AlabamaAlabama law sets rules for health plans using AI to approve care
Starting October 1, 2026, Alabama health plans using AI for advance care approvals must consider each enrollee’s clinical information, and professionals must review certain adverse decisions.
What it does
When a health plan uses AI to decide whether to approve care in advance, it must consider the enrollee’s medical history and other relevant clinical information.
Plans using AI to review requests for advance approval must disclose that use, check its accuracy and fairness, limit how patient data is used, and certify their practices each year.
The Insurance Department may investigate violations and require plans to correct their procedures; repeated violations that show a business pattern may also bring fines or loss of authority to operate.
Argument forPeople seeking care may get decisions that account for their medical history and personal circumstances, with a qualified professional reviewing certain adverse decisions.
Argument againstPlans may need more time from licensed professionals to review denials, delays, or changes based on medical need, which could slow some coverage decisions.
More detail
Plans using AI for medical-need decisions must consider each enrollee’s clinical information. The decision must consider the enrollee’s medical history, circumstances described by the requesting health care provider, and other clinical information in the enrollee’s medical record. This applies when a plan provider uses AI to decide whether care is medically necessary for prior authorization, or advance approval.
Plans using AI in coverage reviews must disclose and check that use, protect patient data, and certify their practices each year. These requirements apply to health plan providers that use AI to review requests for advance approval. The yearly certification must cover the use of individual rather than group data, fair treatment, and compliance with laws against discrimination. An authorized representative may attest based on reasonable reliance on the plan’s policies and procedures and its outside vendors. Patient data must not be used beyond its stated purpose, consistent with HIPAA. The certification is required annually.
The Insurance Department may investigate violations and require plans to correct their procedures. Enforcement covers violations of the AI decision requirements, including decisions made without considering an enrollee’s medical history and relevant clinical circumstances. The department may ask a plan to respond within 30 days and may hold a hearing if it finds the response unsatisfactory. For repeat violations frequent enough to show a general business pattern or practice, the department may also impose a fine of up to $5,000, suspend or revoke the plan provider’s authority, or do both. The law takes effect October 1, 2026.
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Where it stands
- Introduced
- Passed Senate
- Passed House
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Apr 17EnactedBecame Law
- Apr 9EnrolledTo Governor
- Apr 9Delivered to GovernorMinor
- Apr 9Signature Requested
- Apr 8Third Reading in Second House
- Vote recorded Motion to Adopt - Adopted Roll Call 1307. Result: pass.Lower
- Vote recorded Motion to Read a Third Time and Pass as Amended - Adopted Roll Call 1309. Result: pass.Lower
- Vote recorded Gudger Motion to Concur In and Adopt House Amendment - Adopted Roll Call 1261. Result: pass.Upper
- Vote recorded Motion to Adopt - Adopted Roll Call 1308. Result: pass.Lower
- Apr 8Insurance Engrossed Substitute Offered (Insurance)Minor
- Apr 8Motion to Adopt - Adopted Roll Call 1307Major
- Apr 8Shaw 1st Amendment OfferedMinor
- Apr 8Motion to Adopt - Adopted Roll Call 1308Major
- Apr 8Motion to Read a Third Time and Pass as Amended - Adopted Roll Call 1309Passed House
- Apr 8Gudger Motion to Concur In and Adopt House Amendment - Adopted Roll Call 1261Major
- Apr 8Ready to Enroll
- Mar 17Reported Out of Committee Second House (Insurance)
- Mar 17Read for the Second Time and placed on the Calendar (Insurance)Minor
- Feb 19Third Reading in House of Origin
- Vote recorded Third Reading in House of Origin. Result: pass.Upper
- Vote recorded Orr motion to Adopt - Adopted Roll Call 476. Result: pass.Upper
- Vote recorded Motion to Read a Third Time and Pass as Amended - Adopted Roll Call 477. Result: pass.Upper
- Feb 19Healthcare 1st Substitute Offered (Healthcare)Minor
- Feb 19Orr motion to Adopt - Adopted Roll Call 476Major
- Feb 19Motion to Read a Third Time and Pass as Amended - Adopted Roll Call 477Passed Senate
- Feb 19Engrossed
- Feb 19Read for the first time and referred to the House Committee on InsuranceMinor
- Feb 19Pending Committee Action in Second House (Insurance)
- Feb 12Read for the Second Time and placed on the Calendar (Healthcare)Minor
- Feb 11Healthcare 1st Substitute (Healthcare)
- Feb 11Reported Out of Committee House of Origin
- Jan 13Read for the first time and referred to the Senate Committee on HealthcareMinor
- Jan 13Pending Committee Action in House of Origin (Healthcare)Introduced
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