Texas SB 815 (Use of AI systems in Utilization Reviews 2025)

• Authority: Texas
• Parent authority: State governments
• Jurisdiction: United States
• Collections: U.S. state and local documents
• Most recent activity: Enacted
• Most recent activity date: 2025-06-20

Risk subdomain coverage

Good coverage — Comprehensive governance measures or mitigations with clear procedures relating to the risk subdomain are explicitly described.

• Overreliance and unsafe use
• Loss of human agency and autonomy

Minimal coverage — Brief mention but no specific mitigations, recommendations or governance measures relating to the risk subdomain are described.

• Lack of capability or robustness
• Lack of transparency or interpretability

All other risk subdomains had no coverage in this document.

Risk Coverage Summary

The document primarily addresses Human-Computer Interaction risks (5.1, 5.2) and AI System Safety risks (7.3, 7.4). It focuses on preventing overreliance on automated systems in critical healthcare decisions and preserving human agency in adverse determination processes. Coverage is concentrated in approximately 4 subdomains with good depth on human autonomy and system reliability concerns in healthcare contexts.

Sector coverage

Good coverage — Comprehensive governance measures or mitigations with clear procedures relating to the sector are explicitly described.

• Finance & Insurance
• Health Care & Social Assistance

All other sectors had no coverage in this document.

Sectors Summary

The document primarily governs the Health Care and Social Assistance sector by regulating utilization review processes for health benefit claims. It also significantly governs the Finance and Insurance sector through regulation of health insurance utilization review agents and their use of automated systems in claims processing.

Legislative Status

Hard Law

Legislative Status Summary

This is a binding state statute (Senate Bill) that amends the Texas Insurance Code with mandatory prohibitions, enforcement mechanisms through a commissioner with audit authority, and a specific effective date establishing legal obligations.

Actors

Proposer

• Entity Types: AI_Governance_Actor
• Entities: Texas State Legislature; State of Texas
• Summary: The document is a Senate Bill enacted by the Legislature of the State of Texas, which initiated and proposed this governance instrument amending the Texas Insurance Code.

Target

• Entity Types: AI_Deployer
• Entities: utilization review agents; health benefit plan issuers
• Summary: The primary targets are utilization review agents who are prohibited from using automated decision systems for adverse determinations in health benefit claims. These are entities that deploy AI systems in healthcare decision-making contexts.

Enforcer

• Entity Types: AI_Governance_Actor
• Entities: commissioner (Texas Insurance Commissioner)
• Summary: The commissioner is explicitly granted authority to audit and inspect utilization review agents' use of automated decision systems, establishing their role as the enforcement authority.

Monitor

• Entity Types: AI_Governance_Actor
• Entities: commissioner (Texas Insurance Commissioner)
• Summary: The commissioner has explicit monitoring authority through audit and inspection powers over utilization review agents' use of automated decision systems.

AI Lifecycle Stages

Lifecycle stages covered by the documents, as defined in the OECD Framework for the Classification of AI Systems

• Deploy
• Operate and Monitor

AI Lifecycle Summary

The document primarily addresses the Deploy and Operate and Monitor stages of the AI lifecycle, focusing on restrictions on deployment of automated decision systems for adverse determinations and establishing ongoing audit/monitoring mechanisms. It does not cover earlier stages like planning, data collection, or model development.

Technical Scope

Terms relating to technical scope that are mentioned or implicitly referenced in the document

• AI Systems

Technical Scope Summary

The document explicitly defines and mentions both AI systems and automated decision systems. It specifically addresses automated decision systems that incorporate AI systems for making healthcare determinations. There is no mention of frontier AI, general purpose AI, foundation models, generative AI, or compute thresholds.