(8) Use of artificial intelligenceArtificial intelligenceFor purposes of this subsection, "artificial intelligence" means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.24-A MRSA § 4304(8). Beginning January 1, 2026, the use of artificial intelligenceArtificial intelligenceFor purposes of this subsection, "artificial intelligence" means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.24-A MRSA § 4304(8) by a carrierCarrierA carrier, or any 3rd party contracted by a carrier, that uses artificial intelligence to make medical review or utilization review determinations relating to the approval, denial, delay, modification or adjustment of coverage for services under a health plan.24-A MRSA § 4304(8), or by any 3rd party contracted by a carrierCarrierA carrier, or any 3rd party contracted by a carrier, that uses artificial intelligence to make medical review or utilization review determinations relating to the approval, denial, delay, modification or adjustment of coverage for services under a health plan.24-A MRSA § 4304(8), to make medical review or utilization review determinations relating to the approval, denial, delay, modification or adjustment of coverage for services under a health plan is governed by this subsection.

(8)(A)(1) 1 Determinations derived from the use of artificial intelligenceArtificial intelligenceFor purposes of this subsection, "artificial intelligence" means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.24-A MRSA § 4304(8), including algorithms and other software tools, must: (1) Be based upon an enrollee's medical history, as applicable, and individual clinical circumstances as presented by the requesting provider, as well as other relevant clinical information contained in the enrollee's medical record, and not supplant provider decision making;

(8)(A)(2) 2 Not directly or indirectly discriminate against an enrollee on the basis of race, color, religion, national origin, ancestry, age, sex, gender, gender identity, gender expression, sexual orientation, present or predicted disability, expected length of life, degree of medical dependency, quality of life or other health conditions;

(8)(A)(3) 2 Be fairly and equitably applied; and

(8)(A)(4) 3 Be open to inspection, and the use of artificial intelligenceArtificial intelligenceFor purposes of this subsection, "artificial intelligence" means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.24-A MRSA § 4304(8) must be disclosed in the written policies and procedures to an enrollee.

(8)(A) trailing 4 Use of artificial intelligenceArtificial intelligenceFor purposes of this subsection, "artificial intelligence" means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.24-A MRSA § 4304(8) pursuant to this paragraph must be governed by policies that establish accountability for performance, use and outcomes that are reviewed and revised for accuracy and reliability. Data under this paragraph may not be used beyond its intended and stated purpose. Data under this paragraph must be protected from risk that may directly or indirectly cause harm to the enrollee.

(8)(B) 5 A denial, delay, modification or adjustment of health care services based on medical necessity must be made by a clinical peer competent to evaluate the specific clinical issues involved in the health care services requested by the enrollee's provider. The clinical peer making the medical review or utilization review determination shall consider the enrollee's provider's recommendation and the enrollee's medical history, as applicable, and individual clinical circumstances.

(8) definition For purposes of this subsection, "artificial intelligenceArtificial intelligenceFor purposes of this subsection, "artificial intelligence" means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.24-A MRSA § 4304(8)" means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.