New York A 3991: Establishes requirements for the use of artificial intelligence, algorithm, or other software tools in utilization review and management

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A03991 Summary:

BILL NOA03991 

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SAME ASNo Same As

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SPONSORForrest

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COSPNSR

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MLTSPNSR

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Amd §107, add §3224-e, Ins L

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Establishes requirements for the use of artificial intelligence, algorithm, or other software tools in utilization review and management; defines artificial intelligence.

Go to top A03991 Actions:

BILL NOA03991 

&nbsp

01/30/2025referred to insurance

01/07/2026referred to insurance

Go to topA03991 Committee&nbspVotes:

Go to topA03991 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topA03991 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 3991

 2025-2026 Regular Sessions

 IN ASSEMBLY

 January 30, 2025
 ___________

 Introduced by M. of A. FORREST -- read once and referred to the Commit-
 tee on Insurance

 AN ACT to amend the insurance law, in relation to requirements for the
 usage of artificial intelligence in utilization review and management

 The People of the State of New York, represented in Senate and Assem-
 bly, do enact as follows:

 1 Section 1. Subsection (a) of section 107 of the insurance law is
 2 amended by adding a new paragraph 56 to read as follows:
 3 (56) "Artificial intelligence" means an engineered or machine-based
 4 system that varies in its level of autonomy and that can, for explicit
 5 or implicit objectives, infer from the input it receives how to generate
 6 outputs that can influence physical or virtual environments.
 7 § 2. The insurance law is amended by adding a new section 3224-e to
 8 read as follows:
 9 § 3224-e. Requirements for usage of artificial intelligence in utili-
 10 zation review and management. (a) A health care service plan or special-
 11 ized health care service plan that uses an artificial intelligence,
 12 algorithm, or other software tool for the purpose of utilization review
 13 or utilization management functions, or that contracts with or otherwise
 14 works through an entity that uses an artificial intelligence, algorithm,
 15 or other software tool for the purpose of utilization review or utiliza-
 16 tion management functions, shall comply with this section and shall
 17 ensure all of the following:
 18 (1) The artificial intelligence, algorithm, or other software tool
 19 bases its determination on the following information, as applicable:
 20 (i) An enrollee's medical or dental history;
 21 (ii) Individual clinical circumstances as presented by the requesting
 22 provider; and
 23 (iii) Other relevant clinical information contained in the enrollee's
 24 medical or dental record.

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD07314-01-5

 A. 3991 2

 1 (2) The artificial intelligence, algorithm, or other software tool
 2 does not supplant health care provider decision making.
 3 (3) The use of the artificial intelligence, algorithm, or other soft-
 4 ware tool does not adversely discriminate, directly or indirectly,
 5 against an individual on the basis of race, color, religion, national
 6 origin, ancestry, age, sex, gender, gender identity, gender expression,
 7 sexual orientation, present or predicted disability, expected length of
 8 life, degree of medical dependency, quality of life, or other health
 9 conditions.
 10 (4) The artificial intelligence, algorithm, or other software tool is
 11 fairly and equitably applied.
 12 (5) The artificial intelligence, algorithm, or other software tool is
 13 open to inspection.
 14 (6) Disclosures pertaining to the use and oversight of the artificial
 15 intelligence, algorithm, or other software tool are contained in the
 16 written policies and procedures.
 17 (7) The artificial intelligence, algorithm, or other software tool's
 18 performance, use, and outcomes are periodically reviewed and revised to
 19 maximize accuracy and reliability.
 20 (8) Patient data is not used beyond its intended and stated purpose,
 21 consistent with applicable state laws and the federal Health Insurance
 22 Portability and Accountability Act of 1996 (Public Law 104-191).
 23 (9) The artificial intelligence, algorithm, or other software tool
 24 does not directly or indirectly cause harm to the enrollee.
 25 (b) Notwithstanding subsection (a) of t