New York Assembly Bill A11048

New York 2025-2026 Regular Session

• Introduced: 4/24/26
• Refer: 4/24/26

Caption

Relates to the use of artificial intelligence by insurers and clinical peer reviewers for utilization review; establishes additional notice requirements for adverse determinations.

Impact

This legislation is intended to enhance transparency in the decision-making processes of insurers, particularly concerning the automation of health care evaluations. By requiring explicit communication regarding the employment of AI, the bill seeks to mitigate potential biases present in algorithms, thereby ensuring that individual clinical considerations are taken into account alongside statistical data. This is expected to empower health care providers and patients by giving them insights into how AI influences coverage decisions.

Summary

Bill A11048 aims to amend the insurance law and public health law regarding the use of artificial intelligence (AI) in utilization reviews conducted by insurers. Specifically, it mandates that insurers notify both health care providers and insured individuals whenever AI algorithms are utilized in the review process for adverse determinations concerning health care services. This notification must occur at policy initiation and on an annual basis thereafter. Furthermore, insurers must provide detailed disclosures about the criteria and data sets used by these AI systems.

Contention

Despite the proposed benefits, there are concerns regarding the practical implications of implementing such requirements. Critics argue that the complex nature of AI and its decision-making processes may make it challenging for insurers to provide adequate notifications. Additionally, some fear that this legislation could influence the pace of adopting innovative technologies in health care, potentially leading to delays in beneficial AI applications. Balancing regulatory oversight with technological advancement will be a point of contention as this bill moves forward.