than solely on group datasets, to be periodically reviewed for accuracy and reliability, and to comply with HIPAA. Health insurers must establish written policies and procedures, file them with the Kansas Department of Insurance, and disclose them to insureds, providers, and the public upon request.

Enforcement & Penalties
Enforcement Authority
Kansas Department of Insurance is the designated regulatory authority. Health insurers must file policies and procedures with the department. The statute does not create a private right of action or specify a complaint-driven enforcement mechanism; enforcement authority is vested in the department through its existing regulatory oversight of health insurers and utilization review organizations.
Penalties
The statute does not specify monetary penalties, civil penalties, statutory damages, or any specific remedies. Enforcement would rely on existing Kansas Department of Insurance regulatory authority over health insurers and utilization review organizations.
Who Is Covered
This act shall apply to every health insurer and utilization review organization that uses an artificial intelligence, algorithm or other software tool for the purpose of utilization review 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 intelligence, algorithm or other software tool for the purpose of utilization review or utilization management functions based in whole or in part on medical necessity.
Compliance Obligations 6 obligations · click obligation ID to open requirement page
HC-01 Healthcare AI Decision Restrictions · HC-01.3 · Deployer · Healthcare
Section 1(c)(1)(A)-(B)
Plain Language
Health insurers and utilization review organizations must ensure that any AI, algorithm, or software tool used for utilization review bases its determinations on the individual enrollee's medical history, clinical circumstances as presented by the requesting provider, and other relevant clinical information in the enrollee's record. The tool may not make determinations based solely on a group dataset — it must incorporate individualized patient data. This requires configuring AI tools to pull and consider individual-level clinical inputs rather than relying exclusively on population-level or actuarial data.
Statutory Text
Each health insurer and utilization review organization shall ensure that the artificial intelligence, 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 provider; 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;
HC-01 Healthcare AI Decision Restrictions · HC-01.1HC-01.2 · Deployer · Healthcare
Section 1(c)(2), Section 1(d)
Plain Language
AI, algorithms, and software tools are categorically prohibited from denying, delaying, or modifying healthcare services based on medical necessity — even in part. All medical necessity determinations must be made exclusively by a licensed physician or healthcare professional competent in the relevant clinical specialty, who must affirmatively review the treating provider's recommendation, the enrollee's medical history, and individual clinical circumstances. Subsection (d) reinforces this by prohibiting any individual who is not a qualified licensed physician or healthcare professional from denying or modifying authorization requests on medical necessity grounds. In practice, AI tools may inform or support the review process, but the final adverse determination must rest with a qualified human clinician.
Statutory Text
(2) Notwithstanding the provisions of paragraph (1), the artificial intelligence, 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 physician or a licensed healthcare professional who is competent to evaluate the specific clinical issues involved in the healthcare services requested by the healthcare provider by reviewing and considering such healthcare provider's recommendation, the enrollee's medical or other clinical history, as applicable, and individual clinical circumstances. (d) No individual, other than a licensed physician 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.
HC-01 Healthcare AI Decision Restrictions · HC-01.4 · Deployer · Healthcare
Section 1(c)(1)(F)
Plain Language
Health insurers and utilization review organizations must periodically review and revise their AI, algorithm, or software tools used in utilization review to maximize accuracy and reliability. The statute does not specify a minimum review frequency, but the obligation is ongoing and requires affirmative action — merely deploying the tool and leaving it in place without reassessment would not comply.
Statutory Text
Each health insurer and utilization review organization shall ensure that the artificial intelligence, algorithm or other software tool used to review and approve, modify and delay or deny requests by providers: (F) is periodically reviewed and revised to maximize accuracy and reliability;
HC-01 Healthcare AI Decision Restrictions · HC-01.5 · Deployer · Healthcare
Section 1(c)(1)(G)
Plain Language
Health insurers and utilization review organizations must ensure that their AI or software tools use patient data in compliance with HIPAA. This codifies a HIPAA compliance requirement specifically in the context of AI-driven utilization review, reinforcing that patient data fed into or processed by AI tools remains subject to existing federal health privacy protections.
Statutory Text
Each health insurer and utilization review organization shall ensure that the artificial intelligence, algorithm or other software tool used to review and approve, modify and delay or deny requests by providers: (G) uses patient data in compliance with the health insurance portability and accountability act of 1996, public law 104-191;
H-02 Non-Discrimination & Bias Assessment · Deployer · Healthcare
Section 1(c)(1)(C)-(E),(H)
Plain Language
Health insurers and utilization review organizations must ensure their AI tools do not supplant healthcare provider decision-making, do not discriminate directly or indirectly against enrollees in violation of state or federal law, are applied fairly and equitably consistent with HHS regulations and guidance, and do not directly or indirectly cause harm to enrollees. The non-discrimination requirement encompasses both disparate treatment and disparate impact. The fair application standard incorporates any applicable federal regulations or HHS guidance as a compliance floor. The prohibition on supplanting provider decision-making reinforces that AI is a support tool, not a substitute for clinical judgment.
Statutory Text
Each health insurer and utilization review organization shall ensure that the artificial intelligence, algorithm or other software tool used to review and approve, modify and delay or deny requests by providers: (C) does not supplant healthcare provider 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; (H) does not directly or indirectly cause harm to the enrollee.
HC-01 Healthcare AI Decision Restrictions · HC-01.7 · Deployer · Healthcare
Section 1(e), Section 1(f)(1)-(3)
Plain Language
Health insurers must establish written policies and procedures describing their utilization review process for medical necessity decisions, and those policies must require that decisions be consistent with criteria supported by clinical principles. Insurers must file these policies and procedures with the Kansas Department of Insurance and must disclose them to enrollees, healthcare providers, and the public upon request. This creates three distinct obligations: (1) establish the written policies, (2) file them with the regulator, and (3) make them available to stakeholders on request. The filing requirement subjects AI-related utilization review practices to regulatory inspection.
Statutory Text
(e) Each health insurer subject to this act shall establish written policies and procedures that: (1) Describe the process by which the health benefit plan 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 plan 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. (f) (1) Each health insurer subject to this act shall file with the department such health insurer's policies and procedures establishing the process by which such health insurer 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 plan 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. (3) Each health insurer shall disclose such policies and procedures to insureds, healthcare providers and the public upon request.