,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #ajbaj  ,,9 ,,! ,,h\se ,,(         
,,repres5tatives  ,septemb] #a1         
#bjbf,mr4 ,l&sman 7= himself1 ,mr4 ,c>t]
 ( ,georgia1 ,ms4 ,s*ri]1 & ,mr4        
,b>rett7 introduc$ ! foll[+ bill2 :i* 0 
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce1 & 9 addition to ! ,committees 
on ,ways & ,means1 & ,education &       
,work=ce1 = a p]iod to be subsequ5tly   
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xxvii ( !     
,public ,heal? ,s]vice ,act1 ! ,employee
 ,retirem5t ,income ,security ,act (    
#aigd1 & ! ,int]nal ,rev5ue ,code (     
#aihf to regulate ! use ( artificial    
intellig5ce 9 ! review ( claims by gr\p 
heal? plans & heal? insurance issu]s    
(f]+ gr\p or individual heal? insurance 
cov]age4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,doctors ,n ,,ai ,act (     
#bjbf4  #b4 ,am5dm5ts to ! ,public      
,heal? ,s]vice ,act  7a7 ,def9ition (   

artificial intellig5ce sy/em ,section   
#bgia ( ! ,public ,heal? ,s]vice ,act   
7#db ,u4,s4,c4 #cjjii-ia7 is am5d$ by   
add+ at ! end ! foll[+3  7g7 ,! t]m     
artificial intellig5ce sy/em means an   
eng9e]$ or ma*9e-bas$ sy/em1 includ+ any
 algori?m1 pr$ictive model1 ma*9e le>n+ 
sy/em1 or automat$ decision-mak+ s(tw>e1
 t processes data to g5]ate pr$ictions1 
classifications1 recomm5dations1 or     
decisions & t is us$ to mat]ially       
influ5ce1 automate1 or issue            
det]m9ations reg>d+ cov]age ( heal? c>e 
items or s]vices4  4  7b7 ,cl9ical      
judgm5t & artificial intellig5ce ,!     
,public ,heal? ,s]vice ,act is am5d$ by 
ins]t+ aft] section #bgai;,a 7#db       
,u4,s4,c4 #cjj;gg-#ai;a7 ! foll[+ new   
section3  #bgai;,b4 ,cl9ical judgm5t &  
artificial intellig5ce  7a7 ,9 g5]al ,a 
gr\p heal? plan & a heal? insurance     
issu] (f]+ gr\p or individual heal?     
insurance cov]age %all ensure t any     
adv]se b5efit det]m9ation1 :e!r         
initially or ^u appeal1 involv+ cl9ical 

judgm5t-- 7#a7 is n issu$ by an         
artificial intellig5ce sy/em & is n     
dictat$ or det]m9$ by ! output ( su*    
sy/em2  7#b7 is made only by a lic5s$   
heal? c>e pr(essional :o is act+ )9 !   
scope ( ! pr(essional's lic5se & :o has 
tra9+ & exp]i5ce 9 ! provision ( ! heal?
 c>e item or s]vice t is ! subject ( !  
det]m9ation2  7#c7 reflects ! indep5d5t 
cl9ical judgm5t ( su* pr(essional1 :o   
%all conduct an indep5d5t evaluation ( !
 enrollee's individual m$ical           
circum/ances & %all n treat any output (
 an artificial intellig5ce sy/em z      
presumptively valid or def] to su*      
output 9 lieu ( indep5d5t cl9ical       
judgm5t apply+ g5]ally accept$ /&>ds (  
c>e2  7#d7 includes1 9 ! notice requir$ 
"u section #bgai1 if an artificial      
intellig5ce sy/em 0 us$ 9 connection ) !
 det]m9ation-- 7,a7 a /atem5t t su*     
sy/em 0 us$2  7,b7 a description ( its  
role 9 ! review process2 &  7,c7 ! "n1  
pr(essional lic5se1 & cr$5tials ( !     
lic5s$ heal? c>e pr(essional :o made !  

det]m9ation2 &  7#e7 is support$ by     
docum5tation ma9ta9$ z "p ( !           
adm9i/rative record describ+-- 7,a7 !   
artificial intellig5ce sy/em us$2  7,b7 
! role ( su* sy/em 9 ! review process2  
7,c7 any outputs1 scores1               
recomm5dations1 or det]m9ations g5]at$  
by su* sy/em2 &  7,d7 docum5tation      
demon/rat+ compliance ) subp>agraph     
7,c72 &  su* mat]ials %all be consid]$  
"p ( ! adm9i/rative record & made       
available to ! enrollee ^u reque/4  7b7 
,def9itions ,= purposes ( ?is section3  
7#a7 ,adv]se b5efit det]m9ation ,! t]m  
adv]se b5efit det]m9ation includes an   
initial det]m9ation & a det]m9ation on  
int]nal appeal4  7#b7 ,adv]se b5efit    
det]m9ation involv+ cl9ical judgm5t ,!  
t]m adv]se b5efit det]m9ation involv+   
cl9ical judgm5t means an adv]se b5efit  
det]m9ation t is bas$1 9 :ole or 9 "p1  
on m$ical necessity1 appropriat5ess1    
exp]im5tal & inve/igational or simil>   
exclusions or limits1 level ( c>e1 heal?
 c>e sett+1 effectiv5ess1 cl9ical       

