Pennsylvania HB 1925: AI Coverage Review and Insurer Requirements
Pennsylvania HB 1925 proposes new requirements for AI-assisted insurance decisions, including independent clinical review, patient-specific information, disclosure, and governance. Explore the bill's requirements, affected organizations, and how they compare with existing CMS rules.
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TL;DR:
Pennsylvania HB 1925 would require patient-specific AI evaluations and independent clinical review before certain adverse coverage decisions. The proposed bill also addresses insurer disclosure, governance, and documentation requirements.
Pennsylvania HB 1925 would require patient-specific AI evaluations and independent clinical review before certain adverse coverage decisions. The proposed bill also addresses insurer disclosure, governance, and documentation requirements.
What you need to know
- The change: Pennsylvania advanced legislation proposing patient-specific information requirements, documented human review, and additional oversight of AI-assisted insurance decisions.
- Who is affected: If enacted, HB 1925 would apply to covered health insurers, Medical Assistance and CHIP managed care plans, participating healthcare reviewers, and healthcare facilities under separate provisions.
- Why it matters: The bill addresses both the information AI systems evaluate and the independent judgment required before specified adverse coverage decisions.
- What to do first: Review where AI supports utilization decisions, who evaluates its recommendations, and how clinical information and human reviews are documented.
- Key date: HB 1925 reached a Senate committee on October 14, 2026. Under its current text, it would take effect one year after enactment. No effective date has been established.
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