TX SB 815 (No AI-Only Insurance Denials)
Texas Senate Bill 815 — Use of Automated Decision Systems for Adverse Determinations in Utilization Review
Texas · Tex. S.B. 815, 89th Leg., R.S. (2025); Tex. Ins. Code Sec. 4201.156
- Status
- In effect
- Took effect
- September 1, 2025
- Applies to
- Utilization review agents and the health benefit plan issuers that conduct utilization review.
- Enforced by
- Texas Department of Insurance (insurance commissioner)
Texas bars a utilization review agent from using an automated decision system — including certain artificial intelligence — to make an adverse determination, in whole or in part, about whether health care is medically necessary or appropriate. Such coverage denials must involve human clinical judgment, though the law still allows algorithms and AI for administrative support and fraud detection. The Texas Department of Insurance may audit and inspect how utilization review agents use these systems. Violations are subject to the sanctions, cease-and-desist orders, and administrative penalties already available under the Insurance Code.
Who is protected: Texas health benefit plan enrollees subject to utilization review and adverse determinations.
Legal detail
S.B. 815 (89th Leg., R.S.) adds Sec. 4201.156 to the Texas Insurance Code, prohibiting a utilization review agent from using an automated decision system to make, wholly or partly, an adverse determination, while preserving administrative/fraud uses and granting the commissioner audit authority; enforcement runs through existing Insurance Code remedies.
Key facts
| Jurisdiction | Texas |
|---|---|
| Level | State |
| Strength | Limited |
| Enacted | June 20, 2025 |
| Citation | Tex. S.B. 815, 89th Leg., R.S. (2025); Tex. Ins. Code Sec. 4201.156 |
| Private right of action | No, agency enforcement only |
| Penalties | Subject to the sanctions, cease-and-desist orders, and administrative penalties available under the Texas Insurance Code; the commissioner may audit and inspect a utilization review agent's use of an automated decision system at any time. |
| Topics | healthcare AI · insurance AI · automated decision-making |
| Bill text | Texas Legislature Online — S.B. 815, Bill Analysis (Enrolled), 89th Legislature (R.S.) |
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- Texas HB 3512 government AI training mandate (2025) · In effect
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Related healthcare AI rules elsewhere
- Missouri AI Therapy Chatbot Ban (SB 1019) · In effect
- PA v. Character.AI (Fake Psychiatrist Chatbot) · Blocked / in litigation
- RI Therapy Chatbot Ban (2026) · In effect
- RI AI Companion Self-Harm Safety (2026) · Enacted (not yet in effect)
- California AB 489 (AI healthcare chatbot misrepresentation ban) · In effect
- AZ HB 2175 (AI Insurance Denial — Physician Review) · In effect
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