South Carolina · Senate Bill · 126th Session, 2025–2026
SB443
South Carolina SB 443 — To Amend the South Carolina Code of Laws by Adding Section 38-59-23 So As to Require a Licensed Physician to Supervise and Review Healthcare Coverage Decisions Derived from the Use of an Automated-Decision Making Tool

Status ● Introduced Effective N/A Passage Likelihood L

WHAT THIS BILL REGULATES · 1 REQUIREMENT TYPE

How Is This Bill Enforced

Enforcement Authority
No express enforcement mechanism or designated enforcer specified in the bill. The bill amends Title 38 (Insurance), which is administered by the South Carolina Department of Insurance; enforcement would presumably fall under the Department's general regulatory authority over insurers.
Private Right of Action
No private right of action. Enforcement is exclusive to the designated authority.
Penalties
The bill specifies no penalties, damages, or remedies. Enforcement would be governed by the South Carolina Department of Insurance's existing regulatory authority under Title 38.

What This Bill Requires

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.

Statutory Text
Analysis & Obligations
S.C. Code § 38-59-23(A)
Definitions

(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.

S.C. Code § 38-59-23(B)
Prohibition on sole reliance on AI for healthcare coverage decisions
Deployer

(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.

Compliance actions 1 item
1
Entities making healthcare coverage decisions must not take any action on a coverage decision that was made based solely on results derived from the use 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 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).
HC-01.1
S.C. Code § 38-59-23(C)
Healthcare professional supervision of automated coverage decisions
Deployer

(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.

Compliance actions 1 item
2
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 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 prior authorization or concurrent review requests by providers for health care services to insureds.
HC-01.1
Section 2
Effective date

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.

Passage Likelihood

Low
Status Introduced
Chamber No passage
Committee No action
Majority party No
Bipartisan No
Prior session None

Legislative History

2025-03-11 Introduced and read first time
2025-03-11 Referred to Committee on Banking and Insurance

Entry Last Reviewed

2026-05-20
AI generated