AI LAW RADAR · Daily Last verified 22 Aug 2026

Topic dossier

AI in healthcare & coverage decisions

The rules on AI in medical-necessity, prior-authorization, utilization-review and claims decisions — where a licensed clinician has to make the call and what an insurer has to disclose. 15 obligations across 1 jurisdiction — 10 in force. Next dated deadline: 1 Oct 2026.

This is the quietest and most consequential US cluster: a near-uniform rule that an algorithm may inform a coverage decision but may not be its sole basis. Washington's SB 5395, Iowa's HF 2635, Alabama's SB 63 and Georgia's SB 444 each require human clinical review before an adverse determination; Maryland's HB 820 adds quarterly regulator audits; Utah's SB 319 and Indiana's HB 1271 add disclosure of AI use; and Illinois' SB 3114 extends the same logic to the downcoding of medical claims. The obligations below are the instruments AI Law Radar tracks under this theme, each linked to its primary source and dated to its last check.

The Register

15 obligations · 1 jurisdiction

United States 15

US · MD Binding

Maryland AI Utilization Review Requirements (HB 820 / Ch.747)

Binds Health insurance carriers, PBMs, and private review agents conducting utilization review in Maryland. AI tools in health-care utilization review must base decisions on individual clinical information; AI subject to quarterly MIA audit.

Quarterly review of AI utilization tools for effectiveness, accuracy, and fairness required.

Stated maximum penalty — Maryland Insurance Administration (MIA) enforcement

In force · 1 Oct 2025 checked 13 Aug 2026 HB 820 / Ch.747 ↗ high confidence
US · OR Binding

Oregon Bars Nonhuman Entities from Nursing Titles (HB 2748)

Binds Any nonhuman entity, including AI systems, using a protected nursing title or abbreviation in Oregon. Codified as ORS 678.027: a nonhuman entity, including but not limited to an agent powered by artificial intelligence, may not use the titles or abbreviations Advanced Practice Registered Nurse (APRN), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Registered Nurse (RN), Nurse Practitioner (NP), Certified Medication Aide (CMA), or Certified Nursing Assistant (CNA).

Enrolled House Bill 2748 (HB 2748-A), 83rd Oregon Legislative Assembly — 2025 Regular Session; passed House June 13, 2025, Senate June 11, 2025, signed by Gov. Kotek; codified 2025 c.378 §2 (ORS 678.027). The enrolled act contains only Sections 1 and 2 and no effective-date clause, so ORS 171.022 controls: "Except as otherwise provided in the Act, an Act of the Legislative Assembly takes effect on January 1 of the year after passage of the Act" — passed 2025, therefore in force Jan. 1, 2026.

Stated maximum penalty — Violation of ORS 678.010 to 678.415 (which includes 678.027) is a Class C misdemeanor — ORS 678.990(1)

In force · 1 Jan 2026 checked 14 Aug 2026 OR HB 2748 (2025 c.378 §2; ORS 678.027) ↗ high confidence
US · CA Binding

California Extends Health-Profession Title-Protection Law to AI (AB 489)

Binds Any person or entity that develops or deploys AI/GenAI systems using health-profession-protected terms, letters, or phrases (broader than nursing — covers all licensed healing-arts professions, e.g. medicine, dentistry, psychology). Adds Bus. & Prof. Code §§ 4999.8-4999.9: makes existing law that bars falsely indicating or implying possession of a health-care license (e.g., under the Medical Practice Act, Dental Practice Act) enforceable against any person or entity that develops or deploys an AI or GenAI system using protected terms, letters, or phrases in its advertising or functionality. Separately prohibits AI/GenAI use of terms implying that care, advice, reports, or assessments are provided by a licensed natural person. Each prohibited use is a separate violation.

AB 489 (Bonta), approved by Governor and filed with Secretary of State Oct. 11, 2025; no urgency clause, so it took effect Jan. 1, 2026 under the default California statutory effective-date rule (Cal. Const. art. IV, §8(c)).

Stated maximum penalty — Enforced via the applicable health-care licensing board's injunctive authority (Bus. & Prof. Code §125.5) plus the penalty already attached to the underlying title-protection provision being invoked (e.g., unauthorized practice of medicine under §2052 is a public offense punishable by up to 1 year in county jail and/or a $10,000 fine)

In force · 1 Jan 2026 checked 14 Aug 2026 CA AB 489 (Bus. & Prof. Code §§ 4999.8-4999.9) ↗ high confidence
US · DE Binding

Delaware AI Agents Barred from Medical/Nursing Licensure and Titles (HB 191)

Binds Any person or entity deploying or offering an AI agent in Delaware that would be licensed as, or presented under the title of, a nurse, physician, or physician assistant. A nonhuman entity, including an agent powered by artificial intelligence, may not be licensed or certified to practice professional nursing, advanced practice registered nursing, practical nursing, medicine, or as a physician assistant in Delaware, and may not use the associated protected titles — "Nurse", "RN", "LPN", "APRN", "CRNA", "CNS", "CNP", "CNM", "Doctor"/"Dr.", "Physician", "Surgeon", "MD", "DO", "Physician Assistant"/"PA". Amends 24 Del. C. §§ 1920, 1720, 1773. Does not restrict AI clinical decision-support or documentation tools that do not hold themselves out under a licensed title.

