WeVote
Log In

Bill

Bill

HB 515

Augusta Judicial Circuit; superior courts; provide for a sixth judge

2025-2026 Regular Session Introduced by Lynn Heffner and 4 co-sponsors

House Bill 515 mandates that health insurers involve qualified professionals in AI-driven coverage decisions, ensuring patient-specific care and transparency in the process.

House Withdrawn, Recommitted
0
WeVote Research Nonpartisan
Bill Summary · HB 515

Summary of House Bill 515: Regulating Artificial Intelligence in Health Coverage Decisions

Bill Number: HB 515
Introduced: April 3, 2025
Status: Read for the first time and referred to the House Committee on Insurance
Sponsor: Representative Mark Shirey
Classification: Bill
Subject: Insurance

Purpose and Intent

House Bill 515 aims to regulate the use of artificial intelligence (AI) by health insurers in making coverage decisions related to medical treatments. The bill seeks to ensure that decisions regarding medical necessity are made by qualified healthcare professionals, while also providing transparency about the use of AI in these processes.

Key Provisions

  1. Limitations on AI Use:

    • Health insurers must ensure that any coverage determination involving AI is ultimately made by a competent healthcare professional.
    • The healthcare professional must consider the specific circumstances of the patient, as assessed by the attending provider, rather than relying solely on AI recommendations.

  2. Disclosure Requirements:

    • Insurers are required to inform both enrollees in health benefit plans and network healthcare providers about the use of AI in making coverage determinations.

  3. Civil Action for Injuries:

    • Individuals who believe they have been harmed due to the use of AI in coverage decisions may file a civil lawsuit against the insurer for damages.

  4. Compliance and Oversight:

    • The Alabama Department of Insurance is tasked with adopting rules to enforce the provisions of this bill.
    • Insurers must periodically review the outcomes of AI usage, including the rates of treatment denials or modifications.

  5. Data Protection:

    • Patient data used in AI processes must comply with the Health Insurance Portability and Accountability Act (HIPAA) and should not be used beyond its intended purpose.

Who Would Be Affected

  • Health Insurers: Required to adapt their utilization review processes to comply with the new regulations.
  • Healthcare Professionals: Must engage in the decision-making process regarding medical necessity, ensuring that AI recommendations are contextualized with patient-specific information.
  • Patients: Will benefit from increased transparency and the assurance that their treatment decisions are made by qualified professionals rather than solely by AI systems.

Procedural Aspects

  • The bill is currently pending committee action in the House of Origin (Insurance).
  • If passed, the provisions of this act will become effective on October 1, 2025.

Conclusion

House Bill 515 represents a significant step towards regulating the intersection of artificial intelligence and healthcare insurance. By mandating human oversight in coverage decisions and ensuring transparency, the bill aims to protect patients and uphold the integrity of medical decision-making in the age of technology.

Compiled from official sources — confirm details with the bill’s official record.

Sign in to ask a question.