Health plans restrict AI psychotherapy and require safeguards for AI reviews

Carriers and specified review organizations using AI for utilization review must meet safeguards and disclose how they use it. These rules cover carriers using AI for utilization review directly or through another person, and specified pharmacy benefit managers, review organizations, behavioral health organizations, and managed care entities using AI for those reviews. AI reviews must consider applicable individual clinical information, not rely only on group data, follow applicable laws, keep compliance records, and undergo periodic review. AI may assist with utilization review, including expedited approvals. A medical-necessity denial cannot rest solely on AI output; a qualified professional must review and approve it. The rules apply to actions taken on or after January 1, 2027, unless a referendum petition is filed and voters approve the act; in that case, they take effect January 1, 2027, or when the governor officially declares the vote, whichever is later.

Carriers and specified public health-care payers may not cover or pay for psychotherapy conducted directly by an AI system. The restriction covers carriers offering health plans issued or renewed in Colorado and payers for services under the Colorado Medical Assistance Act and the Children's Basic Health Plan Act. The restriction covers psychotherapy provided directly to an individual and conducted by an AI system. It does not bar billing, recordkeeping, video, or other nontherapeutic software used with services from a human provider. Communication software used for supervision or consultation by a licensed, registered, or certified person is also allowed. The restriction applies to covered actions on or after the act's effective date. The act is scheduled to take effect January 1, 2027, unless a referendum petition triggers a vote; if voters approve it, the effective date is January 1, 2027, or the governor's official vote declaration, whichever is later.