Requires health care service plans and disability insurers using AI for utilization review to ensure compliance with clinical criteria, non-discrimination, transparency, and auditability. Prohibits AI from replacing provider decision-making or denying services based on medical necessity.
Analysis summaries, actor details, and coverage mappings were LLM-classified and may contain errors.
This is a binding California state statute with mandatory requirements, enforcement mechanisms including administrative penalties, and regulatory oversight by state departments.
The document has good coverage of approximately 6-7 subdomains, with strong focus on unfair discrimination (1.1), unequal performance across groups (1.3), lack of transparency (7.4), and lack of robustness (7.3). Coverage is concentrated in discrimination/toxicity and AI system safety domains, specifically addressing risks in healthcare AI utilization review systems.
The document exclusively governs the Health Care and Social Assistance sector, specifically regulating health care service plans and disability insurers that use AI for utilization review and management functions. The regulation is comprehensive and sector-specific.
The document primarily focuses on the Deploy and Operate and Monitor stages of the AI lifecycle, with specific requirements for AI systems used in healthcare utilization review. It addresses deployment requirements, ongoing monitoring, periodic review, and audit mechanisms. There is minimal coverage of earlier stages like planning, data collection, or model building.
The document explicitly defines and covers artificial intelligence, algorithms, and software tools used for utilization review. It does not specifically mention frontier AI, general purpose AI, foundation models, or compute thresholds. The focus is on AI systems and tools applied in healthcare decision-making contexts.
California State Legislature; California Senate
This is a California Senate Bill enacted by the California State Legislature, as indicated by the opening text 'THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS' and the designation 'California Senate Bill 1120 (2024)'.
California Department of Managed Health Care (director); California Department of Insurance (commissioner); State Department of Health Care Services
The bill designates specific state regulatory agencies with enforcement authority, including the power to assess administrative penalties and conduct compliance reviews.
California Department of Managed Health Care (director); California Department of Insurance (commissioner); State Department of Health Care Services
The same regulatory agencies responsible for enforcement also conduct monitoring through periodic onsite medical surveys, audits, and compliance reviews.
health care service plans; disability insurers; entities with which they contract for utilization review or utilization management functions; medical groups; independent practice associations
The bill explicitly targets health care service plans and disability insurers that use AI for utilization review, as well as entities they contract with for these services.
7 subdomains (6 Good, 1 Minimal)