guidel9es1 utilization review crit]ia1  
o!r /&>ds requir+ evaluation ( !        
enrollee's m$ical condition or treatm5t 
ne$s1 or g5]ally accept$ /&>ds ( c>e =  
su* treatm5t ne$s4  4  7c7 ,p>ity       
treatm5t ( artificial intellig5ce sy/ems
 ,section #bgbf ( ! ,public ,heal?      
,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#bf7
 is am5d$-- 7#a7 9 subsection           
7a77#h77;,a71 by add+ at ! end ! foll[+ 
new clause3  7vi7 ,:e!r an artificial   
intellig5ce sy/em is us$ 91 or mat]ially
 influ5ces1 ! design1 developm5t1       
application1 or adm9i/ration ( su*      
limitation &1 if s1 suffici5t in=mation 
reg>d+ ! function1 op]ation1 & effects (
 su* sy/em to enable ! ,secret>y to     
evaluate su* function1 op]ation1 &      
effects "u su* limitation ) respect to  
m5tal heal? or sub/ance use disord]     
b5efits z comp>$ to m$ical & surgical   
b5efits1 bo? z writt5 & 9 op]ation4  2 &
  7#b7 by add+ at ! end ! foll[+3  7f7  
,artificial intellig5ce & utilization   
review ,! use ( an artificial           

intellig5ce sy/em 9 connection )        
utilization review %all con/itute a     
treatm5t limitation = purposes ( ?is    
section4  4  #c4 ,am5dm5ts to !         
,employee ,retirem5t ,income ,security  
,act ( #aigd  7a7 ,def9ition (          
artificial intellig5ce sy/em ,section #c
 ( ! ,employee ,retirem5t ,income       
,security ,act ( #aigd 7#bi ,u4,s4,c4   
#ajjb7 is am5d$ by add+ at ! end !      
foll[+3  7#dh7 ,! t]m artificial        
intellig5ce sy/em means an eng9e]$ or   
ma*9e-bas$ sy/em1 includ+ any algori?m1 
pr$ictive model1 ma*9e le>n+ sy/em1 or  
automat$ decision-mak+ s(tw>e1 t        
processes data to g5]ate pr$ictions1    
classifications1 recomm5dations1 or     
decisions & t is us$ to mat]ially       
influ5ce1 automate1 or issue            
det]m9ations reg>d+ cov]age ( heal? c>e 
items or s]vices4  4  7b7 ,claims       
proc$ure requirem5ts ,section #ejc ( !  
,employee ,retirem5t ,income ,security  
,act ( #aigd 7#bi ,u4,s4,c4 #aacc7 is   
am5d$--  7#a7 9 p>agraph 7#b71 by /rik+ 

! p]iod at ! end & ins]t+ 2 &2 &  7#b7  
by add+ at ! end ! foll[+3  7#c7 ensure 
t any adv]se b5efit det]m9ation1 :e!r   
initially or ^u appeal1 involv+ cl9ical 
judgm5t-- 7,a7 is n issu$ by an         
artificial intellig5ce sy/em & is n     
dictat$ or det]m9$ by ! output ( su*    
sy/em2  7,b7 is made only by a lic5s$   
heal? c>e pr(essional :o is act+ )9 !   
scope ( ! pr(essional's lic5se & :o has 
tra9+ & exp]i5ce 9 ! provision ( ! heal?
 c>e item or s]vice t is ! subject ( !  
det]m9ation2  7,c7 reflects ! indep5d5t 
cl9ical judgm5t ( su* pr(essional1 :o   
%all conduct an indep5d5t evaluation ( !
 p>ticipant's or b5efici>y's individual 
m$ical circum/ances & %all n treat any  
output ( an artificial intellig5ce sy/em
 z presumptively valid or def] to su*   
output 9 lieu ( indep5d5t cl9ical       
judgm5t apply+ g5]ally accept$ /&>ds (  
c>e2  7,d7 includes1 9 ! notice requir$ 
"u p>agraph 7#a71 if an artificial      
intellig5ce sy/em 0 us$ 9 connection ) !
 det]m9ation-- 7i7 a /atem5t t su* sy/em

