Summary
Regulates payors’ use of AI in utilization management by requiring that medical-necessity determinations be made by qualified clinicians, not algorithms. Sets guardrails for AI-assisted review and preserves appeal rights/timelines under Knox‑Keene and Insurance Code.
Healthcare Implications
Directly limits fully automated coverage denials and compels health plans/disability insurers to maintain human clinical oversight. Providers should expect documentation standards when AI is used in utilization management and reconsider any payer contracts relying on automated denial tools. For patients, the law strengthens due process and transparency around AI-assisted determinations.