WeVote
Log In

Bill

Bill

SB 246

HEALTH/ACC INSURANCE: Establishes requirements for health insurance issuers using artificial intelligence or automated decision systems. (8/1/26)

2026 Regular Session Introduced by Regina Barrow and 1 co-sponsor

Louisiana SB 246 requires transparent, physician-backed use of AI/ADS in health determinations, with human oversight, enrollees’ rights, and state audits.

Read by title; withdrawn from the files of the Senate.
0
WeVote Research Nonpartisan
Bill Summary · SB 246

Summary of SB 246 (2026) – Health/Acc Insurance: AI and Automated Decision Systems

Purpose and intent

  • Establishes requirements for health insurance issuers, pharmacy benefit managers, and related review entities when using artificial intelligence (AI) or automated decision systems (ADS) in utilization review and coverage determinations.
  • Aims to ensure transparency, human oversight, patient rights, and compliance with federal law (HIPAA and applicable DHHS guidance).

Key provisions and changes

  • Definitions

    • Defines “artificial intelligence” (engineered or machine-based system that can receive input and generate outputs, such as predictions, simulations, or recommendations influencing environments).
    • Defines “automated decision system” (computational process using machine learning, statistics, or AI to produce simplified outputs like scores or classifications that assist or replace human decisions and materially impact a person).

  • Applicability

    • Applies to health insurance issuers, pharmacy benefit managers, or independent review entities that use AI/ADS for utilization review or contract with a carrier that uses AI/ADS for utilization review.

  • Requirements when AI/ADS are used

    • Notice: insurers must inform enrollees when AI/ADS were used in a determination, including the reasons, clinical rationale, and instructions to appeal, plus whether AI/ADS was involved.
    • Non-replacement of provider role: AI/ADS cannot replace the role of a healthcare provider in the determination process.
    • Human oversight: independent human judgment is required from utilization review personnel before adverse determinations related to medical necessity or prior authorization.
    • Compliance: must follow applicable regulations and guidance from the U.S. Department of Health and Human Services; HIPAA compliance must be maintained.
    • Data considerations: must review performance, use, and outcomes of AI/ADS at least quarterly and revise policies/procedures as needed; use patient data only for its stated, intended purpose per HIPAA.
    • Information disclosure: insurers must disclose to enrollees and the department the use of AI/ADS and document the extent to which AI/ADS influenced the determination.

  • Appeals

    • Enrollees have the right to appeal determinations that involve AI/ADS.
    • Any adverse determination where AI/ADS materially contributed shall be presumed invalid unless the issuer can show the determination was independently reached via documented clinical judgment without algorithmic output.
    • If an appeal argues AI/ADS was used, the insurer shall not use AI/ADS in any subsequent review of that claim.

  • Commissioner oversight and data requests

    • The commissioner may inspect and audit AI/ADS used in determinations and require submission of policies, procedures, data sources, training parameters, and validation methods.
    • The commissioner may require independent review of AI/ADS, paid for by the issuer.
    • Issuers must disclose data sources, training parameters, and validation methods upon request.
    • The issuer must pay for necessary independent reviews deemed by the commissioner.

  • Documentation rights

    • Insured individuals may review and obtain copies of all documents relevant to the AI/ADS used in the utilization review or determination process.

  • Section 2401 minimum requirements (federal-law alignment)

    • Ensures processes for appeals of coverage determinations and claims comply with applicable federal law.
    • Allows insured persons to review and obtain copies of AI/ADS-related documents used in determinations upon request.

Who would be affected

  • Health insurance issuers operating in Louisiana.
  • Pharmacy benefit managers (PBMs) and independent review organizations involved in utilization review.
  • Healthcare providers and requesting providers involved in determinations.
  • Enrollees/insured individuals appealing determinations influenced by AI/ADS.
  • Louisiana Department of Insurance (for oversight and enforcement).

Procedural and timeline aspects

  • Effective date: August 1, 2026.
  • Implementations for new plans: applies to new policies/contracts/programs issued on or after January 1, 2027.
  • Existing plans: must convert to conform to the Act no later than the policy renewal date occurring no later than January 1, 2028.
  • Annual/quarterly duties: ongoing quarterly review of AI/ADS performance, with updates to policies as needed.
  • Enforcement: allows the commissioner to inspect/audit AI/ADS and require independent reviews; issuers cover the cost of independent reviews.

Notable amendments adopted

  • Introduced clear definitions for “automated decision systems.”
  • Added requirement that a licensed physician sign adverse determinations.
  • Expanded disclosure obligations when AI/ADS are used in coverage decisions or utilization reviews.
  • Established standards to invalidate AI/ADS-influenced adverse determinations unless independently reached.
  • Enabled commissioner’s audit authority and required data disclosures.
  • Specified effective dates for applicability to new policies and for conversions of existing plans.

Bottom line

SB 246 creates a framework to govern, monitor, and audit the use of AI and ADS in health coverage determinations and utilization reviews in Louisiana. It emphasizes transparency to enrollees, preserves physician clinical judgment, mandates human oversight for adverse decisions, provides robust rights to appeal, and outfits the state with enforcement and reporting tools to ensure compliance.

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

Sign in to ask a question.