Key takeaways Pennsylvania House Bill 1925 would require insurers and healthcare providers to maintain human oversight of all final medical and coverage decisions involving AI systems. The bipartisan...
Pennsylvania legislators introduced bipartisan legislation this week aimed at regulating how artificial intelligence is deployed across the state's healthcare and insurance sectors, joining a growing national movement to establish oversight of algorithmic decision-making in medical care.
House Bill 1925, introduced on October 6, would require insurers, hospitals, and clinicians to disclose their use of AI systems and ensure human decision-makers retain final authority over individual patient care and coverage determinations. The measure represents one of the most comprehensive state-level efforts to regulate AI in healthcare, mandating both transparency and accountability measures for any entity using automated tools in medical or insurance operations.
Under the proposed legislation, any final determination involving patients, including claims decisions, coverage approvals, or medical assessments, must be made by a human reviewer conducting an individualized evaluation.
The requirement directly addresses growing concerns that healthcare organizations and insurers may be over-relying on automated systems to expedite decisions without adequate professional oversight.
State Representative Arvind Venkat, a Democrat from Allegheny County and practicing emergency physician, is leading the legislative effort alongside Representatives Joe Hogan, Tarik Khan, Greg Scott, and Bridget Kosierowski.
Venkat emphasized the rapid proliferation of AI tools throughout healthcare delivery and insurance administration.
"As the only physician in the General Assembly, I have seen the rapid growth of AI usage in health care in real time," Venkat said in a July statement announcing the initiative. "I am grateful for my bipartisan colleagues, including fellow health professionals, who are joining me on this legislation to make sure Pennsylvanians can be confident that AI is being used responsibly and effectively in the health care industry."
Representative Greg Scott, a Democrat from Montgomery County who serves as an emergency medical technician, stressed the irreplaceable value of human clinical judgment.
"I embrace technology and use it daily, but as an EMT, I know firsthand that understanding a person's medical history and needs requires a human element that a computer algorithm cannot fully appreciate," Scott said. "I'm hopeful that this bipartisan effort will create a framework to support innovation, but not at the expense of human life."
The legislation would require insurers to attest to the Pennsylvania Department of Insurance that their AI systems comply with existing state anti-discrimination laws.
Healthcare providers would need to make similar attestations to the Pennsylvania Department of Health, along with providing documentation demonstrating how they determined their AI tools minimize bias and discrimination.
The anti-bias provisions respond to mounting evidence that AI systems can perpetuate or amplify existing disparities in healthcare access and treatment.
Representative Bridget Kosierowski, a Democrat from Lackawanna County and registered nurse with nearly three decades of experience, highlighted the importance of professional evaluation.
"With the introduction of AI, we need experienced doctors and nurses even more now to assess the accuracy of AI to ensure that bias and discrimination haven't influenced its findings," Kosierowski said. "This bill would protect patients and provide the guardrails needed to ensure AI is used responsibly and effectively in the health care industry in our commonwealth."
Representative Tarik Khan, a Democrat from Philadelphia and registered nurse, emphasized patient autonomy in coverage decisions.
"Getting an unjust denial from your insurance company is bad enough, but knowing that AI and not humans are making the decisions is outrageous," Khan said. "I'm proud to work on this bipartisan bill with Dr. Venkat and other legislators to help put patients back in charge of their care."
While the Pennsylvania bill has garnered bipartisan support in the state legislature, the insurance industry is advocating for a different regulatory approach.
America's Health Insurance Plans, the national trade association representing health insurers, argues that federal oversight would be preferable to a patchwork of state-level regulations.
In a policy paper addressing AI governance, AHIP called for a high-level, risk-based regulatory framework at the federal level.
The organization contends this approach would ensure consistent consumer protections nationwide while reducing administrative burdens and compliance costs for insurers operating across multiple states.
AHIP also emphasized the need to protect proprietary technology by limiting disclosure requirements.
The Pennsylvania legislation aligns with similar efforts underway in multiple states.
California recently enacted a law requiring licensed physicians or qualified healthcare providers to review and approve any denial, delay, or modification of care based on medical necessity.
Illinois and Utah have also passed measures governing AI use in specific healthcare decisions.
The legislative push comes as healthcare organizations increasingly deploy AI tools for clinical documentation, billing systems, claims management, utilization reviews, and treatment recommendations.
While supporters argue these technologies can improve efficiency and reduce costs, critics worry about algorithmic bias, lack of transparency, and the potential for automated systems to deny medically necessary care.
For insurers, the proposed regulations could necessitate significant investments in compliance infrastructure, explainable AI systems, and audit capabilities to document non-discriminatory outcomes.
The legislation may also require carriers to modify existing workflows to ensure human professionals make final determinations on coverage and care decisions rather than deferring to automated recommendations.
The Pennsylvania bill reflects emerging international standards as well.
The European Insurance and Occupational Pensions Authority has emphasized proportional, risk-based AI regulation focusing on fairness, data governance, transparency, and human oversight in insurance operations.
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