The bill aims to revise laws related to health utilization review by establishing specific qualifications for physicians involved in making adverse determinations and reviewing grievances for utilization review organizations. It mandates that only licensed physicians can perform these tasks, ensuring they possess a current, valid nonrestricted medical license and have relevant specialties and experience related to the medical conditions under review. Additionally, the bill stipulates that these physicians must operate under the clinical direction of a medical director who is also a licensed physician in the state.

Furthermore, the bill introduces a provision for automatic approval of health care services if a health insurance issuer or utilization review organization fails to comply with the established requirements. This means that if the necessary protocols are not followed, the health care service in question will be automatically deemed authorized, thereby protecting patients' access to necessary medical care. The bill includes several new sections that outline these requirements and codification instructions for integrating them into existing law.