Texas bill takes aim at AI-based coverage denials

A Texas lawmaker has introduced a bill that would prohibit payers from using artificial intelligence to delay, deny or modify claims, NBC affiliate KXAN reported Jan. 21. 

The bill from Sen. Charles Schwertner would also give the Texas Department of Insurance the authority to inspect or audit a health plan's benefits to ensure compliance, according to the report. 

"Artificial intelligence is a technology that is still rapidly developing and has enormous potential to support many systems, including healthcare," Mr. Schwertner said, according to the report. "However, this technology should not be used to make critical, sometimes life-saving decisions regarding a patient’s care. We simply cannot and should not solely rely on algorithms to understand the complexities and unique needs of patients."

On Jan. 1, a California law went into effect that prohibits payers from making coverage decisions based solely on artificial intelligence algorithms. Under that law, any denial, delay or modification of care based on medical necessity must be reviewed and decided by a licensed physician or qualified healthcare provider with expertise in the specific clinical issues at hand. 

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