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," to 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 transparency, accountability, and compliance with state and federal requirements for non-administrative claims and coverage management.

The bill outlines specific requirements for insurers, including the obligation to disclose to the Office of the Health Insurance Commissioner (OHIC) and the Department of Business Regulation (DBR) how they utilize AI in managing healthcare claims and coverage. This includes details on the types of AI models used, the role of AI in decision-making processes, training datasets, performance metrics, governance and risk management policies, and decisions influenced by AI.

Insurers are required to maintain documentation of AI-related decisions for at least five years, including adverse benefit determinations where AI was a substantial factor. They must also submit reports to the OHIC and DBR upon request, providing all necessary information to enforce compliance with the chapter.

Additionally, any non-administrative adverse benefit determinations made by AI systems regarding medically necessary care must be reviewed and approved by a provider with the same license status as the ordering professional provider before finalization. This requirement aims to ensure that decisions about medically necessary care are validated by qualified professionals.

The OHIC, in collaboration with the DBR, is tasked with promulgating rules and regulations necessary for the implementation of this chapter, with the total cost of compliance borne by the insurers. The act is set to take effect upon passage.