AI Frontier Institute

Health Insurance - Artificial Intelligence - Grievance Process and Reporting (AI Health Insurance Accountability Act of 2026)

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HB 795 (the "AI Health Insurance Accountability Act of 2026") was introduced in the Maryland House on February 4, 2026 and assigned to the Health Committee. The sponsor withdrew it on February 23, 2026, after a hearing was canceled. It was never enacted. If enacted, it would have amended the Insurance Article in three ways. First, § 15–10A–02(b)(2)(vi) would require a carrier's internal grievance process to provide for human review of the adverse decision whenever a grievance results from an adverse decision made using artificial intelligence, an algorithm, or other software tools. That review would include compliance with § 15–10B–05.1. Second, § 15–10A–06(a)(1)(iii)9. would add to each carrier's quarterly report to the Insurance Commissioner the total number of grievances reviewed under that human-review requirement. The counts would be broken down by type of claim, by race, gender, and profession of the member, and by type of policy (individual, small group, or large group, and whether it was bought on the health benefit exchange). Third, new § 15–10A–06(a)(3) would apply when more than a Commissioner-set percentage of a carrier's adverse decisions made with the same AI, algorithm, or software tool result in a grievance within a 6-month period. The carrier would then have to provide for a model review process of that tool and submit the findings in its report. Existing § 15–10B–05.1 is reenacted without changes. It sets rules for carriers, pharmacy benefits managers, and private review agents that use AI in utilization review. Those rules include individualized clinical bases for decisions, no unfair discrimination, Commissioner audit access, quarterly performance review, and a ban on using such tools to deny, delay, or modify health care services. The Act would have taken effect October 1, 2026.

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