WHAT THIS BILL REGULATES · 1 REQUIREMENT TYPE
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) "Artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that can, for a given set of human-defined objectives, make predictions, recommendations, or decisions influencing a real or virtual environment.S.C. Code § 38-59-23(A)(1)" means a machine-based system that can, for a given set of human-defined objectives, make predictions, recommendations, or decisions influencing a real or virtual environment.
(A)(2) "Automated decision-making toolAutomated decision-making tool"Automated decision-making tool" means a system or service that uses artificial intelligence and has been specifically developed and marketed, or specifically modified, to make, or to be a controlling factor in making, consequential decisions.S.C. Code § 38-59-23(A)(2)" means a system or service that uses artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that can, for a given set of human-defined objectives, make predictions, recommendations, or decisions influencing a real or virtual environment.S.C. Code § 38-59-23(A)(1) and has been specifically developed and marketed, or specifically modified, to make, or to be a controlling factor in making, consequential decisions.
Subsection (A) establishes the two key defined terms for the new section: artificial intelligence and automated decision-making tool. The AI definition tracks the widely used OECD-style formulation — a machine-based system making predictions, recommendations, or decisions. The automated decision-making tool definition is narrower, requiring that the system use AI and be specifically developed, marketed, or modified to make or be a controlling factor in consequential decisions.
(B) 1 No actions shall be taken concerning healthcare coverage decisions that have been made based solely on results derived from the use or application of artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that can, for a given set of human-defined objectives, make predictions, recommendations, or decisions influencing a real or virtual environment.S.C. Code § 38-59-23(A)(1) or the use of automated decision tools.
Subsection (B) establishes a categorical prohibition: no action may be taken on a healthcare coverage decision that was made based solely on results derived from AI or automated decision tools. This bars insurers and utilization review entities from issuing coverage denials, modifications, or approvals purely on the basis of algorithmic output without human involvement. The provision does not specify who must intervene — that detail is supplied by subsection (C), which requires healthcare professional supervision for prior authorization and concurrent review decisions specifically.
(C) 2 A health care professional, as defined in Section 44-30-20, must supervise and meaningfully review any coverage decisions made using automated decision-making toolsAutomated decision-making tool"Automated decision-making tool" means a system or service that uses artificial intelligence and has been specifically developed and marketed, or specifically modified, to make, or to be a controlling factor in making, consequential decisions.S.C. Code § 38-59-23(A)(2) when those tools are used to inform decisions to modify or deny requests by providers for authorization prior to, or concurrent with, the provision of health care services to insureds.
Subsection (C) imposes a mandatory human-oversight requirement: a healthcare professional (as defined in S.C. Code § 44-30-20) must supervise and meaningfully review any coverage decision made using automated decision-making tools. The obligation is scoped specifically to decisions that modify or deny requests by providers for authorization prior to, or concurrent with, the provision of healthcare services to insureds. This is the bill's operative human-in-the-loop mandate, complementing subsection (B)'s prohibition on sole reliance.
This act takes effect upon approval by the Governor.
The act takes effect upon approval by the Governor. There is no delayed or staged effective date.