Binding law — in force
From 2026-10-01, a health benefit plan provider must make prominent written disclosure regarding its use of artificial intelligence in utilization review in its policies and procedures (SB 63 sec. 1(c)(1)), satisfied by an authorized representative's attestation based on reasonable reliance on internal policies, procedures and third-party vendors (sec. 1(c)(4)). Detect the absence of a written AI-use disclosure in the utilization-review policies.
al-sb63.ai-use-disclosure-in-policies · Ala. SB 63 (2026), sec. 1(c)(1) · official source · jurisdictions: US-AL
The guard to add, and how far to trust this rule
Binding law — in force
From 2026-10-01, a health benefit plan provider must certify annually to the Department of Insurance that the artificial intelligence used for medical-necessity determinations on prior authorization is fairly and equitably applied, including under HHS regulations and guidance, and does not discriminate, directly or indirectly, against any subscriber group or enrollee in violation of state or federal law (SB 63 sec. 1(b)(2)b-c), and must ensure that its use of AI and the outcomes it generates are reviewed on a periodic basis to maximize accuracy and reliability and ensure compliance with subsection (b) (sec. 1(c)(2)); the requirements are satisfied by an attestation of an authorized representative based on reasonable reliance on internal policies, procedures and third-party vendors (sec. 1(c)(4)). Detect the absence of a periodic accuracy, outcome and disparity review supporting the annual certification.
al-sb63.annual-certification-fairness-and-periodic-review · Ala. SB 63 (2026), sec. 1(b)(2) (to the page break) · official source · jurisdictions: US-AL
The guard to add, and how far to trust this rule
Binding law — in force
From 2026-10-01, a health benefit plan provider that uses artificial intelligence to make determinations of medical necessity on prior-authorization requests must base them on all of the enrollee's medical history, any clinical circumstances unique to the enrollee presented by the requesting provider, and additional clinical information in the enrollee's medical record (SB 63 sec. 1(b)(1)), and must certify annually to the Department that the AI does not rely on a group dataset to make determinations (sec. 1(b)(2)a). Detect utilization-review model calls built without the member's clinical record or the provider's submission.
al-sb63.individual-clinical-data-basis · Ala. SB 63 (2026), sec. 1(b)(1) · official source · jurisdictions: US-AL
The guard to add, and how far to trust this rule
Binding law — in force
From 2026-10-01, every decision to deny, delay or modify a prior-authorization request on medical-necessity grounds is for a licensed physician or other health care professional able to weigh what the AI recommends or concludes against the clinical issues unique to the enrollee or raised by the treating provider (SB 63 sec. 1(b)(3)). Detect automated output that sets a denial, delay or modification without that professional's decision.
al-sb63.licensed-reviewer-decides-denial · Ala. SB 63 (2026), sec. 1(b)(3) · official source · jurisdictions: US-AL
The guard to add, and how far to trust this rule
Binding law — in force
From 2026-10-01, a health benefit plan provider must ensure that patient data used in utilization review functions by artificial intelligence is not used beyond its intended and stated purpose, consistent with HIPAA (SB 63 sec. 1(c)(3)). Detect utilization-review patient data flowing to model training or fine-tuning, marketing lists or product analytics.
al-sb63.patient-data-purpose-limit · Ala. SB 63 (2026), sec. 1(c)(3) · official source · jurisdictions: US-AL
The guard to add, and how far to trust this rule
