South Carolina S 920: Thomas F. Hartnett, retirement from SC Legislative Audit Council

Bill Text

2025-2026 Bill 920 Text of Previous Version (May. 06, 2026) - South Carolina Legislature Online 

South Carolina General Assembly
126th Session, 2025-2026

Bill 920

Indicates Matter Stricken
Indicates New Matter

(Text matches printed bills. Document has been reformatted to meet World Wide Web specifications.)

Indicates Matter Stricken

Indicates New Matter

Committee Report

April 30, 2026

S. 920

Introduced 
by Senators Leber and Blackmon 

S. Printed 4/30/26--S. [SEC 
5/6/2026 10:04 AM]

Read the first time February 11, 2026

________

The committee on Senate Banking and 
Insurance

To whom was referred a Bill (S. 920) to amend 
the South Carolina Code of Laws by adding article 25 to chapter 71, title 38 so 
as to provide circumstances that must be considered when a health insurer, etc., 
respectfully

Report:

That they have duly and carefully considered 
the same, and recommend that the same do pass:

RONNIE CROMER for Committee.

_______

A bill

TO AMEND THE SOUTH CAROLINA CODE OF LAWS BY ADDING Article 
25 to Chapter 71, Title 38 so as to provide circumstances that must be 
considered when a health insurer uses artificial intelligence to make 
determinations relating to Prior authorizations, to provide certain disclosures 
to enrollees, and to provide disciplinary actions for violations.

Be it enacted by the 
General Assembly of the State of South Carolina:

SECTION 1. Chapter 71, Title 38 of the S.C. Code is amended by 
adding:

Article 25

Prior Authorization Determinations with Artificial 
Intelligence

 Section 
38-71-2510. As used in this article:

 (1) "Artificial 
intelligence" means a machine-based system that may include software or 
physical hardware that performs tasks, based upon dataset inputs, which require 
human like perception, cognition, planning, learning, communication, or 
physical action and which is capable of improving performance based upon 
learned experience without significant human oversight toward influencing real 
or virtual environments.

 (2) "Department" 
means the Department of Insurance.

 (3) "Enrollee" 
means an individual who contracts for, subscribes to, or participates as a 
dependent under a health benefit plan.

 (4) "Health 
benefit plan" means any individual, blanket, or group plan, 
policy, or contract for healthcare services issued or delivered by:

 (a) a healthcare insurer in this 
State as defined in Sections 38-71-670 and 38-71-840;

 (b) a health maintenance organization 
as defined in Section 38-33-20; and 

 (c) 
the State Health Plan as provided for in Article 5, Chapter 
11, Title 1.

 (5) "Healthcare 
service" means diagnosing, testing, monitoring, or treating a human disease, 
disorder, syndrome, illness, or injury that may include, but not be limited to, 
hospitalization, physician care, treatment, surgery, therapy, drugs, or medical 
equipment.

 (6) "Insurer" 
means:

 (a) an entity that provides health 
insurance coverage in this State as defined in Sections 38-71-670 and 38-71-840;

 (b) a health maintenance organization 
as defined in Section 38-33-20; and 

 (c) the State Health Plan as provided 
for in Article 5, Chapter 11, Title 1.

 (7) "Prior 
authorization" means a written or oral determination made by an insurer that a 
healthcare service is a benefit covered under the applicable health benefit 
plan which, under the enrollee's clinical circumstances, is medically necessary 
or satisfies another requirement imposed by the insurer or law and thus 
satisfies the requirements for payment or reimbursement.

 (8) "Utilization 
review" means the determination of requests for prior authorization or other 
issues of coverage under a health benefit plan according to the rules, 
healthcare service policies, and guidelines adopted by an insurer, or 
requirements imposed by law, and applicable to a health benefit plan.

 Section 
38-71-2520. (A) An insurer that 
uses artificial intelligence, an algorithm, or other software tool to make 
determinations on requests for prior authorization or other decisions on 
coverage under healthcare plans shall base determinations on all of the 
following:

 (1) 
the enrollee's medical history;

 (2) 
any clinical circumstances unique to the enrollee which are presented by the 
requesting healthcare provider; and

 (3) 
additional clinical information about the enrollee which may be present in the 
enrollee's medical record.

 (B) An 
insurer shall certify annually to the department that the artificial 
intelligence, algorithm, or other software tool used to make determinations on 
requests for prior authorization complies with all of the following:

 (1) 
does not rely solely on a group dataset to make determinations;

 (2) 
is configured and applied in a fair manner for each subscriber group and 
enrollee such that resulting determinations are consistent for enrollees who 
present with similar clinical considerations; and

 (3) 
does not discriminate directly or indirectly against any subscriber gro