RI S2564

Requires health insurers to provide coverage for substance use disorders in accordance with American Society of Addiction Medicine criteria, at minimum, rather than merely relying upon those criteria when developing coverage policies.

Mandates that payors conducting utilization review for mental health or substance use treatment must exclusively apply the most recent patient placement criteria from nonprofit professional provider associations and authorize care consistent with those criteria.

Prohibits mental health and substance use disorder coverage and clinical criteria from deviating from generally accepted standards of care, as defined by guidelines from recognized professional associations including LOCUS, CALOCUS-CASII, and Early Childhood Service Intensity Instrument.

Defines "nonprofit professional provider association" to include organizations such as the American Psychiatric Association, American Psychological Association, American Society of Addiction Medicine, and American Academy of Child and Adolescent Psychiatry.

Requires adverse benefit determination notices to include full details of the payor's assessment under relevant criteria when the payor's placement decision differs from what the patient or provider requested.