Bill > H5172

This bill would establish comprehensive regulations for the use of artificial intelligence (AI) by health insurers in Rhode Island, focusing on transparency, accountability, and protection of patient rights. The legislation requires insurers to publicly disclose how they use AI in managing healthcare coverage and claims, including details about algorithms and data sources. Insurers must maintain documentation of AI decisions for at least five years and provide clear appeal processes when AI is used to make adverse determinations about coverage. The bill prohibits insurers from relying exclusively on AI to deny or reduce coverage, mandating that all adverse determinations be reviewed by qualified healthcare professionals who can reverse decisions based on clinical judgment. The legislation also requires ongoing monitoring to ensure AI use does not discriminate against patients, delay necessary medical care, or violate privacy laws. Insurers found in violation could face significant consequences, including fines up to $50,000 per violation, potential license revocation, and the requirement to compensate affected patients. The bill empowers the Office of the Health Insurance Commissioner and the Executive Office of Health and Human Services to enforce these provisions, and it gives patients a private right of action to challenge AI-driven insurance decisions. By establishing these guidelines, the bill aims to promote fair, transparent, and patient-centered use of artificial intelligence in healthcare coverage management.

Health and Social Services

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