Illinois General Assembly - Bill Status for HB0035

Creates the Artificial Intelligence Systems Use in Health Insurance Act. Provides that the Department of Insurance's regulatory oversight of insurers includes oversight of an insurer's use of AI systems to make or support adverse determinations that affect consumers. Provides that any insurer authorized to operate in the State is subject to review by the Department in an investigation or market conduct action regarding the development, implementation, and use of AI systems or predictive models and the outcomes from the use of those AI systems or predictive models. Provides that an insurer authorized to do business in Illinois shall not issue an adverse consumer outcome with regard to the denial, reduction, or termination of insurance plans or benefits that result solely from the use or application of any AI system or predictive model. Provides that any decision-making process for the denial, reduction, or termination of insurance plans or benefits that results from the use of AI systems or predictive models shall be meaningfully reviewed, in accordance with review procedures determined by Department rules, by an individual with authority to override the AI systems and determinations. Authorizes the Department to adopt emergency rules to implement the Act and to adopt rules concerning standards for full and fair disclosure of an insurer's use of AI systems. Makes a conforming change in the Illinois Administrative Procedure Act.

Replaces everything after the enacting clause with the provisions of the introduced bill with the following changes. Makes changes to defined terms. Replaces "insurer" with "health insurance issuer" throughout the Act. Provides that the Department of Insurance's regulatory oversight of health insurance coverage includes oversight of the use of AI systems or predictive models to make or support adverse consumer outcomes. Provides that the Department's authority in an investigation or market conduct action includes review regarding the development, implementation, and use of AI systems or predictive models and the outcomes from the use of those AI systems or predictive models. Provides that, when an adverse consumer outcome is an adverse determination regulated under the Managed Care Reform and Patient Rights Act, the individual with authority to override the AI systems and the determinations of the AI systems shall be a clinical peer as required and defined under that Act. Sets forth provisions concerning a health insurance issuer's required compliance under the Act. Removes provisions concerning emergency rulemaking. Amends the Voluntary Health Services Plans Act. Provides that a health service plan corporation is subject to the provisions of the Artificial Intelligence Systems use in Health Insurance Act.

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