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STATE OF OKLAHOMA
2nd Session of the 60th Legislature (2026)
HOUSE BILL 3675 By: Provenzano
AS INTRODUCED
An Act relating to health insurance; providing
definitions; prohibiting utilization review agents
from using an automated system to make adverse
determinations; permitting Insurance Commissioner
auditing authority; clarifying act does not prohibit
use of automated decision systems for administrative
support or fraud detection; directing notice of
adverse determinations to include certain
information; providing for codification; and
providing an effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6550 of Title 36, unless there
is created a duplication in numbering, reads as follows:
As used in this act:
1. "Adverse determination" means a determination by a
utilization review agent that health care services provided or
proposed to be provided to a patient are not medically necessary or
appropriate, or are experimental or investigational;
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2. "Algorithm" means a computerized procedure consisting of a
set of steps used to accomplish a determined task;
3. "Artificial intelligence system" means any machine learning-
based system that, for any explicit or implicit objective, infers
from the inputs the system receives how to generate outputs,
including content, decisions, predictions, and recommendations, that
can influence physical or virtual environments;
4. "Automated decision system" means an algorithm, including an
algorithm incorporating an artificial intelligence system, that uses
data-based analytics to make, suggest, or recommend certain
determinations, decisions, judgments, or conclusions; and
5. "Qualified human professional" means an individual with the
training, education and certification required to legally make
medical decisions.
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6550.1 of Title 36, unless there
is created a duplication in numbering, reads as follows:
A. Any adverse determination made by an algorithm, artificial
intelligence system, or automated decision system shall be reviewed
by a qualified human professional before being finalized.
B. The Insurance Commissioner may audit and inspect at any time
a utilization review agent's use of an automated decision system for
utilization review.
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C. This section does not prohibit the use of an algorithm,
artificial intelligence system, or automated decision system for
administrative support or fraud-detection functions.
SECTION 3. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6550.2 of Title 36, unless there
is created a duplication in numbering, reads as follows:
Notice of an adverse determination must include:
1. The principal reasons for the adverse determination;
2. The clinical basis for the adverse determination;
3. A description of and the source of the screening criteria
and review procedures used as guidelines in making the adverse
determination; and
4. A description of the procedure for the complaint and appeal
process, including notice to the enrollee of the enrollee's right to
appeal an adverse determination to an independent review
organization and of the procedures to obtain that review.
SECTION 4. This act shall become effective November 1, 2026.
60-2-15132 MJ 01/13/26