AI Frontier Institute

An act relating to the use of artificial intelligence in health care coverage decisions

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Vermont H.776 has not been enacted. It was introduced and referred to the Committee on Health Care on 2026-01-27, and its outcome is listed as committee. If enacted, Sec. 1 would add 18 V.S.A. § 9423 on the use of artificial intelligence in health coverage decisions. A health plan (as defined in section 9418) that uses AI, an algorithm, or another software tool for utilization review, directly or through a contractor, would have to ensure the following under § 9423(a). (1) The tool bases its determination on the insured's medical or clinical history, the clinical circumstances presented by the requesting provider, and other relevant clinical record information. (2) It does not rely solely on a group dataset. (3) It is fairly applied, including under applicable U.S. Department of Health and Human Services regulations and guidance. (4) It is configured and applied consistently across all health plans and insureds, so patients with similar clinical presentations get the same decisions. (5) It is open to inspection for audit or compliance reviews by the Department of Financial Regulation and other State agencies. (6) The health plan's written policies disclose the tool's use in utilization review and the nature and degree of human oversight, to the extent the Department of Financial Regulation requires. (7) The tool's performance, use, and outcomes are reviewed and revised at least quarterly. (8) The tool does not directly or indirectly harm the insured. Under § 9423(b), the tool may not deny, delay, or modify a decision on whether to authorize coverage of health care services. Only a licensed human health care provider who is competent to evaluate the clinical issues involved may make an adverse coverage determination. That provider must review the requesting provider's recommendation, the insured's history as appropriate, and the specific clinical circumstances. Under Sec. 2, the act would take effect July 1, 2026.

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