ME LD955

Health insurance carriers prohibited from denying claims or coverage decisions based solely on artificial intelligence, effective January 1, 2026

Before denying benefits or reducing payment using AI, carriers must conduct utilization review by a Maine-licensed physician examining medical necessity, provider's professional judgment, and impact on enrollee's health outcomes

Enrollees and providers retain the right to appeal any AI-related coverage determination

Carriers must submit quarterly reports to the Bureau of Insurance starting April 15, 2026 on AI-related denials, physician review outcomes, and appeals; the Bureau must provide annual summary reports to the Legislature starting February 1, 2027

Bureau of Insurance required to adopt implementing rules by November 1, 2025