MD HB820: Health Insurance - Utilization Review - Use of Artificial Intelligence

In one paragraph

Maryland HB 820 (2025) governs health insurers, pharmacy benefit managers and private review agents that use AI, algorithms or other software tools in utilization review. Tools must base determinations on the enrollee's own medical or clinical history and circumstances rather than solely on group data, may not replace the provider's role or discriminate unfairly, must be open to audit by the Insurance Commissioner, described in written policies and reviewed quarterly, and may not deny, delay or modify health care services. Carriers' quarterly reports must say whether AI was used in each adverse decision. Effective October 1, 2025.

Plain-English summary, written with AI assistance. The official text controls.

What it means for business

Health insurers and utilization review vendors in Maryland must keep AI tools individualized, auditable and subordinate to clinicians.

Key provisions

1. 1Insurance 15-10B-05.1: applies to carriers, PBMs and private review agents using AI, algorithms or software in utilization review
2. 2Determinations must rest on the enrollee's own clinical record and circumstances, not solely group datasets
3. 3Tools may not supplant the provider's role or unfairly discriminate; open to Commissioner audit; quarterly performance review
4. 4An AI, algorithm or other software tool may not deny, delay or modify health care services
5. 515-10A-06: quarterly reports state whether AI was used in each adverse decision

Latest legislative action

May 20, 2025. Approved by the Governor - Chapter 747

Sponsors (showing 5 of 26)

Roll call votes

Amendments (1)

• Favorable with Amendments 873321/1 Adopted Adopted 2025-03-04