AI Frontier Institute

Regulate the use of artificial intelligence by health insurers

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Ohio S.B. 164 (136th General Assembly, introduced April 1, 2025 and referred to the Financial Institutions, Insurance and Technology committee) has not been enacted. If enacted, it would regulate health insurers' use of artificial intelligence by amending section 3902.50 and enacting new section 3902.80 of the Revised Code. Section 3902.50 would be amended so its definitions apply through section 3902.80. Under section 3902.80(B), each health plan issuer would have to file an annual report with the superintendent of insurance by March 1. The report would list network providers and the number of covered persons enrolled in the state in the prior year. It would also say whether the issuer used, is using, or will use AI-based algorithms in utilization review. If so, the report would include 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 would have to verify the report. The superintendent and the issuer would both have to publish it on their web sites. Section 3902.80(C)(1) would bar issuers from deciding to deny, delay, or modify care based on medical necessity solely on AI results. Under (C)(2), medical necessity determinations would have to be made by a licensed physician or other qualified provider. They would also have to consider the requesting provider's recommendation and the patient's clinical history and circumstances. Under (C)(3), physicians involved in these reviews would have to open and document review of the individual clinical records before making an individualized decision. Under (C)(4), any denial, delay, or modification involving an AI algorithm would need a plain-language explanation of its rationale. Section 3902.80(D) would let the superintendent audit an issuer's AI use at any time, including through a third-party contractor. Section 3902.80(E) would apply the section to health benefit plans issued, amended, or renewed on or after its effective date.

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