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.
Minimal coverage — Brief mention but no specific mitigations, recommendations or governance measures relating to the risk subdomain are described.
All other risk subdomains had no coverage in this document.
Risk Coverage Summary
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.
Good coverage — Comprehensive governance measures or mitigations with clear procedures relating to the sector are explicitly described.
All other sectors had no coverage in this document.
Sectors Summary
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.
Hard Law
Legislative Status Summary
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.
Proposer
Target
Enforcer
Monitor
Lifecycle stages covered by the documents, as defined in the OECD Framework for the Classification of AI Systems
AI Lifecycle Summary
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).
Terms relating to technical scope that are mentioned or implicitly referenced in the document
Technical Scope Summary
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.
Document data from AGORA, CSET Emerging Technology Observatory.