Bill > LD1301

This bill establishes new regulations for health insurance carriers using artificial intelligence (AI) in medical review and coverage determinations, effective January 1, 2026. The legislation requires that AI systems used in reviewing health insurance claims must: be based on an individual's specific medical history and clinical circumstances, avoid discriminating against enrollees based on personal characteristics like race, age, or disability, be applied fairly and equitably, and be transparent with policies open to inspection. Importantly, the bill mandates that any denial, delay, modification, or adjustment of health care services based on medical necessity must be made by a qualified clinical peer who can competently evaluate the specific medical issues, consider the patient's provider's recommendations, and review the individual's medical history. The bill defines artificial intelligence as a machine-based system that can autonomously generate outputs influencing virtual or physical environments. By implementing these requirements, the legislation aims to ensure that AI tools in health insurance do not replace human medical judgment and protect patients from potential algorithmic bias or unfair coverage decisions.

Health and Social Services

https://legislature.maine.gov/legis/bills/display_ps.asp?LD=1301&snum=132