Signed by Gov. Meyer and approved April 23, 2026 as 85 Del. Laws ch. 250; no delayed-effective-date clause, so effective on enactment.

Stated maximum penalty — Medicine: class F felony, $1,000–$5,000 fine and/or up to 3 years (24 Del. C. § 1766(a)); other Ch. 17 violations class B misdemeanor (§ 1766(c)). Nursing/title misuse: up to $1,000 and/or 1 year (24 Del. C. § 1925)

In force · 23 Apr 2026 checked 14 Aug 2026 DE HB 191 (85 Del. Laws ch. 250) ↗ high confidence
US · WA Binding

Washington Prior Authorization AI Transparency Act (SB 5395)

Binds Private health carriers and public employee health plans using AI in prior authorization in Washington. AI cannot be sole basis for denying health care services; human clinical review required for AI-generated denials.

Annual reporting to OIC on AI-generated prior auth statistics required.

Stated maximum penalty — OIC enforcement (civil penalties; license actions)

In force · 11 Jun 2026 checked 13 Aug 2026 SB 5395 ↗ high confidence
US · WA Binding

Washington Bars Nonhuman Entities from Nursing Titles (HB 2155)

Binds Any person or nonhuman entity (including AI systems, chatbots, and automated triage/care tools) presenting itself under a protected nursing title or abbreviation in Washington. Amends RCW 18.79.030: only a human person licensed under ch. 18.79 RCW may practice as, or use the titles of, a registered nurse ("RN"), advanced practice registered nurse/nurse practitioner ("APRN"/"NP"), or licensed practical nurse ("LPN"). No other person or any nonhuman entity may assume those titles or abbreviations, or use other words, letters, signs, or figures indicating it is a nurse.

House Bill 2155, 2026 Regular Session, passed House Feb. 11, 2026 (87-8) and Senate Feb. 26, 2026 (46-2); delivered to Governor Mar. 3 and signed Mar. 9, 2026 as Chapter 6, 2026 Laws. The enrolled act contains no effective-date section; the Legislature's own bill record states "Effective date 6/11/2026" (Washington's default general effective date, 90 days after sine die). Sec. 1 (in force) expires June 30, 2027, when Sec. 2 (an equivalent re-enactment) takes over.

Stated maximum penalty — Enforced as unlicensed practice under RCW 18.130.190: civil fine up to $1,000/day (18.130.190(3)); first violation is a gross misdemeanor, subsequent violations a class C felony (18.130.190(7))

In force · 11 Jun 2026 checked 14 Aug 2026 WA HB 2155 (amending RCW 18.79.030) ↗ high confidence
US · RI Binding

Rhode Island Healthcare AI Documentation Act (H 7538)

Binds Healthcare providers (physicians, PAs, dentists, RNs, LPNs, APRNs, nursing assistants, other DOH-licensed professionals) and healthcare facilities (§ 23-17-2) in Rhode Island. R.I. Gen. Laws ch. 23-106. Healthcare providers and healthcare facilities that employ AI to document in-person or telehealth visits must notify patients of that use and must review the AI-generated documentation for accuracy after the visit (§ 23-106-3).

Enacted as Substitute A (LC004720/SUB A) creating R.I. Gen. Laws ch. 23-106; signed 22 June 2026; effective upon passage. Verified against the enacted Sub A text 2026-08-10.

Stated maximum penalty — RI healthcare licensing enforcement

In force · 22 Jun 2026 checked 13 Aug 2026 H 7538 ↗ high confidence
US · IA Binding

Iowa AI Prior Authorization Restrictions (HF 2635)

Binds Health carriers and utilization review organizations operating in Iowa. AI cannot be sole basis for denying medically necessary services; human clinical review required for adverse determinations.

Electronic prior authorization required from 2027-07-01.

