Artificial intelligence-based algorithm; use; restrictions; automated utilization management system; audit.

(1) An artificial intelligence-based algorithm shall not be the sole basis of a utilization review agent's decision to deny, delay, or modify health care services based, in whole or in part, on medical necessity. (2) A utilization review agent shall disclose to the department, to each health care provider in its network, to each enrollee, and on its public website if artificial intelligence-based algorithms are used or will be used in the utilization review process. (3) The department may, at any time, audit a utilization review agent's automated utilization management system. The department may contract with a third-party entity to perform an audit pursuant to this section.