Health Insurance - Utilization Review - Use of Artificial Intelligence
Impact
If enacted, HB 820 will change the landscape of health insurance practices in Maryland by ensuring that the application of AI in utilization reviews aligns with legal standards meant to protect patients. The bill's requirements aim to enhance the fairness and reliability of care decisions made by AI, thereby addressing potential biases that could arise from automated systems. It could also improve oversight and accountability in how insurers utilize technology for determining coverage and reimbursement decisions.
Summary
House Bill 820 aims to regulate the use of artificial intelligence (AI) and algorithms in health insurance utilization reviews. The bill mandates that any health carrier, pharmacy benefits manager, or private review agent using AI for utilization reviews must ensure that such systems are implemented in a manner compliant with specific guidelines. Key provisions include basing decisions on individual patient data rather than solely on group datasets, and ensuring that AI does not replace the role of healthcare providers in decision-making processes.
Sentiment
The sentiment surrounding HB 820 appears to be cautiously optimistic. Supporters champion the bill's potential to improve health care decision-making quality through increased oversight of AI's role in utilization reviews. However, some stakeholders express concerns about the practical implications of enforcing these guidelines, particularly regarding the availability of resources to monitor compliance and the potential for increasing operational costs for insurers.
Contention
Notable points of contention include the feasibility of implementing AI systems in accordance with the bill's requirements and the intended balance between technology and human oversight in the healthcare decision-making process. Critics may argue that heavy regulation could stifle innovation in health tech. Moreover, the interpretation of what constitutes unfair discrimination and the adequacy of existing federal and state protections may become focal points of debate as the bill progresses.
Prescribes requirements and safeguards for the use of an artificial intelligence, algorithm, or other software tool for the purpose of utilization review for health and accident insurance.
Prescribes requirements and safeguards for the use of an artificial intelligence, algorithm, or other software tool for the purpose of utilization review for health and accident insurance.
Relating to the use of artificial intelligence-based algorithms by health benefit plan issuers, utilization review agents, health care providers, and physicians.