HB1406 — (New TItle) relative to health carrier recordkeeping requirements in utilization review, including specifications regarding the use of artificial intelligence.

HB 1406 - AS INTRODUCEDAMENDED SESSIONBY 26-2971THE 05/08 HOUSE BILL11Mar2026... 1406 AN ACT prohibiting health carriers from using artificial intelligence to change the clinical judgment of a provider.  SPONSORS:

0986h SESSION 26-2971 05/08 HOUSE BILL 1406 AN ACT relative to health carrier recordkeeping requirements in utilization review, including specifications regarding the use of artificial intelligence.

SPONSORS:

Commerce and Consumer Affairs ───────────────────────────────────────────────────────────────── AMENDED ANALYSIS This billbill: prohibits health carriers from using artificial intelligence to change the clinical judgment of a provider.

I.

Requires health carriers under the managed care law to maintain written records relative to their use of artifical intelligence and protocols for ensuring human review of certain determinations.

II.

Requires health carriers to make any adverse determinations relative to a covered individual and maintain records related to an adverse determination including whether artificial intelligence was used.

III.

Establishes health carriers as responsible for the activities of entities which they have contracted with, relative to such requirements.

HB 1406 - AS INTRODUCEDAMENDED 26-2971BY 05/08THE STATEHOUSE OF11Mar2026... NEW HAMPSHIRE In the Year of Our Lord Two Thousand Twenty-Six AN ACT prohibiting health carriers from using artificial intelligence to change the clinical judgment of a provider.  Be it Enacted by the Senate and House of Representatives in General Court convened:

10986h New26-2971 Section;05/08 STATE OF NEW HAMPSHIRE In the Year of Our Lord Two Thousand Twenty-Six AN ACT relative to health carrier recordkeeping requirements in utilization review, including specifications regarding the use of artificial intelligence.

Be it Enacted by the Senate and House of Representatives in General Court convened:

1 New Subparagraph;

UseUtilization ofReview; Artificial Intelligence to Change the Clinical Judgment of the Provider Prohibited.

AmendStandards and Procedures for Use of Artificial IntelligenceAmend RSA 420-J420-J:6, I by inserting after sectionsubparagraph 6-e(d) the following new section:subparagraph:

420-J:6-f(e) UseEach ofhealth Artificialcarrier Intelligenceshall bymaintain Healthwritten Carriersrecords related to Changethe Providerhealth Codescarrier’s Prohibited.use of algorithms, artificial intelligence, or other machine based systems, including but not limited to:

Health(1) carriersWhich arefunctions prohibited from using artificial intelligence, as defined in RSA 5-D:1, to conduct audits of provider codes or to adjust such codes based on recommendations from artificial intelligence thatis wouldused change,for; alter, or amend the clinical judgment of a provider.

Eachand carrier(2) shallProtocols maintainensuring recordsqualified identifyinghuman thereview use of artificialdeterminations intelligenceaffecting toolsprovider incoding claimsdecisions. processing and make such records available to the insurance department upon audit.

A2 violationNew ofParagraph; this section shall constitute an unfair insurance practice under RSA 417, and the commissioner may impose administrative fines or order restitution for any delay or denial of care resulting from such violation.

2Managed EffectiveCare Date.Law;

Utilization Review;

Adverse Determinations;

Contracting Liability.

Amend RSA 420-J:6 by inserting after paragraph XI the following new paragraphs:

XII.

Adverse Determinations.

(a) All adverse determinations, including payment reductions and down coding, must be made by a qualified health care provider.

(b) The health carrier must provide written notice of the adverse determination to the covered person and the covered person's health care provider detailing the reason for the decision.

(c) The health carrier shall maintain records including, but not limited to the following:

(1) The information submitted to the health carrier;

(2) The information reviewed by the qualified health care provider;

(3) Applicable clinical guidelines;

(4) Whether artificial intelligence was used to assist the reviewer;

nd (5) The clinical rationale for the decision.

XIII.

Whenever a health carrier contracts to have another entity perform any functions, including use of artificial intelligence systems developed by another entity, related to utilization review, the commissioner shall hold the health carrier responsible for monitoring the activities of the entity with which it contracts and for ensuring that the requirements of this section and applicable rules are met.

3 Effective Date.