Health carriers would document automated reviews and explain adverse decisions

Health carriers would keep written records about their use of algorithms, artificial intelligence, and other machine-based systems. The requirement applies to health carriers under New Hampshire's managed care law. Records would identify which functions use artificial intelligence and include protocols for qualified human review of decisions affecting provider coding. The proposed act would take effect January 1, 2027.

A qualified health care provider would make each unfavorable decision, and the carrier would send written notice explaining it to the covered person and their provider. These requirements apply to adverse determinations under the managed care law. Unfavorable decisions include payment reductions and decisions to assign a lower code. The proposed act would take effect January 1, 2027.

Health carriers would keep records about unfavorable decisions and be responsible for monitoring firms they hire to perform utilization review. Records cover adverse determinations. The monitoring duty applies to entities performing utilization review functions for a carrier. Records would include information submitted and reviewed, applicable clinical guidelines, whether artificial intelligence assisted the reviewer, and the clinical reason for the decision. When a carrier hires another entity to perform any utilization review function, including through that entity's artificial intelligence systems, the commissioner would hold the carrier responsible for monitoring the entity and ensuring it meets the section's requirements and applicable rules. The proposed act would take effect January 1, 2027.