Stated maximum penalty — Iowa Insurance Division enforcement

In force · 1 Jul 2026 checked 13 Aug 2026 HF 2635 ↗ high confidence
US · CO Binding

Colorado Psychotherapy AI Restrictions (HB 26-1195)

Binds Regulated psychotherapy professionals in Colorado using AI; any entity misrepresenting AI as professional-equivalent. AI cannot deliver psychotherapy without licensed professional's real-time involvement; disclosure and written consent required.

Signed 3 Jun 2026 by Gov. Polis; enacted without a safety clause, so the general post-session effective date applies. IN FORCE since 12 Aug 2026 — the Colorado General Assembly bill record (leg.colorado.gov/bills/hb26-1195) lists the session law as Chapter 358 with Effective Date 08/12/2026, re-confirmed on the day of entry into force. No amendments or delays. Unaffected by the federal court injunction pausing CO SB 26-189 (the broader Colorado AI Act). AG holds exclusive enforcement; $20,000 per violation; 60-day cure period.

Stated maximum penalty — Unfair trade practice (CO Consumer Protection Act; AG enforcement); $20,000 per violation

In force · 12 Aug 2026 checked 13 Aug 2026 HB 26-1195 ↗ high confidence
US · AL Binding

Alabama AI Health Insurance Transparency Act (SB 63)

Binds Health insurers using AI in coverage determinations in Alabama. AI may not be sole basis for coverage denial; health insurers must disclose AI use and file annual certification with Alabama DOI.

Annual certification to Alabama DOI required.

Stated maximum penalty — Alabama DOI disciplinary action (license revocation/suspension)

Applies 1 Oct 2026 checked 22 Aug 2026 SB 63 ↗ high confidence
US · GA Binding

Georgia AI Prior Authorization Act (SB 444)

Binds Health insurers and utilization review entities in Georgia. AI prohibited from issuing adverse prior-authorization determinations without licensed clinical peer review.

Stated maximum penalty — Georgia Insurance Commissioner enforcement

Applies 1 Jan 2027 checked 22 Aug 2026 SB 444 ↗ high confidence
US · UT Binding

Utah AI Prior Authorization Disclosure Act (SB 319)

Binds Health insurers operating in Utah for prior authorization processes. Insurers must disclose AI use in prior authorization reviews; adverse determinations must reflect independent medical judgment.

Stated maximum penalty — Disclosure to Utah Insurance Department required

Applies 1 Jan 2027 checked 20 Aug 2026 SB 319 ↗ high confidence
US · CO Binding

Colorado Healthcare AI Utilization Review Act (HB 26-1139)

Binds Health insurers, pharmacy benefit managers, and managed care entities using AI for utilization review in Colorado. Health insurers and managed care entities using AI for coverage determinations must require human clinician review before denying coverage; AI decisions must be individualized and non-discriminatory; periodic audits required.

Signed June 2, 2026; effective January 1, 2027.

Stated maximum penalty — State insurance enforcement; penalty amount not specified in primary source

Applies 1 Jan 2027 checked 22 Aug 2026 HB 26-1139 ↗ high confidence
US · IL Binding

Illinois Transparency in Downcoding Act (SB 3114 / PA 104-0568)

Binds Health insurance issuers and managed care organizations in Illinois (excludes self-insured ERISA plans and workers' compensation). Prohibits health insurers and managed care organizations from using algorithms or automated tools to downcode medical claims without comprehensive human review; requires AMA CPT coding guideline-compliant physician review of all downcoding determinations; bans discriminatory targeting of providers treating complex/chronic patients.

Signed 2026-07-10 by Governor Pritzker; effective 2028-01-01.

Stated maximum penalty — Fines, restitution, or license suspension (IL Department of Insurance enforcement)

Applies 1 Jan 2028 checked 13 Aug 2026 SB 3114 / PA 104-0568 ↗ high confidence

Questions & answers

From the data

Can an insurer deny a claim using AI alone?

Not in the states tracked here. Washington, Iowa, Alabama, Georgia and Colorado all bar AI from being the sole basis of an adverse coverage or medical-necessity determination, requiring review by a licensed clinician or clinical peer before the denial issues.

Does an insurer have to disclose that it uses AI?

In several states, yes. Utah's SB 319 requires disclosure of AI use in prior-authorization review, Indiana's HB 1271 requires disclosure in adverse determinations, and Alabama's SB 63 adds an annual certification filed with the state Department of Insurance.

What about AI used in the clinic rather than by an insurer?

Rhode Island's H 7538 covers the provider side: healthcare providers using AI transcription during clinical visits document that use and notify patients. Most of the rest of this theme sits with payers and utilization-review entities.

Which jurisdictions does AI Law Radar track for healthcare & coverage decisions?

We currently track healthcare & coverage decisions obligations across 1 jurisdiction: United States. Each is dated and linked to its primary source on this page.