AI Frontier Institute

Enacting the use of artificial intelligence in medical decisions transparency act and requiring that all medical necessity determinations be made by a competent licensed physician or healthcare professional.

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Kansas SB 467 has not been enacted. It was introduced on 2026-02-03 and referred to the Senate Committee on Financial Institutions and Insurance. If enacted, it would create the "use of artificial intelligence in medical decisions transparency act" (Section 1(a)(1)). The act would apply to health insurers and utilization review organizations that use AI, algorithms or other software tools for utilization review or management based in whole or in part on medical necessity, including those that contract with entities that do so (Section 1(a)(2)). Under Section 1(c)(1), such a tool used to approve, modify, delay or deny provider requests would have to: base determinations on the enrollee's clinical history, individual circumstances and other relevant clinical information; not rely solely on a group dataset; not supplant provider decision-making; not discriminate in violation of state or federal law; be applied fairly and equitably under applicable U.S. HHS regulations or guidance; be periodically reviewed and revised for accuracy and reliability; use patient data in compliance with HIPAA; and not directly or indirectly cause harm to the enrollee. Section 1(c)(2) would bar the tool from denying, delaying or modifying healthcare services based in whole or in part on medical necessity. Only a licensed physician or licensed healthcare professional competent to evaluate the clinical issues could make a medical necessity determination, after considering the provider's recommendation, the enrollee's clinical history and individual circumstances. Section 1(d) would bar anyone other than such a professional from denying or modifying authorization requests for medical necessity reasons. Under Section 1(e), health insurers would have to establish written policies and procedures describing their prospective, retrospective and concurrent review processes. These policies would also have to require that medical necessity decisions follow criteria supported by clinical principles. Under Section 1(f), insurers would have to file those policies with the Kansas Department of Insurance and disclose them to insureds, providers and the public on request. Under Section 2, the act would take effect on publication in the statute book.

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