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132nd MAINE LEGISLATURE
FIRST REGULAR SESSION-2025
Legislative Document No. 955S.P. 411 In Senate, March 11, 2025
An Act to Ensure Human Oversight in Medical Insurance Payment
Decisions
Received by the Secretary of the Senate on March 6, 2025. Referred to the Committee on
Health Coverage, Insurance and Financial Services pursuant to Joint Rule 308.2 and ordered
printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator MARTIN of Oxford.
Cosponsored by Representative ZAGER of Portland and
Senators: BENNETT of Oxford, CYRWAY of Kennebec, HARRINGTON of York, TIPPING
of Penobscot, Representatives: Speaker FECTEAU of Biddeford, MORRIS of Turner,
SOBOLESKI of Phillips. Page 1 - 132LR0803(01)
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2 is enacted to read:
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4 to a carrier as defined in section subsection 3 on or after January 1, 2026, a carrier
5 may not deny a claim based solely on the use of artificial intelligence. For the purposes of
6 this subsection, "artificial intelligence" means a computerized system capable of making
7 decisions or recommendations based on algorithms and data analysis.
8 is enacted to read:
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10 medical review or utilization review determinations relating to the approval, denial or
11 adjustment of coverage for services under a health plan based solely on the use of artificial
12 intelligence. Before a carrier denies benefits or reduces payment for services using artificial
13 intelligence, the carrier shall conduct a utilization review done by a physician who is
14 licensed in this State, including a review of the medical necessity of the services, the
15 professional judgment of the enrollee's provider and the impact of any denial of benefits or
16 reduction in payment on the enrollee's health outcomes. An enrollee or provider has the
17 right to appeal any determination under this subsection in accordance with section 4303,
18 subsection 4. For the purposes of this subsection, "artificial intelligence" means a
19 computerized system capable of making decisions or recommendations based on
20 algorithms and data analysis.
21 is enacted to read:
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23 subsection 8 related to the use of artificial intelligence by a carrier. Rules adopted pursuant
24 to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter
25 2-A.
26 is enacted to read:
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28 quarterly thereafter, a carrier shall report to the bureau on the number of denials of coverage
29 under subsection 8, the outcome of the review conducted by a licensed physician in
30 accordance with subsection 8 and the number of appeals of a determination under
31 subsection 8 and the outcome of those appeals. Beginning February 1, 2027 and annually
32 thereafter, the bureau shall submit a report summarizing the quarterly reports from carriers
33 to the joint standing committee of the Legislature having jurisdiction over health insurance
34 matters.
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36 No later than November 1, 2025, the Department of Professional and
37 Financial Regulation, Bureau of Insurance shall adopt rules relating to the use of artificial
38 intelligence as required by the Maine Revised Statutes, Title 24-A, section 4304, subsection
39 9.
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41 This bill prohibits, beginning January 1, 2026, health insurance carriers from denying
42 coverage or claims for services under a health plan solely based on the use of artificial
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42 Page 2 - 132LR0803(01)
43 intelligence. The bill requires that, before a carrier denies benefits or reduces payment for
44 services using artificial intelligence, a carrier must conduct a utilization review done by a
45 physician who is licensed in this State that includes a review of the medical necessity of
46 the services, the professional judgment of the enrollee's provider and the impact of any
47 denial of benefits or reduction in payment on the enrollee's health outcomes. The bill
48 requires carriers and the Department of Professional and Financial Regulation, Bureau of
49 Insurance to report on a quarterly and annual basis, respectively, on the use of artificial
50 intelligence. The bill also requires the bureau to adopt rules related to the use of artificial
51 intelligence by carriers no later than November 1, 2025.
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