The bill amends existing laws regarding insurance coverage for mental health and substance use disorders, ensuring that such coverage is provided under the same terms as other medical conditions. Key provisions include the requirement that payors provide coverage for substance use disorders in accordance with the criteria of the American Society of Addiction Medicine. Additionally, in conducting utilization reviews for service intensity or level of care placement for mental health or substance use disorders, payors must apply the most recent version of age-appropriate patient placement criteria developed by nonprofit professional provider associations. If a payor's application of these criteria is inconsistent with the requested service intensity or level of care, any adverse benefit determination notice must include full details of the payor's assessment.

The bill also stipulates that mental health and substance use disorder coverage and clinical criteria shall not deviate from generally accepted standards of care. It introduces a definition for "generally accepted standards of care," which refers to standards recognized by healthcare providers in relevant clinical specialties, as reflected in sources such as patient placement criteria and clinical practice guidelines developed by nonprofit professional provider associations.

Furthermore, the bill defines "nonprofit professional provider association" as a not-for-profit healthcare provider professional association that issues peer-reviewed guidelines and clinical recommendations. The act is set to take effect upon passage.