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SB 2010

AN ACT RELATING TO INSURANCE -- THE TRANSPARENCY AND ACCOUNTABILITY IN ARTIFICIAL INTELLIGENCE USE BY HEALTH INSURERS TO MANAGE COVERAGE AND CLAIMS ACT

2026 Regular Session Introduced by John Burke and 10 co-sponsors

Requires insurers to disclose and justify AI use in claims decisions, with regular oversight, appeals, and provider-reviewed reversals for AI-influenced medically necessary determi

06/09/2026 Senate passed Sub A
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WeVote Research Nonpartisan
Bill Summary · SB 2010

Overview

SB 2010 (Rhode Island, 2026) establishes The Transparency and Accountability in Artificial Intelligence Use by Health Insurers to Manage Coverage and Claims Act. The bill aims to regulate how health insurers in Rhode Island use artificial intelligence (AI) in decisions related to coverage and claims, ensuring transparency, accountability, and compliance with state and federal requirements.

  • Introduced: January 9, 2026
  • Referred to: Senate Artificial Intelligence & Emerging Tech
  • Effective date: Upon passage

Main Purpose

  • To regulate the use of AI by health insurers for managing healthcare claims and coverage.
  • To promote transparency about AI usage, governance, data practices, and performance.
  • To ensure appropriate review and appeal processes for AI-influenced adverse benefit determinations, especially those concerning medically necessary care.

Key Provisions

1) Transparency Requirements (27-84-3)

  • Insurers must disclose to the RI Office of the Health Insurance Commissioner (OHIC) and the Department of Business Regulation (DBR):
    • Types of AI models used
    • The role of AI in decision-making for claims/coverage
    • Training datasets and data governance
    • Risk management policies
    • Specific decisions on healthcare claims/coverage where AI was used or a substantial factor
  • Insurers must, upon request, provide all information (documents and software) needed to enforce the chapter.
  • Insurers must maintain documentation of AI-driven decisions for at least five years, including adverse determinations.

2) Reporting (27-84-3)

  • DBR/OHIC must issue an initial report to the Governor, Senate President, and House Speaker within 18 months of the act’s effective date, and annually thereafter.
  • Annual reports must include for each insurer:
    • Types of AI models used
    • The AI’s role in approving/denying claims or coverage
    • Training, testing, and risk management measures (data governance, bias mitigation)
    • Performance metrics: number of claims, acceptance/denial rates, average time per claim, appeals rate, and denial reversal rate

3) Non-Administrative Adverse Benefit Determination Review (27-84-4)

  • Non-administrative ADBs where AI substantially influenced the decision regarding medically necessary care must be reviewed and approved by a provider with the same license status as the ordering provider.
  • The provider’s rationale must be documented in the patient’s case record.
  • If requirements are not followed, the AI-driven non-administrative ADB shall be reversed.
  • Appeals for these determinations follow the standard appeals process in Rhode Island law (Chapter 18.9, Title 27).

4) Enforcement and Compliance (27-84-5)

  • OHIC, with DBR, will promulgate rules necessary to implement the chapter.
  • All compliance costs are borne by the insurer.

5) Severability (27-84-6)

  • If any provision is found unconstitutional or invalid, it may be severed without invalidating the rest of the chapter.

who is Affected

  • Health insurers licensed in Rhode Island (including providers of health insurance, HMOs, PPOs, etc., and potentially Pharmacy Benefit Managers as defined).
  • Enrollees/patients whose claims or coverage decisions are influenced or determined by AI systems.
  • State regulators OHIC and DBR responsible for oversight, reporting, and enforcement.
  • Healthcare providers involved in reviewing AI-influenced adverse benefit determinations.

Timeline and Procedural Aspects

  • Effective date: Upon passage.
  • Initial reporting: Within 18 months of enactment.
  • Ongoing reporting: Annually thereafter.
  • Regulation: Rules to implement the act will be issued by OHIC and DBR in collaboration.

Potential Impacts

  • Increased transparency about AI systems used in coverage/claims decisions.
  • Improved accountability for AI-driven determinations affecting medically necessary care.
  • Enhanced regulatory oversight with public-facing and insurer-specific performance metrics.
  • Additional data governance, bias mitigation, and documentation requirements for insurers.
  • Possible cost implications for insurers to maintain records and comply with reporting and review processes.

This summary covers the bill's core aims, definitions, required disclosures, oversight structure, and the procedural steps for enforcement and implementation.

Compiled from official sources — confirm details with the bill’s official record.

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