RI H7190

Health insurers must disclose to the Office of the Health Insurance Commissioner (OHIC) and Department of Business Regulation (DBR) how they use AI to manage claims, including AI model types, training datasets, performance metrics, and governance policies.

Non-administrative adverse benefit determinations involving AI must be reviewed and approved by a licensed provider with the same license status as the ordering provider before being finalized; failure to comply results in automatic reversal of the denial.

Insurers must maintain documentation of AI-related decisions for at least 5 years and submit all information, documents, and software upon request to enable enforcement.

OHIC/DBR must provide an initial report to the governor and legislative leaders within 18 months of the act's effective date, then annually, detailing each insurer's AI usage, claim acceptance/denial rates, appeal rates, and denial reversal percentages.

All compliance costs must be borne by insurers, and the act takes effect upon passage.