Requires utilization review programs using algorithmic processes to ensure clinical peers make adverse determinations, comply with accreditation standards, and include policies for algorithm verification. Establishes registration every two years with proof of compliance. Sets appeal procedures for adverse determinations.
Analysis summaries, actor details, and coverage mappings were LLM-classified and may contain errors.
This is a binding state legislative amendment to the Managed Care Reform and Patient Rights Act with mandatory requirements, enforcement mechanisms, and regulatory oversight by the Department of Insurance.
The document has minimal coverage of AI risk domains, with primary focus on AI system security (2.2) through requirements for algorithm verification and accreditation. There is minimal coverage of lack of robustness (7.3) through medical necessity review requirements, and minimal coverage of lack of transparency (7.4) through clinical peer review mandates. The document addresses algorithmic processes in healthcare utilization review but does not extensively cover most AI risk categories.
The document exclusively governs AI use in the Health Care and Social Assistance sector, specifically targeting utilization review programs and health care plans that use algorithmic automated processes for medical necessity determinations. No other economic sectors are regulated.
The document primarily addresses the Deploy and Operate and Monitor stages of the AI lifecycle for algorithmic automated processes used in healthcare utilization review. It establishes requirements for deployment (accreditation, registration) and ongoing monitoring (biennial registration, program integrity systems, physician verification of algorithmic outputs).
The document explicitly addresses algorithmic automated processes used in utilization review for medical necessity determinations. It does not use standard AI terminology like 'AI models' or 'AI systems' but instead refers to 'algorithmic automated process' throughout. There is no mention of frontier AI, general purpose AI, foundation models, generative AI, or compute thresholds.
Idaho State Legislature (amending Illinois Managed Care Reform and Patient Rights Act - note: document header indicates Idaho but content is Illinois law)
The document is a legislative amendment to the Managed Care Reform and Patient Rights Act, proposed through the state legislative process as indicated by the bill structure and statutory citations.
Department of Insurance, Director of the Department of Insurance, Director of the Department of Public Health (in consultation)
The Department of Insurance has explicit enforcement authority including registration oversight, corrective action plans, cease and desist orders, and administrative hearings.
Department of Insurance, Utilization Review Accreditation Commission, National Committee for Quality Assurance, Accreditation Association for Ambulatory Health Care
The Department monitors compliance through biennial registration requirements and proof of accreditation. Accreditation organizations provide ongoing monitoring of utilization review standards and algorithmic processes.
Health care plans, utilization review programs, health maintenance organizations, managed care community networks, accountable care entities
The legislation explicitly targets health care plans and utilization review programs that use algorithmic automated processes for medical necessity determinations in healthcare services.
3 subdomains (3 Minimal)