The proposed 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 primary aim of this legislation is to regulate the use of artificial intelligence (AI) by health insurers, ensuring that their practices are transparent, accountable, and compliant with both state and federal regulations regarding non-administrative claims and coverage management.

The bill provides specific definitions for terms related to adverse benefit determinations, AI, enrollees, insurers, medically necessary care, and providers, establishing a framework for understanding the implications of AI in healthcare decision-making.

Key provisions of the bill require insurers to disclose to the Office of the Health Insurance Commissioner (OHIC) and the Department of Business Regulation (DBR) how they use AI to manage healthcare claims and coverage. This includes details on the types of AI models used, the role of AI in decision-making, training datasets, performance metrics, governance and risk management policies, and decisions influenced by AI. Insurers must maintain documentation of AI-related decisions for at least five years and submit reports upon request that detail their AI practices.

Additionally, any non-administrative adverse benefit determinations made by AI systems must be reviewed and approved by a licensed provider with the same license status as the ordering professional provider before finalization. The bill mandates that the costs of compliance with these requirements be borne by the insurers and includes a severability clause to ensure that if any provision of the chapter is found unconstitutional or invalid, the remaining provisions will still remain in effect. The act will take effect upon passage.