Shown verbatim: the complete text as captured from the official PDF posted by the Oklahoma Legislature, fetched 2026-07-23. Page and line markers are part of the official record; nothing is edited or removed. The official bill page.
1 STATE OF OKLAHOMA
2 2nd Session of the 60th Legislature (2026)
3 HOUSE BILL 3675 By: Provenzano
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6 AS INTRODUCED
7 An Act relating to health insurance; providing
definitions; prohibiting utilization review agents
8 from using an automated system to make adverse
determinations; permitting Insurance Commissioner
9 auditing authority; clarifying act does not prohibit
use of automated decision systems for administrative
10 support or fraud detection; directing notice of
adverse determinations to include certain
11 information; providing for codification; and
providing an effective date.
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15 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
16 SECTION 1. NEW LAW A new section of law to be codified
17 in the Oklahoma Statutes as Section 6550 of Title 36, unless there
18 is created a duplication in numbering, reads as follows:
19 As used in this act:
20 1. "Adverse determination" means a determination by a
21 utilization review agent that health care services provided or
22 proposed to be provided to a patient are not medically necessary or
23 appropriate, or are experimental or investigational;
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Req. No. 15132 Page 1
1 2. "Algorithm" means a computerized procedure consisting of a
2 set of steps used to accomplish a determined task;
3 3. "Artificial intelligence system" means any machine learning-
4 based system that, for any explicit or implicit objective, infers
5 from the inputs the system receives how to generate outputs,
6 including content, decisions, predictions, and recommendations, that
7 can influence physical or virtual environments;
8 4. "Automated decision system" means an algorithm, including an
9 algorithm incorporating an artificial intelligence system, that uses
10 data-based analytics to make, suggest, or recommend certain
11 determinations, decisions, judgments, or conclusions; and
12 5. "Qualified human professional" means an individual with the
13 training, education and certification required to legally make
14 medical decisions.
15 SECTION 2. NEW LAW A new section of law to be codified
16 in the Oklahoma Statutes as Section 6550.1 of Title 36, unless there
17 is created a duplication in numbering, reads as follows:
18 A. Any adverse determination made by an algorithm, artificial
19 intelligence system, or automated decision system shall be reviewed
20 by a qualified human professional before being finalized.
21 B. The Insurance Commissioner may audit and inspect at any time
22 a utilization review agent's use of an automated decision system for
23 utilization review.
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Req. No. 15132 Page 2
1 C. This section does not prohibit the use of an algorithm,
2 artificial intelligence system, or automated decision system for
3 administrative support or fraud-detection functions.
4 SECTION 3. NEW LAW A new section of law to be codified
5 in the Oklahoma Statutes as Section 6550.2 of Title 36, unless there
6 is created a duplication in numbering, reads as follows:
7 Notice of an adverse determination must include:
8 1. The principal reasons for the adverse determination;
9 2. The clinical basis for the adverse determination;
10 3. A description of and the source of the screening criteria
11 and review procedures used as guidelines in making the adverse
12 determination; and
13 4. A description of the procedure for the complaint and appeal
14 process, including notice to the enrollee of the enrollee's right to
15 appeal an adverse determination to an independent review
16 organization and of the procedures to obtain that review.
17 SECTION 4. This act shall become effective November 1, 2026.
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19 60-2-15132 MJ 01/13/26
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Req. No. 15132 Page 3Every fact on this page links to its source, starting with the official bill record.