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Bill

Bill

HB 820

Health Insurance - Utilization Review - Use of Artificial Intelligence

2025 Regular Session Introduced by Heather Bagnall Tudball and 24 co-sponsors

Maryland law requires health insurers to validate AI systems used in coverage decisions and maintain human oversight of automated utilization review determinations.

Approved by the Governor - Chapter 747
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Bill Summary · HB 820

Legislative bill overview

HB 820 establishes regulatory requirements for health insurers' use of artificial intelligence in utilization review decisions—the process determining whether medical treatments are medically necessary and should be covered. The bill mandates transparency, validation standards, and human oversight for AI systems used in these coverage determinations.

Why is this important

Utilization review directly affects patient access to prescribed treatments and medications. As insurers increasingly adopt AI to process these decisions at scale, the bill addresses concerns that automated systems may deny necessary care without adequate human review or explainability, potentially affecting thousands of coverage denials annually.

Potential points of contention

  • Operational costs: Requirements for AI validation, documentation, and human review oversight may increase administrative expenses that insurers pass to employers or consumers through higher premiums
  • Vagueness on standards: The bill's specific technical validation standards for AI systems may be unclear, creating compliance uncertainty and potentially inconsistent implementation across insurers
  • Delay in coverage decisions: Mandatory human review safeguards could slow the speed of utilization review determinations, affecting patients awaiting treatment authorization

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

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