Improving access to appropriate mental health and substance use disorder services.

Updated the definition of covered services to include 'mental health and substance use disorder services,' ensuring both are treated under the same parity rules.

Added a new requirement that health plans cannot deny coverage based on a patient's length of abstinence from drugs or alcohol, provided the abstinence was due to incarceration or prior treatment.

Expanded the list of valid evidence-based sources for clinical standards to explicitly include 'evidence-based clinical criteria' alongside scientific studies and literature.

Clarified that patient placement criteria can only be used to approve services, not to deny them, and added requirements for carriers to provide detailed assessments when denying care.

Added a clause stating that carriers are not required to cover benefits that have already been authorized and provided by a public entitlement program like Medicaid.

Changed the effective date for new coverage provisions from January 1, 2021, to January 1, 2027, and adjusted repeal dates accordingly.

Added a new diagnostic classification (DC:0-5) for infants and young children to the list of covered conditions.

Corrected the section numbering sequence, renumbering the final two sections from 12 and 13 to 11 and 12.

The definition of 'clinical review criteria' was broadened to explicitly include 'decision rules' used by health care benefit managers, ensuring these third-party administrators are held to the same standards as insurers.

The definition of 'mental health services' was updated to explicitly include substance use disorders for health plans issued or renewed on or after January 1, 2027, ensuring parity coverage for addiction treatment.

Insurers are now required to comply with specific quantitative and nonquantitative treatment limitation requirements from the 2024 Federal Mental Health Parity and Addiction Equity Act regulations.

The maximum time allowed for insurers to request a refund from providers was reduced from 24 months to 24 months for general services, but to 6 months for mental health services (increased to 9 months for coordination of benefits cases).

Prior authorization rules for inpatient and residential mental health and substance use disorder treatment were updated to require a minimum of two business days of coverage before a review can be initiated, increasing from the previous standard.

New requirements mandate that utilization review and clinical review criteria must not deviate from generally accepted standards of care, with specific guidance on how to handle disagreements with providers.

The list of therapies exempt from prior authorization was updated to specifically include 'office visits' for outpatient mental health and substance use disorder care.

The effective date for the new provisions was delayed from January 1, 2026, to January 1, 2027, giving the industry more time to adjust to the updated parity and utilization review standards.

The bill's reading date was updated from February 21, 2025, to February 28, 2025.

The bill was reclassified from 'Substitute House Bill' to 'Second Substitute House Bill', reflecting amendments made during the legislative process.

The responsible legislative committee was changed from 'Health Care & Wellness' to 'Appropriations'.

A new provision was added stating that if specific funding for the act is not provided by June 30, 2025, the entire bill becomes null and void.