MD HB820

Prohibits artificial intelligence, algorithms, or other software tools from denying, delaying, or modifying health care services during utilization review

Requires AI-based utilization review tools to base determinations on individual enrollee medical history and clinical circumstances, not solely on group datasets

Mandates that AI tools cannot replace the role of health care providers in the determination process and must not result in unfair discrimination against enrollees

Requires carriers to report quarterly whether AI tools were used in making adverse decisions, and to review AI performance and outcomes at least quarterly for accuracy and reliability

Applies to insurers, HMOs, dental plan organizations, pharmacy benefits managers, and private review agents conducting utilization review in Maryland, effective October 1, 2025