Amendment #121 to S3141

AI Regulations

Mr. Mahoney of Worcester moves to amend the bill by striking out section 34 and inserting in place thereof the following section:-

“SECTION 34. Section 12 of chapter 176O of the General Laws is hereby amended by inserting after the second paragraph the following:-

An automated utilization review tool that employs artificial intelligence, an algorithm or other software to conduct, or to generate information relied upon in, utilization review shall comply with all applicable provisions of this chapter and applicable state and federal law.

A carrier or utilization review organization that uses an automated utilization review tool, or that contracts with or otherwise acts through an entity that uses an automated utilization review tool in connection with a prospective, concurrent or retrospective review of a request for a covered benefit shall remain responsible for compliance with this section by any entity acting on its behalf.

A carrier or utilization review organization shall periodically evaluate the performance, use and outcomes of an automated utilization review tool and modify or discontinue use as necessary to improve accuracy and reliability.”