 0 us$2  7ii7 a description ( its role 9
 ! review process2 &  7iii7 ! "n1       
pr(essional lic5se1 & cr$5tials ( !     
lic5s$ heal? c>e pr(essional :o made !  
det]m9ation2 &  7,e7 is support$ by     
docum5tation ma9ta9$ z "p ( !           
adm9i/rative record describ+-- 7i7 !    
artificial intellig5ce sy/em us$2  7ii7 
! role ( su* sy/em 9 ! review process2  
7iii7 any outputs1 scores1              
recomm5dations1 or det]m9ations g5]at$  
by su* sy/em2 &  7iv7 docum5tation      
demon/rat+ compliance ) subp>agraph     
7,c72 &  su* mat]ials %all be consid]$  
"p ( ! adm9i/rative record & made       
available to ! p>ticipant or b5efici>y  
^u reque/4  ,= purposes ( ?is p>agraph1 
! t]m adv]se b5efit det]m9ation includes
 an initial det]m9ation & a det]m9ation 
on int]nal appeal1 & ! t]m adv]se b5efit
 det]m9ation involv+ cl9ical judgm5t    
means an adv]se b5efit det]m9ation t is 
bas$1 9 :ole or 9 "p1 on m$ical         
necessity1 appropriat5ess1 exp]im5tal & 
inve/igational or simil> exclusions or  

limits1 level ( c>e1 heal? c>e sett+1   
effectiv5ess1 cl9ical guidel9es1        
utilization review crit]ia1 o!r /&>ds   
requir+ evaluation ( ! p>ticipant's or  
b5efici>y's m$ical condition or treatm5t
 ne$s1 or g5]ally accept$ /&>ds ( c>e = 
su* treatm5t ne$s4 4  7c7 ,p>ity        
treatm5t ( artificial intellig5ce sy/ems
 ,section #gab ( ! ,employee ,retirem5t 
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #aahe;a7 is am5d$---  7#a7 9  
subsection 7a77#h77;,a71 by add+ at !   
end ! foll[+ new clause3  7vi7 ,:e!r an 
artificial intellig5ce sy/em is us$ 91  
or mat]ially influ5ces1 ! design1       
developm5t1 application1 or adm9i/ration
 ( su* limitation &1 if s1 suffici5t    
in=mation reg>d+ ! function1 op]ation1 &
 effects ( su* sy/em to enable !        
,secret>y to evaluate su* function1     
op]ation1 & effects "u su* limitation ) 
respect to m5tal heal? or sub/ance use  
disord] b5efits z comp>$ to m$ical &    
surgical b5efits1 bo? z writt5 & 9      
op]ation4  2 &  7#b7 by add+ at ! end ! 

foll[+3  7h7 ,artificial intellig5ce &  
utilization review ,! use ( an          
artificial intellig5ce sy/em 9          
connection ) utilization review %all    
con/itute a treatm5t limitation =       
purposes ( ?is section4  4  #d4         
,am5dm5ts to ! ,int]nal ,rev5ue ,code ( 
#aihf  7a7 ,def9ition ( artificial      
intellig5ce sy/em ,section #ihcb ( !    
,int]nal ,rev5ue ,code ( #aihf is am5d$ 
by add+ at ! end ! foll[+ new p>agraph3 
7#aa7 ,artificial intellig5ce sy/em ,!  
t]m artificial intellig5ce sy/em means  
an eng9e]$ or ma*9e-bas$ sy/em1 includ+ 
any algori?m1 pr$ictive model1 ma*9e    
le>n+ sy/em1 or automat$ decision-mak+  
s(tw>e1 t processes data to g5]ate      
pr$ictions1 classifications1            
recomm5dations1 or decisions & t is us$ 
to mat]ially influ5ce1 automate1 or     
issue det]m9ations reg>d+ cov]age (     
heal? c>e items or s]vices4  4  7b7     
,cl9ical judgm5t & artificial           
intellig5ce ,sub*apt] ,b ( *apt] #ajj ( 
! ,int]nal ,rev5ue ,code ( #aihf is     

