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Senate strike requires an individual medical director review before denial of prior authorization or claim
Summary
Senate amendments to HB 2175 remove an outright AI prohibition and instead require that any denial of a claim or prior authorization on medical necessity grounds be reviewed individually by a medical director exercising independent medical judgment; bill contains a delayed effective date of June 30, 2026.
House Bill 21-75, subject to a Senate strike‑everything amendment, now addresses prior authorization claims. The Senate version requires that before a health-care insurer may deny a provider‑submitted claim or prior authorization on the basis of medical necessity, that denial must be reviewed individually by a medical director who must exercise independent medical judgment and may not rely solely on recommendations from other sources.
Staff explained that the House version had included explicit language about artificial intelligence; the Senate strike removed the category‑level prohibition and replaced it with an individual medical director review requirement. The bill includes a delayed effective date of June 30, 2026. Representative Aguilar said the change was intended to prevent automatic denials by AI systems, and caucus members said they hoped the amendment would reduce automatic claim refusals.
No caucus motion or vote was recorded; staff will follow up on technical definitions (for example, whether the bill’s language constrains use of decision-support tools) as members requested.
