On March 25, 2025, Maine lawmakers introduced Senate Bill 1301, a significant piece of legislation aimed at regulating the use of artificial intelligence (AI) in health insurance decision-making. Set to take effect on January 1, 2026, the bill establishes strict guidelines for health insurance carriers and their third-party contractors regarding how AI can be utilized in medical review and utilization review processes.

The primary purpose of Senate Bill 1301 is to ensure that AI-driven determinations for health coverage—such as approvals, denials, delays, modifications, or adjustments—are made fairly and transparently. Key provisions of the bill mandate that any AI systems used must be based on an enrollee's medical history and individual clinical circumstances, ensuring that provider decision-making is not supplanted. Furthermore, the bill prohibits discrimination based on various factors, including race, gender, and disability, and requires that AI applications be open to inspection and clearly disclosed in health plan policies.

A notable aspect of the bill is its requirement that any denial or modification of healthcare services based on medical necessity must be made by a qualified clinical peer. This provision aims to maintain a human element in critical healthcare decisions, ensuring that AI tools support rather than replace professional judgment.

The introduction of Senate Bill 1301 has sparked discussions among stakeholders in the healthcare and technology sectors. Proponents argue that the bill is a necessary step to protect patients from potential biases inherent in AI systems, while critics express concerns about the feasibility of implementing such regulations and the potential impact on the efficiency of healthcare delivery.

The implications of this legislation are significant, as it seeks to balance innovation in healthcare technology with the need for accountability and fairness. Experts suggest that if passed, the bill could set a precedent for other states considering similar regulations, potentially reshaping how AI is integrated into healthcare systems nationwide.

As the legislative process unfolds, stakeholders will be closely monitoring the bill's progress and its potential impact on the future of healthcare in Maine and beyond.