Georgia CommonsSB 444: Private Review Agents; certain decisions with regard to the provision of insurance coverage for healthcare services shall not be based solely on artificial intelligence systems; provide
Last action May 5, 2026 · Effective Date 2027-01-01
Senate Bill 444 would require that health insurance companies in Georgia have a licensed medical reviewer, not just artificial intelligence, sign off before denying coverage for a healthcare service.
The summaries below were written by an AI model (claude-sonnet-5) from the text of the bill and are not part of it. Quote the text, not the summary. The stored text is the Enrolled version, the latest LegiScan holds.
In plain language
Georgia insurance companies use private review agents and utilization review entities to decide whether to approve or deny coverage for medical treatments. This bill adds a new section to Georgia's insurance law (O.C.G.A. Chapter 46 of Title 33) addressing how artificial intelligence can be used in that process. The bill allows insurers to use artificial intelligence systems, artificial intelligence, or other software tools to automate tasks and help with decision-making, as long as those tools are part of an approved utilization review plan. However, it prohibits AI from issuing a final denial of coverage (called an adverse determination) to a patient on its own. A human private review agent or utilization review entity, including a clinical peer, must be involved before a denial is finalized, and AI cannot override that person's judgment. The law would take effect January 1, 2027.
What the bill does
- Adds a new Code section (33-46-7.1) letting insurers use AI systems for utilization review, but only within an approved review plan.
- Bars AI systems from issuing an adverse determination (a coverage denial) to a patient without a human private review agent or utilization review entity involved.
- Requires a clinical peer, a medical professional with relevant expertise, to participate before a denial is finalized.
- States that AI tools cannot override or supersede the judgment of the clinical peer reviewing the case.
- Defines 'artificial intelligence' and 'artificial intelligence system' for purposes of this insurance law.
- Sets the law to take effect January 1, 2027.
Who it affects
Health insurance companies and their private review agents and utilization review entities in Georgia, the clinical peers (licensed medical professionals) who review coverage decisions, and patients whose insurance claims go through utilization review for healthcare services.
Why it matters
Patients seeking insurance approval for medical care would be guaranteed that a human medical reviewer, not just an automated algorithm, has a role in any decision to deny coverage. This could affect how quickly and how coverage denials are issued by Georgia insurers.
Key provisions
- Section 1 adds Code Section 33-46-7.1 defining 'artificial intelligence' and 'artificial intelligence system' for insurance review purposes.
- Subsection (b) permits private review agents and utilization review entities to use AI tools if they are part of a compliant utilization review plan approved under existing standards and Commissioner rules.
- Subsection (c) allows AI to automate tasks and assist decision-making but bars it from issuing an adverse determination without a human private review agent or utilization review entity and a participating clinical peer.
- Subsection (c) also states AI tools cannot supersede the judgment of the clinical peer involved in the review.
- Section 2 sets the effective date as January 1, 2027.
- Section 3 repeals conflicting laws.
From the bill
“such systems shall not issue an adverse determination to a patient until a natural person qualifying as a private review agent or a utilization review entity conducts a utilization review in which a clinical peer participates.”
“In no event shall artificial intelligence systems, artificial intelligence, or other software tools supersede the judgment of such clinical peer.”
Status timeline
- Effective Date 2027-01-01
- Act 411
- Senate Date Signed by Governor (Senate)
- Senate Sent to Governor (Senate)
- Senate Agreed House Amend or Sub (Senate)
- House Passed/Adopted By Substitute (House)
- House Third Readers (House)
- House Committee Favorably Reported By Substitute (House)
Show full history (16 actions)
- House Second Readers (House)
- House First Readers (House)
- Senate Passed/Adopted (Senate)
- Senate Third Read (Senate)
- Senate Read Second Time (Senate)
- Senate Committee Favorably Reported (Senate)
- Senate Read and Referred (Senate)
- Senate Hopper (Senate)
Sponsors
- Kay Kirkpatrick (R, SD-032)
- Ben Watson (R, SD-001)
- Mike Hodges (R, SD-003)
- Ed Harbison (D, SD-015)
- Larry Walker (R, SD-020)
- Lee Hawkins (R, HD-027)
Votes
- Senate voteFebruary 11, 2026
49 yea, 0 nay (0 not voting, 5 absent)
- House voteMarch 19, 2026
166 yea, 0 nay (3 not voting, 7 absent)
- Senate voteMarch 25, 2026
47 yea, 0 nay (2 not voting, 5 absent)
Topics
- health insurance
- artificial intelligence regulation
- insurance coverage denials
- utilization review
- healthcare policy