House Bill No. [insert bill number] aims to revise laws concerning the use of artificial intelligence (AI) in health insurance by imposing specific restrictions on health insurance issuers that utilize AI for utilization review or management functions. The bill mandates that any AI, algorithm, or software tool used must consider a covered person's medical history, individual clinical circumstances, and other relevant clinical information, rather than relying solely on group datasets. Additionally, it emphasizes that such tools should not replace healthcare provider decision-making, must not discriminate against enrollees, and should be subject to audits and compliance reviews. The bill also stipulates that determinations of medical necessity must be made exclusively by licensed healthcare professionals.

Furthermore, the bill amends Section 33-18-201 of the Montana Code Annotated to prohibit unfair claim settlement practices, including the improper use of AI in claims processing. It introduces a new provision that explicitly states that AI must be used in accordance with the guidelines established in Section 1 of the bill. This ensures that the application of AI in insurance claims aligns with the defined standards and does not lead to unfair practices. The bill also includes a codification instruction to integrate the new section into Title 33, chapter 32 of the Montana Code.

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