Maryland HB 820 regulates how health insurance carriers, pharmacy benefits managers, and private review agents use AI in utilization review. The law has been in effect since October 1, 2025, signed May 20, 2025 as Chapter 747.
AI Limits in Maryland HB 820
AI tools cannot replace a clinician’s decision making and cannot deny, delay, or modify care on their own. Determinations must be based on the individual patient’s medical history and clinical circumstances rather than group data alone. The tools must not discriminate against enrollees.
Compliance Obligations
Covered entities must adopt written AI policies, run quarterly performance reviews of their tools, and protect patient data. Any insurer or health tech vendor whose AI touches prior authorization or claims review in Maryland is affected.
Documentation matters here. Written policies and quarterly review records are what regulators will look for when an AI-assisted determination is challenged.
Source: Maryland General Assembly: HB 820
Report a violation: If you believe a business is violating this law, you can file a complaint with the Maryland Attorney General Consumer Protection Division.
