HB1297
Concerning Artificial Intelligence, Algorithms, And Other Automated Technologies; And To Regulate Certain Practices Of Healthcare Insurers.
AI-Generated Summary
This bill, House Bill 1297, aims to regulate the use of artificial intelligence (AI), algorithms, and other automated technologies by healthcare insurers in Arkansas. It defines key terms like "artificial intelligence," "enrollee," and "health benefit plan." A primary provision requires healthcare insurers to disclose the strengths, limitations, known biases, and effectiveness of AI algorithms used in their utilization review processes. These disclosures must be made to the Insurance Commissioner, healthcare providers, enrollees, and the public via the insurer's website. The bill also mandates that AI algorithms comply with privacy and interoperability standards and require enrollee consent for data usage in AI development. Furthermore, recommendations made by AI in utilization review must be supported by explanations understandable to individuals. Healthcare insurers are prohibited from making decisions solely based on AI and must ensure that adverse determinations are reviewed by qualified healthcare providers. The bill mandates ongoing quality assurance testing of AI algorithms, including assessments for safety, efficacy, and fairness, with results to be published publicly. Finally, it allows the Insurance Commissioner to audit automated utilization management systems and requires insurers to publish data on approval, denial, and appeal rates of these systems.
Potential Impact Analysis
Who Might Benefit?
['Enrollees in health benefit plans would benefit from increased transparency regarding how AI affects their healthcare service approvals and denials. They would have clearer explanations for decisions and a defined process for contesting outcomes. Healthcare providers would also benefit from greater insight into the AI algorithms used by insurers in their networks, allowing for better collaboration and understanding of coverage decisions. The Insurance Commissioner would gain enhanced oversight capabilities through audit powers and required data submissions, potentially leading to a more regulated and accountable healthcare insurance market. Finally, the general public, through public website disclosures, would have access to information about the AI practices of healthcare insurers, fostering broader awareness and potential for accountability.']
Who Might Suffer?
['Healthcare insurers would be directly impacted by the new compliance requirements. They would incur costs associated with developing and implementing disclosure mechanisms, obtaining enrollee consent for data usage, conducting rigorous quality assurance testing, and potentially re-evaluating or modifying their AI systems to meet new standards. The prohibition against using AI as the sole basis for decisions and the requirement for human clinician oversight, especially for adverse determinations, could lead to increased operational complexity and potentially slower review processes. Additionally, the need to publish detailed information about their AI algorithms and performance metrics could expose them to greater scrutiny and competitive pressure. Third-party entities contracted for audits would also see increased business opportunities.']