CO HB 1139: Use of Artificial Intelligence in Health Care (openstates.org)

Section 2 of the bill requires entities that use an artificial intelligence system or algorithm (AI system) for the purpose of conducting utilization review of health-care services, including health insurance carriers, pharmacy benefit managers, private utilization review organizations, behavioral health administrative services organizations, and managed care entities (entities) , to ensure that the AI system complies with certain requirements specified in the bill when determining coverage for services. Specifically, the AI system used must:Not base its determination solely on group data; andMake determinations based on medical or clinical history, the patient's individual clinical circumstances, and other relevant factors specified in the bill, with denial of coverage reviewed by a licensed clinician or physician. The AI system may be used to assist in utilization review, including expedited approvals. A denial or delay of coverage for a service based in whole or in part on medical necessity must be reviewed by a licensed clinician or physician who is competent to evaluate the specific clinical issues. Entities that use AI systems shall disclose to the division of insurance, the department of human services, or the department of health care policy and financing, as applicable, the utilization review functions for which the AI system will be used and the points in the utilization review process when it will be used, the process for human oversight of adverse coverage dete...