Law / United States / Maryland
HB 820 / Ch. 747 (2025), Artificial Intelligence in Health Insurance Utilization Review
Md. Code Ann., Ins. §15-10B-05.1
A citation is an address, not a summary. The first part names the law; what follows narrows it to the exact section, article or paragraph.
In force 11 months, effective 1 October 2025.
An AI risk obligations rule binding private bodies.
As of 6 September 2026.
What it requires
- Base any determination an AI, algorithm, or other software tool makes in utilization review on the enrollee's own medical or clinical history, individual clinical circumstances, or other relevant clinical information in the enrollee's record, never solely on a group dataset.
- Keep a health care provider in the determination process; the tool may not replace that role.
- Ensure the tool is fairly and equitably applied and does not result in unfair discrimination or directly or indirectly cause harm to an enrollee.
- Make the tool available for audit or compliance review by the Insurance Commissioner, and review its performance, use, and outcomes at least quarterly.
- The tool may not itself deny, delay, or modify health care services.
- This applies to carriers, and to pharmacy benefits managers or private review agents that conduct utilization review on a carrier's behalf.
Who checks it
Audit expectation
periodic
Who audits it
Self, Regulator
Where the report goes
Produced on request
What this law does
Drafted with AI from the cited sources under the direction of UnGovr staff. UnGovr holds editorial responsibility for this page.
Effective October 1, 2025, a carrier, pharmacy benefits manager, or private review agent that uses artificial intelligence, an algorithm, or other software tool to conduct utilization review must base its determinations on the enrollee's own medical or clinical history and individual clinical circumstances rather than a group dataset alone, keep a health care provider in the determination process, ensure fair and non-discriminatory application, and make the tool available for audit by the Insurance Commissioner.
The tool may not directly or indirectly cause harm to an enrollee, and it may not itself deny, delay, or modify health care services. A companion reporting section requires carriers to disclose to the Commissioner, case by case, whether AI, an algorithm, or other software tool was used in each adverse coverage decision.
When LexLint raises it
high_risk_decisions