Health Insurance - Use of Artificial Intelligence - Human Evaluation

HB 1385 requires health insurers and pharmacy benefit managers using artificial intelligence (AI) for medical treatment reviews (utilization review) to include licensed healthcare professionals in key evaluations. Specifically, it mandates that AI decisions must be reviewed by a licensed professional who can question, modify, or override AI determinations based on a patient’s full medical history and individual circumstances. The bill also requires quarterly reviews of AI performance using human assessments of real-world health outcomes to improve accuracy and safety. These provisions apply to all AI tools used in utilization review processes within Maryland’s health insurance system, effective October 1, 2026.