WHAT THIS BILL REGULATES · 2 REQUIREMENT TYPES
How Is This Bill Enforced
Verbatim statutory text on the left; plain-language analysis and a per-section checklist on the right. Numbered markers cross-link to the matching checklist row.
(1)–(5) 1 ON A QUARTERLY BASIS, EACH CARRIER SHALL SUBMIT TO THE COMMISSIONER A REPORT ON THE CREATION, DEPLOYMENT, AND USE OF ARTIFICIAL INTELLIGENCE OR AUTOMATED DECISION–MAKING SYSTEMS BY THE CARRIER, INCLUDING INFORMATION ON: (1) WHEN AND FOR WHAT PURPOSE THE ARTIFICIAL INTELLIGENCE OR AUTOMATED DECISION–MAKING SYSTEM IS BEING USED; (2) THE PERSON RESPONSIBLE FOR TRAINING THE ARTIFICIAL INTELLIGENCE OR AUTOMATED DECISION–MAKING SYSTEM; (3) THE MAJOR SOURCES OF DATA, EXPERTISE, AND METHODS USED TO TRAIN THE ARTIFICIAL INTELLIGENCE OR AUTOMATED DECISION–MAKING SYSTEM; (4) ADDITIONAL GUIDANCE USED BY THE ARTIFICIAL INTELLIGENCE OR AUTOMATED DECISION–MAKING SYSTEM TO MAKE RECOMMENDATIONS, INCLUDING OUTCOMES AND HOW THEY ALIGNED WITH HUMAN EXPECTATIONS AND VALUES; AND (5) TESTS PERFORMED TO IDENTIFY BIAS IN THE ARTIFICIAL INTELLIGENCE OR AUTOMATED DECISION–MAKING SYSTEM AND THE STEPS TAKEN TO PROACTIVELY ADDRESS ANY ISSUES OF BIAS, INCLUDING ANY NEW DATA SETS USED TO TRAIN THE ARTIFICIAL INTELLIGENCE OR AUTOMATED DECISION–MAKING SYSTEM.
This new section requires every health insurance carrier in Maryland to submit quarterly reports to the Insurance Commissioner detailing the carrier's creation, deployment, and use of artificial intelligence or automated decision-making systems. The report must cover five categories: the purpose and timing of AI use, the person responsible for training the system, major data sources and training methods, additional guidance the system uses to make recommendations (including outcome alignment with human values), and bias testing results and remediation steps. This represents a comprehensive AI transparency obligation directed at a sector-specific regulator, distinct from public-facing disclosure requirements.
(a)(1) On a quarterly basis, each carrier shall submit to the Commissioner, on the form the Commissioner requires, a report that describes: (1) the number of members entitled to health care benefits under a policy, plan, or certificate issued or delivered in the State by the carrier;
(a)(2) 2 the number of clean claims for reimbursement processed by the carrier, AGGREGATED BY ZIP CODE, RACE, ETHNICITY, GENDER, AND AGE OF MEMBERS;
(a)(3)(I)–(X) 2 the activities of the carrier under this subtitle, including: (I) THE NUMBER OF GRIEVANCES FILED WITH THE CARRIER, AGGREGATED BY ZIP CODE, RACE, ETHNICITY, GENDER, AND AGE OF MEMBERS; (II) the outcome of each grievance filed with the carrier, AGGREGATED BY ZIP CODE, RACE, ETHNICITY, GENDER, AND AGE OF MEMBERS; (III) the number and outcomes of cases that were considered emergency cases under § 15–10A–02(b)(2)(i) of this subtitle; (IV) the time within which the carrier made a grievance decision on each emergency case; (V) the time within which the carrier made a grievance decision on all other cases that were not considered emergency cases; (VI) the number of grievances filed with the carrier that resulted from an adverse decision involving length of stay for inpatient hospitalization as related to the medical procedure involved; (VII) the number of adverse decisions issued by the carrier under § 15–10A–02(f) of this subtitle, whether the adverse decision involved a prior authorization or step therapy protocol, and the type of service at issue in the adverse decisions, AGGREGATED BY ZIP CODE, RACE, ETHNICITY, GENDER, AND AGE OF MEMBERS; (VIII) the number of adverse decisions overturned after a reconsideration request under § 15–10B–06 of this title; (IX) the number of requests made and granted under § 15–831(c)(1) and (2) of this title; and (X) THE MONETARY VALUE OF EACH GRIEVANCE DECISION MADE BY THE CARRIER AND THE OUTCOME OF THE DECISION;
(a)(4) 2 THE AVERAGE HOLD TIME AND THE AVERAGE TOTAL TIME FOR CALLS MADE TO THE CARRIER'S GRIEVANCE AND APPEAL CALL CENTERS, AGGREGATED BY EMERGENCY AND NONEMERGENCY CASES;
(a)(5) 2 the number and outcome of all other cases that are not subject to activities of the carrier under this subtitle that resulted from an adverse decision involving the length of stay for inpatient hospitalization as related to the medical procedure involved; AND
(a)(6) 2 THE MONETARY VALUE OF CASES FOR WHICH AN ADVERSE DECISION WAS ISSUED THAT ARE NOT SUBJECT TO THE ACTIVITIES OF THE CARRIER UNDER THIS SUBTITLE.
(b)(1)–(3) The Commissioner shall: (1) compile an annual summary report based on the information provided: (i) under subsection (a) of this section; and (ii) by the Secretary under § 19–705.2(e) of the Health – General Article; (2) report any violations or actions taken under § 15–10B–11 of this title; and (3) provide copies of the summary report to the Governor and, subject to § 2–1257 of the State Government Article, to the General Assembly.
This section amends the existing quarterly adverse decision and grievance reporting framework to require demographic disaggregation of key data fields by zip code, race, ethnicity, gender, and age. New data elements include the monetary value of each grievance decision, average hold time and total call time for grievance and appeal call centers (broken out by emergency and non-emergency cases), and the monetary value of adverse decision cases outside the subtitle's scope. The Commissioner's existing duty to compile annual summary reports and provide them to the Governor and General Assembly is unchanged.
The demographic disaggregation requirements — while not AI-specific on their face — serve a bias-detection function by enabling regulators to identify disparate patterns in adverse decisions and grievances across protected characteristics. Combined with the new § 15–147 AI reporting, this creates a framework for monitoring whether AI-driven claims processing produces disparate outcomes.