AI Frontier Institute

Promotes transparency and accountability in the use of artificial intelligence by health insurers to manage coverage and claims.

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Rhode Island S 2010 Sub A has passed the Senate but has not been enacted. If enacted, it would add a new chapter 84 to title 27, "The Transparency and Accountability in Artificial Intelligence Use by Health Insurers to Manage Coverage and Claims Act" (27-84-1). The chapter aims to ensure transparency, accountability and compliance when health insurers use AI for non-administrative claims and coverage management. Under 27-84-3, insurers would have to disclose to OHIC and DBR how they use AI in claims and coverage. This covers model types, the role of AI in decisions, training datasets, performance metrics, governance and risk policies, and decisions where AI made or was a substantial factor. They would also have to provide enforcement-related information, including documents and software, on request. They would have to keep documentation of AI decisions, including adverse benefit determinations, for at least five years. DBR/OHIC would send an initial report to the governor, Senate president and House speaker within 18 months of the effective date, then annually. For each insurer, the report would cover model types, AI's role, training, testing and risk management, and performance metrics such as claims accepted and denied, reviewer time, appeals and reversals. Under 27-84-4, a non-administrative adverse benefit determination about medically necessary care in which AI made or was a substantial factor must be reviewed and approved by a provider with the same license status as the ordering professional provider, and the rationale must be documented in the case record. If this review is skipped, the determination is invalid and must be reconsidered. Appeals follow chapter 18.9 of title 27. Under 27-84-5, OHIC with DBR would issue rules, and insurers would bear compliance costs. 27-84-6 provides severability. Section 2 makes the act effective upon passage.

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