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.
609.825 Human review of prior authorization for medical necessity or experimental status. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.852.
This section extends the substantive prohibition in § 632.852 to three categories of managed care entities — limited service health organizations, preferred provider plans, and defined network plans. It creates no independent obligation but ensures these entity types are subject to the same AI prior authorization denial prohibition that applies to disability insurance policies and self-insured health plans under § 632.852.
1 632.852 Human review of prior authorization for medical necessity or experimental status. A disability insurance policy, as defined in s. 632.895 (1) (a), or a self-insured health plan, as defined in s. 632.85 (1) (c), may not use artificial intelligence to deny a prior authorization for medical necessity or experimental status. An appropriate licensed health care provider who is an individual shall review a prior authorization that involves medical necessity or experimental status before the disability insurance policy or self-insured health plan may deny the prior authorization.
This is the bill's sole operative section. It imposes two linked requirements on disability insurance policies and self-insured health plans. First, these entities may not use artificial intelligence to deny a prior authorization for medical necessity or experimental status — a categorical prohibition on AI-driven denials in this context. Second, before any such denial may issue, an appropriate licensed health care provider who is an individual must review the prior authorization. The individual-provider requirement forecloses both AI-only and AI-plus-entity review processes — a natural person with clinical credentials must conduct the review.
The provision is narrowly scoped: it covers only denials of prior authorization involving medical necessity or experimental status. AI use in approvals, in other coverage determinations, or in prior authorization decisions not involving medical necessity or experimental status falls outside its scope.
(1) For policies and plans containing provisions inconsistent with s. 632.852, the treatment of s. 632.852 first applies to policy or plan years beginning on the effective date of this subsection, except as provided in sub. (2).
(2) For policies and plans that are affected by a collective bargaining agreement containing provisions inconsistent with s. 632.852, the treatment of s. 632.872 first applies to policy or plan years beginning on the effective date of this subsection or on the day on which the collective bargaining agreement is newly established, extended, modified, or renewed, whichever is later.
This section establishes the initial applicability rules for § 632.852. For most policies and plans, the new requirements apply beginning with the first policy or plan year that starts on or after the effective date. For policies and plans subject to collective bargaining agreements containing inconsistent provisions, applicability is deferred until the later of the effective date or the date the collective bargaining agreement is newly established, extended, modified, or renewed.
(1) This act takes effect on the first day of the 4th month beginning after publication.
The act takes effect on the first day of the fourth month beginning after publication. Because the bill has not been enacted, the specific effective date is not yet determinable.