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 require insurers to publicly disclose their AI usage, including underlying algorithms and data used, maintain documentation of AI decisions for five years, and notify enrollees and healthcare providers when AI is used for adverse determinations, providing a clear process for appeals.

Insurers are prohibited from solely relying on AI for denying, reducing, or altering coverage for medically necessary care, and adverse determinations must be reviewed by qualified healthcare professionals without conflicts of interest. The bill mandates ongoing monitoring and audits of AI use by insurers and third parties to ensure compliance with privacy laws and non-discrimination requirements.

Enforcement mechanisms are established, granting the office of the health insurance commissioner and the executive office of health and human services the authority to implement and enforce the provisions of the act. Violations may result in fines of up to $50,000 per violation, orders to change AI usage, revocation or suspension of licenses, and compensation for affected enrollees and healthcare providers.

The bill also includes provisions for severability and clarifies that it supplements existing laws, controlling in case of direct conflict.

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