The proposed bill introduces "The Transparency and Accountability in Artificial Intelligence Use by Health Insurers to Manage Coverage and Claims Act" into Title 27 of the General Laws, aiming to regulate the use of artificial intelligence (AI) by health insurers. Key provisions include requirements for insurers to publicly disclose their AI usage, maintain documentation of AI decisions for five years, and notify enrollees when AI is used for adverse determinations. Insurers are prohibited from solely relying on AI for denying or altering coverage for medically necessary care, and adverse determinations must be reviewed by qualified healthcare professionals. The bill also establishes enforcement mechanisms, including fines of up to fifty thousand dollars per violation, potential revocation or suspension of licenses, and a private right of action for enrollees to ensure compliance.

Additionally, the bill amends the duties of the Secretary of the Executive Office of Health and Human Services (EOHHS) to enhance oversight and accountability in Medicaid administration and introduces provisions to improve the efficiency of health services in Rhode Island. It establishes a workgroup for standardized processes in electronic eligibility verification and claims processing, mandates improved communication regarding prior authorization, and requires annual reporting on healthcare topics. The bill deletes conflicting legal language to ensure the smooth implementation of these new requirements and emphasizes the integration of behavioral health care with physical health care, ensuring compliance with mental health parity requirements. Overall, the legislation seeks to enhance consumer protection and streamline healthcare administration in the state.

Statutes affected:
5172: 42-7.2-5, 42-14.5-3