Maine Weighs Restricting AI-Based Health Care Decisions

LD-1301 “requires that carriers only use AI, algorithms and other software in a way that takes patients' medical history and individual circumstances into account. It can’t discriminate against patients based on their personal characteristics, and it must be disclosed and the software open to inspection,” said sponsor Sen. Mike Tipping (D) in written testimony. “Second, it requires that any denial, delay, modification or adjustment of health care services be made by a human being, not a computer.”

LD-955 would prohibit health insurance companies from denying claims or changing coverage due to an AI decision. “This bill would ensure that AI does not replace human judgment when it comes to important healthcare decisions,” sponsor Sen. Joe Martin (R) wrote. “Before an insurance company can deny a claim or reduce coverage based on AI, a licensed doctor in Maine must first review the case. … Patients and doctors will also have the right to challenge any decision made by AI through the normal appeals process.”

America’s Health Insurance Plans opposed the bills and highlighted AI’s upsides. “Al can shorten decision making, reduce provider burden, increase administrative efficiency, ensure the safety and quality of care, reduce costs and enhance affordability for patients,” the national association wrote. "Legislation should not broadly prohibit the use of Al." It added that “only humans make final determinations resulting in denials based on clinical factors.”

However, MaineHealth supported LD-1301 and LD-955. “As carriers increasingly use [AI] to review and deny claims, we strongly support both bills before you today,” the nonprofit integrated health system said in written testimony. “While AI is an important tool that can increase efficiency, it is critical that there is careful oversight of the practice as well as qualified clinical peers to review claim denials and adjustments.”