Lexology October 9, 2024
California’s new law, SB 1120, set to take effect on January 1, 2025, regulates how health care service plans (HCSPs) and disability insurers use automated decision-making tools, such as artificial intelligence, to analyze medical necessity in utilization reviews affecting California enrollees. Compared to federal guidelines, this law is more prescriptive, requiring HCSPs and disability insurers that use automated decision-making tools to base decisions on individual clinical data, and ensure only health care professionals – not the tools – deny, delay, or modify provision of health care based on medical necessity...
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