The bill amends Chapter 27-18.9 of the General Laws, known as the "Benefit Determination and Utilization Review Act," by adding a new section, 27-18.9-16, which outlines specific provisions regarding utilization review decisions. It prohibits insurers from retrospectively denying coverage for healthcare services provided to a covered person if prior approval was obtained from the insurer or its designee, unless the approval was based upon fraudulent, materially inaccurate, or misrepresented information.

Additionally, for health benefit plans issued or renewed on or after the effective date of this section, insurers are prohibited from requiring or conducting a prospective or concurrent review for prescription medications that: (1) are used in the treatment of alcohol or opioid use disorder; (2) contain Methadone, Buprenorphine, or Naltrexone; or (3) were approved by the United States Food and Drug Administration for the mitigation of opioid withdrawal symptoms before the effective date of this section.

Furthermore, the bill mandates that each Medicaid managed care organization, when conducting utilization reviews for Medicaid benefits, shall use the medical necessity criteria selected by the Rhode Island division of insurance for making determinations of medical necessity and clinical appropriateness pursuant to the utilization review plan. This act will take effect upon passage.