The proposed bill introduces Chapter 83, 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. This chapter aims 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, including anti-discrimination and privacy laws.

Key provisions of the bill include:

- Insurers are required to publicly disclose how they use AI to manage claims and coverage, including the underlying algorithms, data used, and resulting determinations.
- Insurers must maintain documentation of AI decisions for at least five years.
- Enrollees and healthcare providers must be notified when AI has been used to issue an adverse determination, along with a clear and timely process for appealing such determinations.
- Insurers are prohibited from relying exclusively on AI or automated decision tools to deny, reduce, or alter coverage or claims for medically necessary care. Adverse determinations must be reviewed by qualified healthcare professionals who can reverse decisions based on clinical judgment.
- Insurers are required to conduct ongoing monitoring, audits, and oversight of all employees and third parties using AI on their behalf to manage enrollee coverage or claims, ensuring that enrollee rights are protected and that AI use does not violate state and federal anti-discrimination laws.

The bill also establishes enforcement mechanisms, allowing the office of the health insurance commissioner and the executive office of health and human services to promulgate rules and regulations necessary for implementation. Enrollees are granted a private right of action to enforce the provisions of this chapter, and violations may result in fines, orders to change AI usage, and revocation or suspension of insurers' licenses.

This chapter supplements existing laws, and in case of any conflict, its provisions will take precedence. The act will take effect upon passage.

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