Bill > LD955

This bill establishes new regulations for health insurance carriers' use of artificial intelligence (AI) in medical insurance payment decisions, effective January 1, 2026. The legislation prohibits insurance carriers from denying coverage or claims solely based on AI, requiring human medical oversight for any potential coverage denials or payment reductions. Specifically, before making a negative coverage determination using AI, a carrier must conduct a utilization review performed by a licensed physician in the state, which includes evaluating the medical necessity of services, considering the healthcare provider's professional judgment, and assessing the potential impact on the patient's health outcomes. The bill mandates that carriers provide quarterly reports to the Bureau of Insurance detailing AI-related coverage denials, physician review outcomes, and appeal information, with the bureau then submitting an annual summary to the state legislature. Additionally, the legislation requires the Bureau of Insurance to develop rules governing AI use by carriers, to be completed by November 1, 2025. The bill defines artificial intelligence as a computerized system capable of making decisions or recommendations through algorithms and data analysis, and ensures that patients and providers retain the right to appeal any AI-influenced coverage determinations.

Health and Social Services

https://legislature.maine.gov/legis/bills/display_ps.asp?LD=955&snum=132