Insight
SB 815 Limits Automated Adverse Determinations
Texas utilization review agents may not use automated decision systems to make adverse determinations.
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SB 815 added Insurance Code § 4201.156. Subsection (a) prohibits using an automated decision system to make, wholly or partly, an adverse utilization-review determination. Subsection (c) excepts specified administrative-support and fraud-detection uses. The statute took effect September 1, 2025; its application provision covers utilization review for plans delivered, issued or renewed on or after January 1, 2026.
A clinician signing an automatically generated denial does not automatically resolve the statutory issue. The Texas Department of Insurance (TDI) bulletin of June 12, 2026 addresses human review of consequential insurance decisions as agency guidance under existing law; it does not narrow Insurance Code § 4201.156 or replace the statutory exceptions.
Sources
- Insurance Utilization Review
- SB815, 89th Legislature, Regular Session, 2025
- Commissioner Bulletin B-0003-26