Compliance Alert: Maryland, Texas Regulate Use of Artificial Intelligence in Utilization Reviews

LOS ANGELES & AUSTIN, Texas - EntSun -- Maryland and Texas have new artificial intelligence laws that will prohibit carriers or utilization review agents from using AI to make adverse determinations.

In Texas, utilization review agents may use an AI tool for administrative support or fraud-detection functions. However, agents cannot use AI to make adverse determinations.

In Maryland, carriers using AI in utilization reviews must ensure that the AI tool does not supplant the role of health care providers in medical necessity decisions, among other prohibitions. Also, carriers using AI in utilization reviews must ensure that the tool does not delay or modify health care services or harm an enrollee.

Maryland will also require carriers filing utilization plans to include information on how the AI tool will be used. They must also ensure that the performance, use, and outcomes of an AI tool are reviewed and revised at least quarterly.

More on EntSun News

• Advantage Marketing Launches 3-Minute Assessment to Help SMBs Diagnose and Fix Marketing Gaps
• Matter Studio Gallery Presented "Evolving Matter," a Pop-Up Exhibition Examining Material Transformation and Contemporary Form
• Justin Jeansonne and his Music Manager Donna Cardellino Head To Nashville
• Raquel Riley Thomas' AOAGWLLC and Hazel Simpson's Sis to Sis Productions Ink Co-Production Deal, Launching Strategic Creative Alliance
• InterMountain Management Announces the Re-opening of Holiday Inn Express & Suites Alexandria

To ensure compliance with these new laws, both Maryland and Texas state insurance departments may audit and inspect a company's AI tools.

To learn more about the Maryland and Texas AI measures, along with more than 15 other utilization review laws enacted and regulations adopted recently, access the real-time statutory/regulatory updates in the "Utilization Review Guide," an electronic 51-state compilation of utilization review statutes, regulations, and forms, at https://payhip.com/b/vsbKo, under the "Subscriptions" tab.

The UR Guide covers the following topics:

• Utilization Review Agent Duties
• Application/Certification Requirements
• Grounds for Certification Denials
• Notice of Change Requirements
• Recordkeeping and Reporting Requirements
• Renewal Requirements
• Confidentiality Requirements
• Complaints
• Exemption Criteria
• Prohibitions
• Waivers
• Deadlines
• Penalties
• Appeal Procedures

The real-time statutory/regulatory updates are only available to subscribers on a yearly plan. However no real-time updates are provided to one-time e-book purchasers, although they may purchase real-time updates separately and later.

More on EntSun News

• Bay Street Yard to host "Girls Night Out the Show" on April 20
• CB Stuffer Expands New England Footprint with Launch at Common Man Roadside in Hooksett, NH
• Contracting Resources Group Named to the 2026 Inc. Regionals: Mid-Atlantic List
• PBR returns to Queen Creek Arizona
• Dividend Stock Guru Unveils High Yield Dividend Stock Research Reports

About Croneal Consulting Group

Croneal Consulting Group is an information and research services firm that provides publications, database development services, and Web portals for members of the legal, regulatory, and government communities. Besides UST Reports, an insurance bulletin reporting service for five United States territories (American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the Virgin Islands), the firm counts as its flagship product, InsuranceBulletins.com, an Insurance Bulletin Alert Tracking System, with more than 10,000 insurance bulletins released from 51 state insurance departments from 2006 to the current date.

For CCG's products and services, visit these sites:

http://www.payhip.com/ccg
http://www.insurancebulletins.com
http://www.cronealconsultinggroup.com