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 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 requirements of the bill include mandates for 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 documentation of adverse benefit determinations where AI was a substantial factor.

Insurers are required to maintain documentation of AI decisions for at least five years and must submit relevant information, including documents and software, upon request. Additionally, any non-administrative adverse benefit determination made by AI must be reviewed and approved by a licensed provider with the same license status as the ordering professional provider before finalization. Failure to comply with this requirement will result in the reversal of the non-administrative adverse determination.

The bill also mandates that OHIC and DBR provide an initial report to the governor, the senate president, and the speaker of the house on the use of AI by health insurers within eighteen months of the effective date of this chapter, with annual reports thereafter. These reports will detail how health insurers use AI to manage claims and coverage, including the types of AI models used, their role in decision-making, and performance metrics related to claims processing.

The act will take effect upon passage.