am5d$ by ins]t+ aft] section #ihae !    
foll[+ new section3  #ihae;,a4 ,cl9ical 
judgm5t & artificial intellig5ce  7a7 ,9
 g5]al ,a gr\p heal? plan %all ensure t 
any adv]se b5efit det]m9ation1 :e!r     
initially or ^u appeal1 involv+ cl9ical 
judgm5t--  7#a7 is n issu$ by an        
artificial intellig5ce sy/em & is n     
dictat$ or det]m9$ by ! output ( su*    
sy/em2  7#b7 is made only by a lic5s$   
heal? c>e pr(essional :o is act+ )9 !   
scope ( ! pr(essional's lic5se & :o has 
tra9+ & exp]i5ce 9 ! provision ( ! heal?
 c>e item or s]vice t is ! subject ( !  
det]m9ation2  7#c7 reflects ! indep5d5t 
cl9ical judgm5t ( su* pr(essional1 :o   
%all conduct an indep5d5t evaluation ( !
 p>ticipant's or b5efici>y's individual 
m$ical circum/ances & %all n treat any  
output ( an artificial intellig5ce sy/em
 z presumptively valid or def] to su*   
output 9 lieu ( indep5d5t cl9ical       
judgm5t apply+ g5]ally accept$ /&>ds (  
c>e2  7#d7 includes1 9 ! notice requir$ 
"u ?is *apt]1 if an artificial          

intellig5ce sy/em 0 us$ 9 connection ) !
 det]m9ation--  7,a7 a /atem5t t su*    
sy/em 0 us$2  7,b7 a description ( its  
role 9 ! review process2 &  7,c7 ! "n1  
pr(essional lic5se1 & cr$5tials ( !     
lic5s$ heal? c>e pr(essional :o made !  
det]m9ation2  7#e7 is support$ by       
docum5tation ma9ta9$ z "p ( !           
adm9i/rative record describ+--  7,a7 !  
artificial intellig5ce sy/em us$2  7,b7 
! role ( su* sy/em 9 ! review process2  
7,c7 any outputs1 scores1               
recomm5dations1 or det]m9ations g5]at$  
by su* sy/em2 &  7,d7 docum5tation      
demon/rat+ compliance ) subp>agraph     
7,c72  & su* mat]ials %all be consid]$  
"p ( ! adm9i/rative record & made       
available to ! p>ticipant or b5efici>y  
^u reque/4  7b7 ,def9itions ,= purposes 
( ?is section-- 7#a7 ,adv]se b5efit     
det]m9ation ,! t]m adv]se b5efit        
det]m9ation includes an initial         
det]m9ation & a det]m9ation on int]nal  
appeal4  7#b7 ,adv]se b5efit det]m9ation
 involv+ cl9ical judgm5t ,! t]m adv]se  

b5efit det]m9ation involv+ cl9ical      
judgm5t means an adv]se b5efit          
det]m9ation t is bas$1 9 :ole or 9 "p1  
on m$ical necessity1 appropriat5ess1    
exp]im5tal & inve/igational or simil>   
exclusions or limits1 level ( c>e1 heal?
 c>e sett+1 effectiv5ess1 cl9ical       
guidel9es1 utilization review crit]ia1  
o!r /&>ds requir+ evaluation ( !        
p>ticipant's or b5efici>y's m$ical      
condition or treatm5t ne$s1 or g5]ally  
accept$ /&>ds ( c>e = su* treatm5t ne$s4
  4  7c7 ,p>ity treatm5t ,section #ihab 
( ! ,int]nal ,rev5ue ,code ( #aihf is   
am5d$--  7#a7 9 subsection 7a77#h77;,a71
 by add+ at ! end ! foll[+ new clause3  
7vi7 ,:e!r an artificial intellig5ce    
sy/em is us$ 91 or mat]ially influ5ces1 
! design1 developm5t1 application1 or   
adm9i/ration ( su* limitation &1 if s1  
suffici5t in=mation reg>d+ ! function1  
op]ation1 & effects ( su* sy/em to      
enable ! ,secret>y to evaluate su*      
function1 op]ation1 & effects "u su*    
limitation ) respect to m5tal heal? or  

sub/ance use disord] b5efits z comp>$ to
 m$ical & surgical b5efits1 bo? z writt5
 & 9 op]ation4  2 &  7#b7 by add+ at !  
end ! foll[+3  7f7 ,artificial          
intellig5ce & utilization review ,! use 
( an artificial intellig5ce sy/em 9     
connection ) utilization review %all    
con/itute a treatm5t limitation =       
purposes ( ?is section4  4  7d7 ,cl]ical
 am5dm5t ,! table ( sections = sub*apt] 
,b ( *apt] #ajj ( ! ,int]nal ,rev5ue    
,code ( #aihf is am5d$ by ins]t+ aft] ! 
item relat$ to section #ihae ! foll[+   
new item3  ,sec4 #ihae;,a4 ,cl9ical     
judgm5t & artificial intellig5ce4  4    
#e4 ,effective date ,! am5dm5ts made by 
?is ,act %all apply to plan ye>s beg9n+ 
on or aft] ,janu>y #a ( ! fir/ cal5d>   
ye> beg9n+ n less ?an #ab mon?s aft] !  
date ( ! enactm5t ( ?is ,act4