In one paragraph
Massachusetts S46 would amend G.L. c. 176O, s. 12 so that insurers using AI, algorithms or software for medical-necessity review may not let the tool deny, delay or modify care; only a licensed physician or competent licensed professional may decide. On October 16, 2025 it accompanied new draft S2632, which on April 2, 2026 was sent to Senate Ways and Means with an ought-to-pass recommendation.
Plain-English summary, written with AI assistance. The official text controls.
What it means for business
None yet: the bill has not been enacted. If enacted, health carriers and utilization review organizations would need licensed clinicians to make medical-necessity decisions and audit-ready AI policies.
Key provisions
- Amends G.L. c. 176O, s. 12: a carrier or utilization review organization using AI, algorithms or software for medical-necessity review must ensure the tool bases decisions on the insured's medical history and circumstances, does not rely solely on a group dataset, and does not supplant provider decision-making.
- The tool must not discriminate, must be open to audit by the Division of Insurance and EOHHS, and must be disclosed in written policies and periodically reviewed.
- AI 'shall not deny, delay, or modify health care services' on medical necessity; only a licensed physician or competent licensed health professional may make those determinations.
- The Division and EOHHS may issue guidance within one year after relevant rules; MassHealth managed plans are covered only if federal approvals are obtained.
Latest legislative action
Oct 16, 2025. Accompanied a new draft, see S2632
Sponsors (showing 5 of 32)
| Name | Role |
|---|---|
| Cynthia Stone Creem D | Primary |
| Linda Dorcena Forry | Primary |
| Ryan C. Fattman R | Primary |
| Susan L. Moran | Primary |
| Angelo J. Puppolo, Jr. | Cosponsor |
Topics and industries
Related topics
Affected industries
This page is general information, not legal advice. Summaries are AI-assisted and may contain errors; read the statute for the controlling text and talk to a lawyer about your situation. Full disclaimer · Report an error