Bill > HB795

This bill, the AI Health Insurance Accountability Act of 2026, mandates that health insurance carriers (which include insurers, non-profit health service plans, health maintenance organizations, dental plan organizations, and other entities providing regulated health benefit plans) must ensure that their internal grievance processes include a human review for any adverse decisions made using artificial intelligence (AI), algorithms, or other software tools, and that this review also checks for compliance with specific regulations. Carriers will also be required to report detailed information quarterly to the Commissioner about grievances, particularly those stemming from AI-driven adverse decisions, including the type of claim, and the race, gender, and profession of the member, as well as the type of policy. Furthermore, if a significant percentage of a carrier's adverse decisions made by the same AI, algorithm, or software tool result in a grievance within a six-month period, the carrier must conduct a model review of that tool and submit the findings. The bill also clarifies that AI, algorithms, or software tools used in utilization review must base decisions on an enrollee's individual medical history and circumstances, not solely on group data, and cannot replace the role of a healthcare provider or lead to unfair discrimination or harm, with a specific prohibition against these tools directly or indirectly denying, delaying, or modifying health care services. This Act is set to take effect on October 1, 2026.

Health and Social Services

https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/HB0795?ys=2026RS