AI Frontier Institute

Relating to use of artificial intelligence in utilization review conducted for health benefit plans.

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Texas H.B. 2922, introduced by Representative Spiller, amends Chapter 4201 of the Insurance Code by adding Section 4201.156 to regulate the use of artificial intelligence in utilization review for health benefit plans. Under Section 4201.156(a), a utilization review agent is prohibited from using an AI-based algorithm as the sole basis for any decision to wholly or partly deny, delay, or modify health care services for an enrollee on grounds of medical necessity or appropriateness. The bill explicitly reserves those determinations exclusively to a physician or licensed health care provider acting in accordance with Chapter 4201. Section 4201.156(b) grants the commissioner authority to audit and inspect a utilization review agent's use of AI for utilization review at any time. The Act takes effect September 1, 2025.

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