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.
(56) "Artificial intelligenceArtificial intelligence"Artificial intelligence" means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.Insurance Law § 107(a)(56)" means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.
Section 1 of the bill adds a new paragraph 56 to Insurance Law § 107(a), defining artificial intelligence for purposes of the Insurance Law. The definition is broad and technology-neutral, covering any engineered or machine-based system that varies in autonomy and infers from inputs how to generate outputs influencing physical or virtual environments. This definition closely tracks the NIST AI RMF and federal Executive Order 14110 language.
(a)(1) 1 The artificial intelligenceArtificial intelligence"Artificial intelligence" means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.Insurance Law § 107(a)(56), algorithm, or other software tool bases its determination on the following information, as applicable: (i) An enrollee's medical or dental history; (ii) Individual clinical circumstances as presented by the requesting provider; and (iii) Other relevant clinical information contained in the enrollee's medical or dental record.
(a)(2) 2 The artificial intelligenceArtificial intelligence"Artificial intelligence" means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.Insurance Law § 107(a)(56), algorithm, or other software tool does not supplant health care provider decision making.
(a)(3)–(4) 3 The use of the artificial intelligenceArtificial intelligence"Artificial intelligence" means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.Insurance Law § 107(a)(56), algorithm, or other software tool does not adversely discriminate, directly or indirectly, against an individual on the basis of race, color, religion, national origin, ancestry, age, sex, gender, gender identity, gender expression, sexual orientation, present or predicted disability, expected length of life, degree of medical dependency, quality of life, or other health conditions. (4) The artificial intelligenceArtificial intelligence"Artificial intelligence" means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.Insurance Law § 107(a)(56), algorithm, or other software tool is fairly and equitably applied.
(a)(5) 4 The artificial intelligenceArtificial intelligence"Artificial intelligence" means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.Insurance Law § 107(a)(56), algorithm, or other software tool is open to inspection.
(a)(6) 5 Disclosures pertaining to the use and oversight of the artificial intelligenceArtificial intelligence"Artificial intelligence" means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.Insurance Law § 107(a)(56), algorithm, or other software tool are contained in the written policies and procedures.
(a)(7) 6 The artificial intelligenceArtificial intelligence"Artificial intelligence" means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.Insurance Law § 107(a)(56), algorithm, or other software tool's performance, use, and outcomes are periodically reviewed and revised to maximize accuracy and reliability.
(a)(8) 7 Patient data is not used beyond its intended and stated purpose, consistent with applicable state laws and the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191).
(a)(9) 8 The artificial intelligenceArtificial intelligence"Artificial intelligence" means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.Insurance Law § 107(a)(56), algorithm, or other software tool does not directly or indirectly cause harm to the enrollee.
(b) 9 Notwithstanding subsection (a) of this section, a denial, delay, or modification of health care services based on medical necessity shall be made by a licensed physician or other health care provider competent to evaluate the specific clinical issues involved in the health care services requested by the provider by considering the requesting provider's recommendation and based on recommendation, the enrollee's medical or dental history, as applicable, and individual clinical circumstances.
Section 3224-e is the operative core of the bill. Subsection (a) imposes nine enumerated requirements on any health care service plan or specialized health care service plan that uses AI, an algorithm, or other software tool for utilization review or utilization management, including plans that contract with third-party entities performing those functions. The requirements span individualized clinical data use, prohibition on supplanting provider decision-making, non-discrimination, equitable application, openness to inspection, written policy disclosures, periodic performance review, patient data purpose limitation, and a general do-no-harm standard.
Subsection (b) separately requires that any denial, delay, or modification of services based on medical necessity must be made by a licensed physician or competent health care provider who considers the requesting provider's recommendation and the enrollee's individual clinical circumstances. This effectively prohibits AI from serving as the sole or final decision-maker on adverse medical necessity determinations.
This act shall take effect immediately.
Section 3 provides that the act takes effect immediately upon enactment. There is no delayed implementation period or phased compliance timeline.