The bill amends the "Benefit Determination and Utilization Review Act" by introducing a new section that prohibits retrospective denial of coverage for healthcare services related to alcohol or substance use disorder when prior approval has been obtained, unless the approval was based on fraudulent, materially inaccurate, or misrepresented information. Additionally, for health benefit plans issued or renewed on or after January 1, 2027, insurers will not be allowed to require or conduct prospective or concurrent reviews for certain prescription medications used in the treatment of alcohol or opioid use disorder, specifically those containing methadone, buprenorphine, or naltrexone, or those approved by the FDA for managing alcohol or opioid use disorder or mitigating withdrawal symptoms.

Furthermore, the bill adds a new section to the "Medical Assistance" chapter, mandating that Medicaid managed care organizations utilize the medical necessity criteria selected by the executive office of health and human services for conducting utilization reviews. This act is set to take effect upon passage.