Bill > HB556

This bill establishes comprehensive restrictions on how health insurance issuers can use artificial intelligence (AI) in their utilization review and management processes. The legislation requires that AI tools used for medical necessity determinations must be based on individual patient clinical history, cannot rely solely on group datasets, and must not replace healthcare provider decision-making. Specifically, the bill mandates that AI systems cannot discriminate against enrollees, must be open to audit, periodically reviewed for accuracy, protect patient data consistent with HIPAA, and most critically, cannot independently deny, delay, or modify healthcare services. The bill defines AI as a machine-based system that can infer outputs to influence environments and establishes that final medical necessity determinations must be made by a licensed physician who reviews the specific clinical circumstances. Additionally, the bill amends existing insurance law to explicitly prohibit the inappropriate use of AI in claims processing, allowing the insurance commissioner to impose penalties on issuers who fail to comply with these new regulations. The goal appears to be ensuring that AI serves as a supportive tool in healthcare decision-making while preventing it from making autonomous determinations that could potentially harm patient care.

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https://bills.legmt.gov/#/laws/bill/2/LC3970