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Session of 2026
SENATE BILL No. 467
By Senator Holscher
2-3
AN ACT concerning accident and health insurance; relating to utilization
review; enacting the use of artificial intelligence in medical decisions
transparency act; establishing requirements for the use of artificial
intelligence by certain health insurers and utilization review entities;
requiring that all medical necessity determinations be made by a
competent licensed physician or healthcare professional.
Be it enacted by the Legislature of the State of Kansas:
Section 1. (a) (1) This section shall be known and may be cited as the
use of artificial intelligence in medical decisions transparency act.
(2) This act shall apply to every health insurer and utilization review
organization that uses an artificial intelligence, algorithm or other software
tool for the purpose of utilization review or utilization management
functions based in whole or in part on medical necessity or that contracts
with or otherwise works through an entity that uses an artificial
intelligence, algorithm or other software tool for the purpose of utilization
review or utilization management functions based in whole or in part on
medical necessity.
(b) As used in this act:
(1) "Act" means the use of artificial intelligence in medical decisions
transparency act.
(2) "Artificial intelligence" means an engineered or machine-based
system that varies in level of autonomy and can, for explicit or implicit
objectives, infer from the input that such system receives how to generate
outputs that can influence physical or virtual environments.
(3) "Department" means the Kansas department of insurance.
(4) "Health benefit plan" means the same as defined in K.S.A. 40-
4602, and amendments thereto.
(5) "Health insurer" means the same as defined in K.S.A. 40-4602,
and amendments thereto.
(6) "Healthcare provider" or "provider" means the same as defined in
K.S.A. 40-22a03, and amendments thereto.
(7) "Physician" means the same as defined in K.S.A. 65-5502, and
amendments thereto.
(8) "Utilization review" means the same as defined in K.S.A. 40-
22a03, and amendments thereto.
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(9) "Utilization review organization" means the same as defined in
K.S.A. 40-22a03, and amendments thereto.
(c) (1) Each health insurer and utilization review organization shall
ensure that the artificial intelligence, algorithm or other software tool used
to review and approve, modify and delay or deny requests by providers:
(A) Makes a determination based on the following information, as
applicable:
(i) An enrollee's medical or other clinical history;
(ii) individual clinical circumstances as presented by the requesting
healthcare provider; and
(iii) other relevant clinical information contained in the enrollee's
medical or other clinical record;
(B) does not make a determination based solely on a group dataset;
(C) does not supplant healthcare provider decision-making;
(D) does not discriminate, directly or indirectly, against enrollees in
violation of state or federal law;
(E) is fairly and equitably applied, in accordance with any applicable
regulations or guidance issued by the United States department of health
and human services;
(F) is periodically reviewed and revised to maximize accuracy and
reliability;
(G) uses patient data in compliance with the health insurance
portability and accountability act of 1996, public law 104-191; and
(H) does not directly or indirectly cause harm to the enrollee.
(2) Notwithstanding the provisions of paragraph (1), the artificial
intelligence, algorithm or other software tool shall not deny, delay or
modify healthcare services based in whole or in part on medical necessity.
A determination of medical necessity shall be made only by a licensed
physician or a licensed healthcare professional who is competent to
evaluate the specific clinical issues involved in the healthcare services
requested by the healthcare provider by reviewing and considering such
healthcare provider's recommendation, the enrollee's medical or other
clinical history, as applicable, and individual clinical circumstances.
(d) No individual, other than a licensed physician or a licensed
healthcare professional who is competent to evaluate the specific clinical
issues involved in the healthcare services requested by the provider, shall
deny or modify requests for authorization of healthcare services for an
enrollee for reasons of medical necessity.
(e) Each health insurer subject to this act shall establish written
policies and procedures that:
(1) Describe the process by which the health benefit plan
prospectively, retrospectively or concurrently reviews and approves,
modifies and delays or denies requests, based in whole or in part on
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medical necessity, by healthcare providers of healthcare services for health
benefit plan enrollees; and
(2) require decisions to be based on the medical necessity of proposed
healthcare services are consistent with criteria or guidelines that are
supported by clinical principles and processes.
(f) (1) Each health insurer subject to this act shall file with the
department such health insurer's policies and procedures establishing the
process by which such health insurer prospectively, retrospectively or
concurrently reviews and approves, modifies and delays or denies
requests, based in whole or in part on medical necessity, by providers of
healthcare services for health benefit plan enrollees.
(2) Pursuant to paragraph (1), such policies and procedures shall
ensure that healthcare decisions based on the medical necessity of
proposed healthcare services are consistent with criteria or guidelines that
are supported by clinical principles and processes.
(3) Each health insurer shall disclose such policies and procedures to
insureds, healthcare providers and the public upon request.
Sec. 2. This act shall take effect and be in force from and after its
publication in the statute book.
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