Law / United States / Alabama
SB 63 (2026), Artificial Intelligence in Health Insurance Prior Authorization
Ala. SB 63, 2026 Regular Session
A citation is an address, not a summary. The first part names the law; what follows narrows it to the exact section, article or paragraph.
In force in 15 days, effective 1 October 2026.
An AI sector rules rule binding private bodies.
As of 8 September 2026.
What it requires
- If you are a health benefit plan provider using artificial intelligence to make medical-necessity determinations on prior-authorization requests, base each determination on the enrollee's own medical history, the clinical circumstances the treating provider presents, and other clinical information in the enrollee's record, not a group dataset.
- Certify annually to the Alabama Department of Insurance that the artificial intelligence does not rely on a group dataset, is applied fairly and equitably consistent with applicable federal guidance, and does not discriminate against any subscriber group or enrollee.
- Have a licensed physician or other health care professional competent to evaluate the artificial intelligence's recommendation make the final determination to deny, delay, or modify a prior-authorization request based on medical necessity.
- Make prominent written disclosure of your use of artificial intelligence in utilization review in your policies and procedures, review its outcomes periodically for accuracy, and keep patient data used in that review within its stated purpose under HIPAA.
If you get it wrong
Criminal exposureNo
Private right of actionNo
Penalty structure
Administrative fine only, capped at $5,000, and only for a violation of the AI prior-authorization requirements occurring with such frequency as to indicate a general business pattern or practice; for the same pattern the department may instead or additionally suspend or revoke the provider's certificate of authority.
- Rule
- Fixed only
- As of
- 8 September 2026
- Currency
- USD
- Fixed cap
- 5,000
Who enforces it
Enforcement body
Alabama Department of Insurance
What it reaches
Obligation class
Governance, Disclosure, Reporting
What this law does
Drafted with AI from the cited sources under the direction of UnGovr staff. UnGovr holds editorial responsibility for this page.
A health benefit plan provider that uses artificial intelligence to determine medical necessity for a request for prior authorization must base the determination on the enrollee's own medical history, the clinical circumstances the treating health care provider presents, and other clinical information in the enrollee's medical record.
The provider must certify annually to the Alabama Department of Insurance that the artificial intelligence does not rely on a group dataset, is applied fairly and equitably consistent with applicable federal guidance, and does not discriminate against any subscriber group or enrollee.
A determination to deny, delay, or modify a prior-authorization request based on medical necessity must always be made by a licensed physician or other health care professional competent to evaluate the artificial intelligence's recommendation in light of the enrollee's own clinical circumstances.
The provider must make prominent written disclosure of its use of artificial intelligence in utilization review in its policies and procedures, periodically review the outcomes for accuracy, and keep patient data used in that review within its intended purpose under HIPAA.
The Department of Insurance may investigate an alleged violation and order corrective changes to the provider's procedures, and for a violation occurring with the frequency of a general business pattern or practice, may impose an administrative fine of up to $5,000 or suspend or revoke the provider's certificate of authority. This act becomes effective October 1, 2026.
When LexLint raises it
high_risk_decisions
Read the law
official text, enrolled SB 63 (2026 Regular Session), Alabama Legislature