An Act to Ensure Human Oversight in Medical Insurance Payment
Maine Legislature, Session 132, LD 0955
Sponsors: MARTIN, ZAGER, FECTEAU
Amends: 24-A MRSA §2436, 24-A MRSA §4304

Legislative Document
No. 955
S.P. 411
In Senate, March 11, 2025
An Act to Ensure Human Oversight in Medical Insurance Payment 
Decisions
Received by the Secretary of the Senate on March 6, 2025.  Referred to the Committee on 
Health Coverage, Insurance and Financial Services pursuant to Joint Rule 308.2 and ordered 
printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator MARTIN of Oxford.
Cosponsored by Representative ZAGER of Portland and
Senators: BENNETT of Oxford, CYRWAY of Kennebec, HARRINGTON of York, TIPPING 
of Penobscot, Representatives: Speaker FECTEAU of Biddeford, MORRIS of Turner, 
SOBOLESKI of Phillips.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §2436, sub-§2-D is enacted to read:
2-D.   For a claim submitted by a health care provider or health care facility with respect 
to a carrier as defined in section 4301‑A, subsection 3 on or after January 1, 2026, a carrier 
may not deny a claim based solely on the use of artificial intelligence. For the purposes of 
this subsection, "artificial intelligence" means a computerized system capable of making 
decisions or recommendations based on algorithms and data analysis.
Sec. 2.  24-A MRSA §4304, sub-§8 is enacted to read:
8.  Use of artificial intelligence.  Beginning January 1, 2026, a carrier may not make 
medical review or utilization review determinations relating to the approval, denial or 
adjustment of coverage for services under a health plan based solely on the use of artificial 
intelligence. Before a carrier denies benefits or reduces payment for services using artificial 
intelligence, the carrier shall conduct a utilization review done by a physician who is 
licensed in this State, including a review of the medical necessity of the services, the 
professional judgment of the enrollee's provider and the impact of any denial of benefits or 
reduction in payment on the enrollee's health outcomes.  An enrollee or provider has the 
right to appeal any determination under this subsection in accordance with section 4303, 
subsection 4. For the purposes of this subsection, "artificial intelligence" means a 
computerized system capable of making decisions or recommendations based on 
algorithms and data analysis.
Sec. 3.  24-A MRSA §4304, sub-§9 is enacted to read:
9.  Rulemaking.  The bureau shall adopt rules to implement the provisions of 
subsection 8 related to the use of artificial intelligence by a carrier. Rules adopted pursuant 
to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 
2-A.
Sec. 4.  24-A MRSA §4304, sub-§10 is enacted to read:
10.  Reporting on use of artificial intelligence.  Beginning April 15, 2026 and 
quarterly thereafter, a carrier shall report to the bureau on the number of denials of coverage 
under subsection 8, the outcome of the review conducted by a licensed physician in 
accordance with subsection 8 and the number of appeals of a determination under 
subsection 8 and the outcome of those appeals. Beginning February 1, 2027 and annually 
thereafter, the bureau shall submit a report summarizing the quarterly reports from carriers 
to the joint standing committee of the Legislature having jurisdiction over health insurance 
matters.
Sec. 5. Use of artificial intelligence by health insurance carriers; 
rulemaking. No later than November 1, 2025, the Department of Professional and 
Financial Regulation, Bureau of Insurance shall adopt rules relating to the use of artificial 
intelligence as required by the Maine Revised Statutes, Title 24-A, section 4304, subsection 
9.
SUMMARY
This bill prohibits, beginning January 1, 2026, health insurance carriers from denying 
coverage or claims for services under a health plan solely based on the use of artificial 
intelligence. The bill requires that, before a carrier denies benefits or reduces payment for 
services using artificial intelligence, a carrier must conduct a utilization review done by a 
physician who is licensed in this State that includes a review of the medical necessity of 
the services, the professional judgment of the enrollee's provider and the impact of any 
denial of benefits or reduction in payment on the enrollee's health outcomes. The bill 
requires carriers and the Department of Professional and Financial Regulation, Bureau of 
Insurance to report on a quarterly and annual basis, respectively, on the use of artificial 
intelligence. The bill also requires the bureau to adopt rules related to the use of artificial 
intelligence by carriers no later than November 1, 2025.