1| STATE OF OKLAHOMA | | | 2| 2nd Session of the 60th Legislature (2026) | | | 3|HOUSE BILL 3675 By: Provenzano | | | 4| | | | 5| | | | 6| AS INTRODUCED | | | 7| An Act relating to health insurance; providing | | definitions; prohibiting utilization review agents | 8| from using an automated system to make adverse | | determinations; permitting Insurance Commissioner | 9| auditing authority; clarifying act does not prohibit | | use of automated decision systems for administrative | 10| support or fraud detection; directing notice of | | adverse determinations to include certain | 11| information; providing for codification; and | | providing an effective date. | 12| | | | 13| | | | 14| | | | 15|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: | | | 16| SECTION 1. NEW LAW A new section of law to be codified | | | 17|in the Oklahoma Statutes as Section 6550 of Title 36, unless there | | | 18|is created a duplication in numbering, reads as follows: | | | 19| As used in this act: | | | 20| 1. "Adverse determination" means a determination by a | | | 21|utilization review agent that health care services provided or | | | 22|proposed to be provided to a patient are not medically necessary or | | | 23|appropriate, or are experimental or investigational; | | | 24| | | | Req. No. 15132 Page 1 ___________________________________________________________________________
1| 2. "Algorithm" means a computerized procedure consisting of a | | | 2|set of steps used to accomplish a determined task; | | | 3| 3. "Artificial intelligence system" means any machine | | | 4|learning-based system that, for any explicit or implicit objective, | | | 5|infers from the inputs the system receives how to generate outputs, | | | 6|including content, decisions, predictions, and recommendations, that | | | 7|can influence physical or virtual environments; | | | 8| 4. "Automated decision system" means an algorithm, including an | | | 9|algorithm incorporating an artificial intelligence system, that uses | | | 10|data-based analytics to make, suggest, or recommend certain | | | 11|determinations, decisions, judgments, or conclusions; and | | | 12| 5. "Qualified human professional" means an individual with the | | | 13|training, education and certification required to legally make | | | 14|medical decisions. | | | 15| SECTION 2. NEW LAW A new section of law to be codified | | | 16|in the Oklahoma Statutes as Section 6550.1 of Title 36, unless there | | | 17|is created a duplication in numbering, reads as follows: | | | 18| A. Any adverse determination made by an algorithm, artificial | | | 19|intelligence system, or automated decision system shall be reviewed | | | 20|by a qualified human professional before being finalized. | | | 21| B. The Insurance Commissioner may audit and inspect at any time | | | 22|a utilization review agent's use of an automated decision system for | | | 23|utilization review. | | | 24| | | | Req. No. 15132 Page 2 ___________________________________________________________________________
1| C. This section does not prohibit the use of an algorithm, | | | 2|artificial intelligence system, or automated decision system for | | | 3|administrative support or fraud-detection functions. | | | 4| SECTION 3. NEW LAW A new section of law to be codified | | | 5|in the Oklahoma Statutes as Section 6550.2 of Title 36, unless there | | | 6|is created a duplication in numbering, reads as follows: | | | 7| Notice of an adverse determination must include: | | | 8| 1. The principal reasons for the adverse determination; | | | 9| 2. The clinical basis for the adverse determination; | | | 10| 3. A description of and the source of the screening criteria | | | 11|and review procedures used as guidelines in making the adverse | | | 12|determination; and | | | 13| 4. A description of the procedure for the complaint and appeal | | | 14|process, including notice to the enrollee of the enrollee's right to | | | 15|appeal an adverse determination to an independent review | | | 16|organization and of the procedures to obtain that review. | | | 17| SECTION 4. This act shall become effective November 1, 2026. | | | 18| | | | 19| 60-2-15132 MJ 01/13/26 | | | 20| | | | 21| | | | 22| | | | 23| | | | 24| | | | Req. No. 15132 Page 3