New York S 10241: Relates to the use of artificial intelligence for utilization review

Bill Text

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S10241 Summary:

BILL NOS10241 

&nbsp

SAME ASSAME AS A11048

&nbsp

SPONSORHINCHEY

&nbsp

COSPNSR

&nbsp

MLTSPNSR

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Add §338, amd §§3216, 3221, 4303, 4900 & 4903, Ins L; amd §§4900 & 4903, Pub Health L

&nbsp

Relates to the use of artificial intelligence by insurers and clinical peer reviewers for utilization review; establishes additional notice requirements for adverse determinations.

Go to top S10241 Actions:

BILL NOS10241 

&nbsp

05/08/2026REFERRED TO INSURANCE

Go to topS10241 Committee&nbspVotes:

Go to topS10241 Floor&nbspVotes:

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

Go to topS10241 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 10241

 IN SENATE

 May 8, 2026
 ___________

 Introduced by Sen. HINCHEY -- read twice and ordered printed, and when
 printed to be committed to the Committee on Insurance

 AN ACT to amend the insurance law and the public health law, in relation
 to the use of artificial intelligence for utilization review

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

 1 Section 1. The insurance law is amended by adding a new section 338 to
 2 read as follows:
 3 § 338. Notification regarding the use of artificial intelligence for
 4 utilization review. (a) As used in this section, the following terms
 5 shall have the following meanings:
 6 (1) "Adverse determination" shall have the same meaning as such term
 7 is defined by section forty-nine hundred of this chapter.
 8 (2) "Artificial intelligence-based algorithm" means any algorithm-
 9 based system that can, for a given set of human-defined objectives, make
 10 predictions, recommendations and/or decisions influencing real or virtu-
 11 al environments. An artificial intelligence-based algorithm uses machine
 12 and human-based inputs to:
 13 (A) perceive real and virtual environments;
 14 (B) abstract such perceptions into models through analysis in an auto-
 15 mated manner; and
 16 (C) use model inference to formulate options for information or
 17 action.
 18 (3) "Clinical peer reviewer" shall have the same meaning as such term
 19 is defined by section forty-nine hundred of this chapter.
 20 (4) "Emergency condition" shall have the same meaning as such term is
 21 defined by section forty-nine hundred of this chapter.
 22 (5) "Health care provider" shall have the same meaning as such term is
 23 defined by section thirty-two hundred twenty-four-a of this chapter.
 24 (6) "Insurer" means an insurer authorized to write accident and health
 25 insurance in this state, a corporation organized pursuant to article
 26 forty-three of this chapter, and a health maintenance organization
 27 certified pursuant to article forty-four of the public health law.

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD15313-01-6

 S. 10241 2

 1 (7) "Utilization review" shall have the same meaning as such term is
 2 defined by section forty-nine hundred of this chapter.
 3 (b)(1) The superintendent shall require all insurers to provide writ-
 4 ten notice to insureds, enrollees, and health care providers about the
 5 use of artificial intelligence-based algorithms in their utilization
 6 review process. Such written notice shall be sent when the artificial
 7 intelligence-based algorithm is first adopted by the insurer and once
 8 during each subsequent policy period. In addition, such insurers shall
 9 provide a clear and conspicuous notice on their websites about their use
 10 of artificial intelligence-based algorithms in the utilization review
 11 process.
 12 (2) If artificial intelligence-based algorithms are used in the utili-
 13 zation review process, each insurer shall disclose to the insured's or
 14 enrollee's health care provider, and, upon request, to the insured or
 15 enrollee, the following information: the criteria governing such artifi-
 16 cial intelligence-based algorithm, the data sets used to train such
 17 artificial intelligence-based algorithm, the artificial intelligence-
 18 based algorithm itself, and the outcomes produced by software that uses
 19 the artificial intelligence-based algorithm.
 20 (3) An insurer's use of artificial intelligence-based