Bill > H7190

This bill, titled "The Transparency and Accountability in Artificial Intelligence Use by Health Insurers to Manage Coverage and Claims Act," aims to ensure that health insurers are transparent and accountable when using artificial intelligence (AI), which is defined as a machine-based system that makes predictions, recommendations, or decisions, to manage healthcare claims and coverage. Key provisions include requiring insurers to disclose to the Office of the Health Insurance Commissioner (OHIC) and the Department of Business Regulation (DBR) how they use AI, including the types of AI models, their role in decision-making, training data, performance metrics, and risk management policies. Insurers must also maintain documentation of AI decisions for at least five years, especially for "adverse benefit determinations" (decisions to deny, reduce, or terminate coverage), which are categorized as either "administrative" (not requiring medical judgment) or "non-administrative" (requiring medical judgment). For non-administrative adverse benefit determinations involving AI, a provider with the same license as the ordering professional must review and approve the decision before it's finalized, and failure to do so will result in the reversal of the determination. The DBR and OHIC will also be required to report annually to the governor and legislative leaders on how health insurers are using AI, including details on model types, decision-making roles, data governance, and performance metrics like claim acceptance/denial rates and appeal outcomes. The bill also clarifies that the costs of complying with these requirements will be borne by the insurers and will take effect upon passage.

Health and Social Services

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