AI Frontier Institute

Regulate the use of artificial intelligence by health insurers

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Ohio H.B. 579 (136th General Assembly, introduced 2025-11-05 and referred to the House Insurance Committee) has not been enacted. If enacted, it would regulate health insurers' use of artificial intelligence. It would amend section 3902.50 of the Revised Code so that its definitions also apply to new section 3902.80, and it would repeal the existing version of 3902.50 (Section 2). New section 3902.80 would do the following. (1) Annual reporting: by March 1 each year, every health plan issuer must file a report with the superintendent of insurance (3902.80(B)(1)). The report must list the providers in its network and the number of covered persons enrolled in the state in the prior year. It must also say whether the issuer used, is using, or will use AI-based algorithms in utilization review. If it does, the report must give the algorithm criteria, the training data sets, the algorithm itself, the outcomes of the software, and data on how long a human reviewer spends examining an adverse determination before signing off. An officer must verify the report. The superintendent and the issuer must both publish it on their websites (3902.80(B)(2)-(3)). (2) Limits on AI decisions: a health plan issuer may not deny, delay, or modify care based on medical necessity "based solely on" AI results (3902.80(C)(1)). Medical necessity determinations must be made by a licensed physician or a qualified provider, and must consider the requesting provider's recommendation, the patient's clinical history, and individual circumstances (3902.80(C)(2)). Physicians involved in these reviews must open and document review of the individual clinical records before making an individualized documented decision (3902.80(C)(3)). Any denial, delay, or modification involving an AI algorithm must come with a plain-language explanation of the rationale (3902.80(C)(4)). (3) Audits: the superintendent may audit an issuer's AI use at any time, including through a third-party contractor (3902.80(D)). (4) Applicability: the section applies to health benefit plans issued, amended, or renewed on or after its effective date (3902.80(E)).

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