Summary
Amends Illinois utilization review requirements so that when a health plan or other utilization review program uses algorithmic automated processes in medical-necessity review, only a clinical peer may issue adverse determinations, and any such systems must rely on objective, evidence-based criteria consistent with URAC or National Committee for Quality Assurance accreditation.
Healthcare Implications
Directly regulates use of AI-enabled utilization review in health insurance, limiting fully automated adverse decisions and reinforcing human clinical oversight and evidence-based criteria for coverage decisions affecting patient access to care.