Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Ai In Healthcare Utilization Review topic
No spam. Unsubscribe anytime.
Bill would require disclosure and audits when insurers use AI in utilization review; sponsor frames measure as first step
Summary
Delegate Terri Hill introduced House Bill 820 to require insurers to disclose and audit use of artificial intelligence and machine‑learning systems in utilization management. The measure would require documentation that automated tools rely on a patient's clinical history, bar AI from making final determinations without human review, and ask the
Delegate Terri Hill described House Bill 820 as a targeted response to growing use of artificial intelligence in utilization review. ‘‘When insurance carriers use automated tools to make coverage decisions, we need transparency, human oversight, and regular audits to ensure those systems do not deny care arbitrarily or embed bias,’’ Hill said.
Nut graf: HB 820 would require carriers using algorithmic or AI systems in utilization‑management decisions to document how those systems are used, to ensure decisions are grounded in a patient’s clinical record, to log whether an automated tool played a role in a denial and to subject AI‑informed decisions to periodic audit. Proponents said the measure is primarily a reporting and oversight step to help regulators understand how automated decision‑making is changing claims workflows.
Supporters pointed to high‑profile news coverage and settlements tied to automated denial systems, and to advocacy reports showing rapid growth in denials. Insurer witnesses said carriers already operate under MIA guidance and a 2024 MIA bulletin; industry representatives asked for technical edits but said they would work with the sponsor. MIA confirmed the agency can enforce reporting and suggested narrow technical changes to ensure enforceability.
Ending: The committee viewed HB 820 as complementary to the work‑group and reporting bills on denials and requested the MIA and stakeholders pursue agreed technical language. No final vote was recorded at the hearing.
