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 that outlines specific provisions regarding utilization review decisions. It stipulates that a utilization review decision shall not retrospectively deny coverage for healthcare services provided to a covered person when prior approval has been obtained from the insurer or its designee, unless the approval was based upon fraudulent, materially inaccurate, or misrepresented information submitted by the covered person, authorized person, or the provider.

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 certain prescription medications: (1) that are used in the treatment of alcohol or opioid use disorder; (2) that contain Methadone, Buprenorphine, or Naltrexone; or (3) that 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 Medicaid managed care organizations utilize the medical necessity criteria selected by the Rhode Island division of insurance when conducting utilization reviews for Medicaid benefits. This act will take effect upon passage.