This bill amends the General Laws in Chapter 27-38.2, which pertains to insurance coverage for mental illness and substance use disorders, by introducing new definitions and clarifying existing terms. It defines "Generally accepted standards of mental health and substance use disorder care" and adds a definition for "Medically necessary treatment of a mental health or substance use disorder." The bill revises the definition of "Mental health and substance use disorders" to align with the latest diagnostic categories from the WHO and APA, while removing the exclusion of tobacco and caffeine. It introduces "Utilization review" and requires that insurance policies issued after January 1, 2025, cover medically necessary treatments without requiring providers to furnish medical records to prove necessity. The bill prohibits insurers from limiting benefits for chronic disorders to short-term treatment and mandates that medical necessity determinations comply with specific requirements.

Furthermore, the bill sets forth that insurers cannot rescind treatment authorization after it has been given and must arrange for out-of-network services at in-network costs if necessary services are unavailable. It prohibits insurers from limiting benefits based on potential public entitlement coverage and from adopting conflicting policy terms. Civil penalties are established for violations. The bill also requires that utilization reviews for mental health and substance use disorders apply the most recent criteria and guidelines from relevant clinical specialties, with detailed requirements for insurers to ensure proper use of these criteria, including education programs, material provision, and interrater reliability testing with a minimum pass rate of 90%. Penalties for non-compliance include fines up to $10,000 for willful violations. The bill applies to all insurance contracts from January 1, 2025, and takes effect upon passage.