Bill > S46

This bill amends Chapter 176O of the Massachusetts General Laws to establish comprehensive regulations for using artificial intelligence (AI), algorithms, and software tools in healthcare utilization review and management. The bill requires that carriers and utilization review organizations using such technological tools ensure their AI systems base determinations on individual patient medical history, clinical circumstances, and relevant medical records, and not solely on group datasets. The legislation mandates that these AI tools cannot replace healthcare provider decision-making, must not discriminate against patients, and must be applied fairly and equitably. Importantly, the bill stipulates that medical necessity determinations can only be made by licensed physicians or qualified healthcare professionals who review provider recommendations and patient-specific clinical information. The bill defines AI as a machine-based system that can infer outputs to influence environments and applies to prospective, retrospective, and concurrent healthcare service reviews. The legislation includes provisions for periodic performance reviews of AI tools, data protection, preventing patient harm, and ensures that these systems are open to audit and compliance reviews by state health agencies. The bill also includes specific provisions for MassHealth managed health benefit plans, contingent on federal approvals.

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https://malegislature.gov/Bills/194/S46