RELATING TO INSURANCE -- THE TRANSPARENCY AND ACCOUNTABILITY IN, ARTIFICIAL INTELLIGENCE USE BY HEALTH INSURERS TO MANAGE COVERAGE, AND CLAIMS ACT
Summary
H7190 would create a new chapter in Rhode Island insurance law governing how health insurers use artificial intelligence to manage coverage and claims. The bill defines artificial intelligence broadly and applies to insurers, health plans, and related entities, including pharmacy benefit managers. Its stated purpose is to ensure transparency, accountability, and compliance with state and federal requirements when AI is used in non-administrative claims and coverage decisions.
The bill requires insurers to disclose to the Office of the Health Insurance Commissioner and the Department of Business Regulation detailed information about their AI systems, including the models used, the role AI plays in decision-making, training data, performance metrics, governance policies, and specific claims or coverage decisions in which AI was a substantial factor. Insurers would also have to retain documentation of AI-related decisions for five years and provide records to regulators upon request. In addition, the bill directs the agencies to issue an initial report to legislative and executive leaders within 18 months and annual reports thereafter summarizing insurer AI use and related performance data.
Impact
The bill would add new regulatory obligations to Title 27 of the Rhode Island General Laws and expand the oversight authority of OHIC and DBR over health insurers’ use of AI. For non-administrative adverse benefit determinations involving medically necessary care, any AI-influenced denial or other adverse decision would have to be reviewed and approved by a provider with the same license status as the ordering provider before it becomes final, or the determination must be reversed. The bill also preserves the existing appeals process under chapter 18.9 of title 27 and authorizes OHIC, in collaboration with DBR, to adopt implementing regulations. Compliance costs would be borne by insurers.
Sentiment
No committee transcript or vote record is available, so there is no documented floor or committee sentiment to summarize. Based on the bill text and caption, the measure appears to be framed as a consumer-protection and oversight bill aimed at increasing transparency in insurer decision-making rather than restricting AI outright. The sponsors’ framing suggests support for accountability in health coverage decisions, especially where AI may affect access to medically necessary care.
Contention
The main likely point of contention is the bill’s requirement that AI-influenced non-administrative adverse benefit determinations be reviewed and approved by a provider of the same license status before finalization. Insurers may view this as administratively burdensome, costly, or difficult to implement at scale, while supporters are likely to argue it is necessary to prevent inappropriate denials and ensure clinical judgment remains central. Another potential issue is the breadth of the disclosure and reporting requirements, including access to documents and software, retention obligations, and detailed reporting on models, datasets, bias mitigation, and denial/appeal metrics.
Provides certain controls over prescription drug costs by imposing transparency, oversight and accountability requirements on commercial insurers and their pharmacy benefit managers.
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Sets controls on Medicaid prescription drug costs by imposing transparency and accountability requirements on managed care organizations (MCOs) and their pharmacy benefit managers (PBMs).
Sets controls on Medicaid prescription drug costs by imposing transparency and accountability requirements on managed care organizations (MCOs) and their pharmacy benefit managers (PBMs).
Requires every individual or group health insurance contract effective on or after January 1, 2026, to provide coverage to the insured and the insured's spouse and dependents for all FDA-approved contraceptive drugs, devices and other products.
Drains: appeals; period to appeal apportionment or assessment costs on drain projects; modify. Amends secs. 72 & 72a of 1956 PA 40 (MCL 280.72 & 280.72a).