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 stipulates that a utilization review decision cannot retrospectively deny coverage for healthcare services if prior approval was obtained from the insurer, unless the approval was based on fraudulent or materially inaccurate information. Additionally, for health benefit plans issued or renewed after the effective date of this section, insurers are prohibited from requiring or conducting prospective or concurrent reviews for certain prescription medications used in the treatment of alcohol or opioid use disorders, specifically those containing Methadone, Buprenorphine, or Naltrexone, or those approved for mitigating opioid withdrawal symptoms.

Furthermore, the bill mandates that Medicaid managed care organizations utilize medical necessity criteria selected by the Rhode Island division of insurance for determining medical necessity and clinical appropriateness in their utilization reviews. This act is designed to enhance access to necessary medications for individuals dealing with substance use disorders and streamline the review process for healthcare services. The provisions of this act will take effect upon passage.