House Bill No. introduced by J. Cohenour and others aims to revise laws concerning the use of artificial intelligence (AI) in health insurance. The bill establishes specific restrictions for health insurance issuers that utilize AI, algorithms, or other software tools for utilization review or management functions related to medical necessity. Key requirements include ensuring that AI decisions are based on individual clinical circumstances and relevant medical history, not solely on group datasets, and that such tools do not replace healthcare provider decision-making. Additionally, the bill mandates that AI applications must not discriminate against enrollees, must be subject to audits, and must comply with federal regulations. A licensed physician must make determinations of medical necessity, and any failure to comply with these provisions could result in penalties.

The bill also amends Section 33-18-201 of the Montana Code Annotated, which outlines unfair claim settlement practices. It adds a new provision that prohibits the use of artificial intelligence in ways not prescribed under the new section related to claims under an insurance policy. This amendment aims to ensure that AI is used responsibly and in accordance with the established guidelines, thereby protecting consumers and maintaining fair practices in the insurance industry. The bill includes a codification instruction indicating that the new section will be integrated into Title 33, chapter 32 of the Montana Code.

Statutes affected:
LC Text: 33-18-201
HB0556_1(1): 33-18-201
HB0556_1(2): 33-18-201
HB0556_1(3): 33-18-201
HB0556_1: 33-18-201