This bill amends the managed care law to enhance recordkeeping requirements for health carriers regarding the use of artificial intelligence (AI) in utilization review processes. It mandates that health carriers maintain written records detailing their use of algorithms and AI, including the specific functions for which AI is employed and the protocols in place to ensure qualified human review of decisions that affect provider coding. Additionally, the bill requires health carriers to document all adverse determinations, such as payment reductions, ensuring that these decisions are made by qualified healthcare providers and that written notices are provided to both the covered individual and their healthcare provider, explaining the rationale behind the decisions.

Furthermore, the bill establishes that health carriers are responsible for the actions of any contracted entities that perform functions related to utilization review, including the use of AI systems. This includes a requirement for health carriers to monitor these entities to ensure compliance with the new recordkeeping standards. The effective date for these provisions is set for January 1, 2027. The bill introduces new subparagraphs and paragraphs to RSA 420-J:6, while no specific deletions from current law are noted in the provided text.

Statutes affected:
As Amended by the House: 420-J:6