The bill introduces a new chapter, titled "The Transparency and Accountability in Artificial Intelligence Use by Health Insurers to Manage Coverage and Claims Act," into Title 27 of the General Laws concerning insurance. The purpose of this chapter is to regulate the use of artificial intelligence (AI) by health insurers to ensure transparency, accountability, and compliance with state and federal requirements for claims and coverage management.

Key provisions include:

- Insurers are required to disclose how they use AI to manage healthcare claims and coverage, including the types of AI models used, the role of AI in decision-making, training datasets, performance metrics, governance and risk management policies, and decisions on healthcare claims and coverage where AI was a substantial factor.
- Insurers must maintain documentation of AI decisions for at least five years, including adverse benefit determinations where AI was a substantial factor.
- The Office of the Health Insurance Commissioner (OHIC) and the Department of Business Regulation (DBR) will require insurers to submit information upon request to enforce compliance with the chapter.
- DBR/OHIC is mandated to provide an annual report to the governor, the senate president, and the speaker of the house detailing how health insurers use AI, including the types of models used, the role of AI in decision-making, and performance metrics.
- By June 30, 2026, DBR/OHIC shall promulgate rules and regulations for health insurers to comply with the reporting requirements.
- Any adverse benefit determination made by an AI system regarding medically necessary care must be reviewed and approved by a qualified healthcare professional before finalization, with documentation of their rationale included in the enrollee's case record.
- The act includes a severability clause, ensuring that if any provision is found unconstitutional or invalid, the remaining provisions will still be enforceable.

The act is set to take effect on June 30, 2026.

Statutes affected:
13: 42-7.2-5, 42-14.5-3