MD HB1385

Audits and compliance reviews of AI tools used for health insurance utilization review must include evaluation by a licensed health care professional who can review patient medical records, consider individual circumstances, and question, modify, or override AI determinations

Quarterly reviews of AI tool performance and outcomes must include human evaluation of real-world health outcomes resulting from AI decisions

Findings from human evaluations must be used to improve AI tools, making them safer, more accurate, and more responsive to patient needs

Applies to health insurers, HMOs, dental plans, pharmacy benefits managers, and private review agents that use AI, algorithms, or software for utilization review decisions

Effective October 1, 2026