Louisiana lawmakers are advancing a bill that would restrict how payers use AI and automated decision systems when making coverage determinations, requiring human clinical judgment before any denial and giving enrollees new rights to challenge AI-influenced denials.
If passed, the bill would take effect Aug. 1, 2026, and apply to new policies issued on or after Jan. 1, 2027. Existing plans would have to comply no later than their renewal date or Jan. 1, 2028, whichever comes first.
The bill covers insurers, PBMs, and independent review organizations that use AI or automated systems for utilization review, or that contract with a carrier that does.
Under the legislation, AI could not be used to delay, deny, or modify healthcare services on their own. Any adverse determination would require independent judgment from a human utilization reviewer before being made, and a physician who personally reviewed the medical record would be required to sign off on each denial. AI determinations could not be based solely on group data sets and would be required to account for individual clinical circumstances and the patient’s history.
Insurers would also be required to disclose to enrollees and the state’s insurance department when AI was used in any coverage determination or utilization review, and to document the extent to which the technology influenced the outcome.
Any adverse determination in which AI materially contributed would be presumed invalid unless the insurer could demonstrate the decision was independently reached through documented clinical judgment without reliance on algorithmic output. If the denial was appealed on AI grounds, the insurer could not use AI in any following review of the claim. Enrollees would also have the right to obtain copies of all documents related to any AI system used in the decision.
