SECTION 1. Section 12 of chapter 176O of the General Laws, as appearing in the 2008 Official Edition, is hereby amended by inserting after the word “provider”, in line 20, the following words: “provided, however, that in making an adverse determination for mental health or substance abuse treatment, the carrier or its designated utilization review organization shall defer to the judgment of the treating clinician unless there is a preponderance of evidence that the requested admission, continued stay or other health care service does not meet the requirements for coverage based on medical necessity, appropriateness of health care setting and level of care, or effectiveness.”
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