2025 - 2026 LEGISLATURE
LRB-6143/1
EKL:cdc
March 13, 2026 - Introduced by Representatives Tenorio, Cruz, Clancy, Madison, McCarville, Miresse, Rivera-Wagner, Sinicki, Udell and Kirsch, cosponsored by Senators Roys, Larson and Spreitzer. Referred to Committee on Insurance.
AB1109,1,3
1An Act to create 609.825 and 632.852 of the statutes; relating to: use of
2artificial intelligence to deny prior authorization for medical necessity or
3experimental status. Analysis by the Legislative Reference Bureau
This bill provides that a health insurance policy or self-insured governmental health plan may not use artificial intelligence to deny a prior authorization for medical necessity or experimental status. Rather, under the bill, a licensed health care provider who is an individual must review a prior authorization that involves medical necessity or experimental status before the policy or plan may deny the prior authorization.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
AB1109,14Section 1. 609.825 of the statutes is created to read: AB1109,1,75609.825 Human review of prior authorization for medical necessity or 6experimental status. Limited service health organizations, preferred provider 7plans, and defined network plans are subject to s. 632.852. AB1109,2
1Section 2. 632.852 of the statutes is created to read: AB1109,2,92632.852 Human review of prior authorization for medical necessity or 3experimental status. A disability insurance policy, as defined in s. 632.895 (1) 4(a), or a self-insured health plan, as defined in s. 632.85 (1) (c), may not use artificial 5intelligence to deny a prior authorization for medical necessity or experimental 6status. An appropriate licensed health care provider who is an individual shall 7review a prior authorization that involves medical necessity or experimental status 8before the disability insurance policy or self-insured health plan may deny the prior 9authorization. AB1109,310Section 3. Initial applicability. AB1109,2,1311(1) For policies and plans containing provisions inconsistent with s. 632.852, 12the treatment of s. 632.852 first applies to policy or plan years beginning on the 13effective date of this subsection, except as provided in sub. (2). AB1109,2,1814(2) For policies and plans that are affected by a collective bargaining 15agreement containing provisions inconsistent with s. 632.852, the treatment of s. 16632.872 first applies to policy or plan years beginning on the effective date of this 17subsection or on the day on which the collective bargaining agreement is newly 18established, extended, modified, or renewed, whichever is later. AB1109,2,2120(1) This act takes effect on the first day of the 4th month beginning after 21publication.
