OMP Domain Profile: Clinical AI Decision Accountability Under Joint Commission/CHAI Guidance, California SB 1120, and Emerging US State and Federal Healthcare AI Obligations

This document defines a domain profile of the Operating Model Protocol (OMP) for AI systems deployed in clinical and healthcare decision contexts subject to qualified human reviewer requirements under the US Joint Commission and Coalition for Health AI (CHAI) Responsible Use Guide (September 2025), California Senate Bill 1120 (SB 1120, effective January 1, 2025), New York Assembly Bill A9149 (pending), and related US state and federal healthcare AI accountability obligations. The profile -- designated CareGuard -- specifies how OMP's deterministic routing invariant, Watchtower enforcement framework, and three-layer cryptographic integrity architecture satisfy the qualified human reviewer documentation requirements, clinical decision traceability obligations, and AI governance evidence standards applicable to healthcare AI deployments. The profile addresses four clinical deployment categories: medical necessity determinations, clinical decision support, diagnostic AI assistance, and prior authorisation AI systems. The OMP core specification is defined in the Operating Model Protocol Internet-Draft (draft-veridom-omp).