Law / United States / 
Texas
S.B. 815 (2025), utilization review agent ban on automated decision systems for adverse determinations
In force since .
An AI sector rules rule binding private bodies.
- Criminal exposure
- No
- Obligation class
- Prohibition
- Audit expectation
- none
As of .
What it requires
- If you are a utilization review agent, do not use an automated decision system, including one that incorporates an AI system, to make an adverse determination wholly or partly; an algorithm, AI system or automated decision system may still be used for administrative support or fraud detection.NIST AI RMFMAP 3.5
- Include in each notice of an adverse determination a description of and the source of the screening criteria and review procedures used as guidelines in making the adverse determination.no control in the NIST AI RMF
These lines are LexLint's reading of the law's text, as of .
In the frameworks
- NIST AI RMF
- MAP 3.5Processes for human oversight are defined, assessed, and documented in accordance with organizational policies from the GOVERN function.
Our reading of where this law's duties sit in each framework, and in the NIST AI RMF, line by line beside each duty above. It never says that running a control meets the law. How we read a framework against the law
What it makes you log
Logging duty
Section 4201.156 bars the use of an automated decision system for adverse determinations and lets the commissioner audit and inspect a utilization review agent's use of one. It states no duty to create, keep, or produce a log or record.
- Kind
- None
- As of
What this law does
Senate Bill 815 added Section 4201.156 to the Texas Insurance Code, under which a utilization review agent may not use an automated decision system to make, wholly or partly, an adverse determination. An automated decision system is an algorithm, including an algorithm incorporating an artificial intelligence system, that uses data-based analytics to make, suggest, or recommend certain determinations, decisions, judgments, or conclusions.
An adverse determination is a determination by a utilization review agent that health care services provided or proposed to be provided to a patient are not medically necessary or appropriate or are experimental or investigational. The ban does not prohibit the use of an algorithm, artificial intelligence system, or automated decision system for administrative support or fraud-detection functions.
The commissioner may audit and inspect at any time a utilization review agent's use of an automated decision system for utilization review. A notice of an adverse determination must include a description of and the source of the screening criteria and review procedures used as guidelines in making the adverse determination. The amended chapter applies only to utilization review conducted for a health benefit plan delivered, issued for delivery, or renewed on or after . The act is Chapter 989 of the Acts of the 89th Legislature, Regular Session. The act took effect .
When LexLint raises it
When your app profile says your app handles health records or is an insurer.