Amends TCA Title 8, Chapter 27; Title 56 and Title 71.
Tennessee SB1261 requires health insurance issuers that utilize artificial intelligence or algorithms for utilization review or management to ensure these tools adhere to specific standards regarding medical necessity assessments. The bill affects health insurance providers, including those involved in the TennCare program, and mandates that determinations of medical necessity be made solely by licensed healthcare professionals. Key provisions include requirements for transparency in the use of AI tools, regular performance reviews, and prohibitions against using AI to deny or modify healthcare services based on medical necessity.
Tennessee SB1261 requires health insurance issuers that utilize artificial intelligence or algorithms for utilization review or management to ensure these tools adhere to specific standards regarding medical necessity assessments. The bill affects health insurance providers, including those involved in the TennCare program, and mandates that determinations of medical necessity be made solely by licensed healthcare professionals. Key provisions include requirements for transparency in the use of AI tools, regular performance reviews, and prohibitions against using AI to deny or modify healthcare services based on medical necessity.
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Yarbro, Jeff
114th General Assembly
February 6, 2025
February 12, 2025
Passed on Second Consideration, refer to Senate Commerce and Labor Committee