HB515 Alabama 2025 Session

Summary

Primary Sponsor

Mark ShireyRepresentative

Republican

Session

2025 Regular Session

Title

Artificial intelligence; regulate use in health coverage decisions

Summary

HB515 would regulate how health insurers use artificial intelligence in coverage decisions, keeping final medical determinations with clinicians and requiring transparency to patients and providers.

What This Bill Does

It requires that a licensed health care professional always make the coverage decision, though they may consider an AI recommendation. Insurers must disclose to enrollees and network providers that AI is used in determinations. The bill sets standards for AI in utilization review, requires periodic review of AI outcomes, and ensures HIPAA protections. It also creates a civil action option for people injured by AI use in coverage decisions, and authorizes the Alabama Department of Insurance to enforce the rules. The act becomes effective October 1, 2025.

Who It Affects

• Health plan enrollees and patients: gain disclosure about AI use, and have a legal avenue if they are harmed by AI-driven decisions; medical necessity still determined by clinicians.
• Insurers and network providers/practitioners performing utilization review: must follow AI usage standards, provide disclosures, periodically review AI outcomes, and face possible civil liability for violations.

Key Provisions

• Defines key terms including artificial intelligence, health benefit plan, insurer, patient, and utilization management/review.
• Final determination of medical necessity must be made by a licensed health care professional who can evaluate AI recommendations in light of the patient's clinical issues.
• Insurers must make prominent written disclosures to enrollees and contracted providers that AI is used in utilization management/review.
• AI-based determinations must follow criteria: use relevant clinical information, consider patient-specific circumstances, not rely solely on group data, not ignore provider decision making, and avoid discrimination; must comply with applicable laws.
• Insurers must periodically review AI usage and outcomes, including denial/modification rates relative to requests.
• Data used by AI must be used within its stated purpose and in line with HIPAA protections.
• A person injured by a violation may sue the insurer or contractor for damages, injunctive relief, and costs/fees.
• The Alabama Department of Insurance may adopt enforcement rules to implement the act.
• Effective date: October 1, 2025.

AI-generated summary using openai/gpt-5-nano on Feb 22, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Insurance