An Act relating to the use of certain automated systems in, and certain adverse determinations made in connection with, the health benefit claims process
Texas | SB 815
Categories
Key Requirements
A utilization review agent may not use an automated decision system to make an adverse determination, in whole or in part. AI, algorithms and automated decision systems may be used only for administrative support and fraud/abuse detection functions, with human oversight. Notices of adverse determination must describe the source of the screening criteria and the review procedures used.
Regulated Parties
Utilization review agents for health benefit plans
Enforcement
The Commissioner of Insurance may audit and inspect a utilization review agent's use of automated decision systems at any time
Sources
Notes
Enrolled text confirms September 1, 2025 effective date and January 1, 2026 applicability; the June 20, 2025 signing date comes from Steptoe's state AI legislative tracker and TrackBill. Companion bill HB 2922.
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