The bill amends section 3157a of the Michigan Insurance Code of 1956, focusing on the responsibilities of healthcare providers and insurers regarding the treatment of injured persons under personal protection insurance. It establishes that by providing treatment, products, services, or accommodations for accidental bodily injuries after July 1, 2020, healthcare providers agree to submit necessary records for utilization review and comply with departmental decisions. The bill also outlines that submitting false or misleading information constitutes a fraudulent insurance act, and mandates the department to create rules for utilization review, including criteria for identifying excessive utilization and procedures for acquiring necessary records and appealing determinations.

Additionally, the bill allows insurers to require explanations from healthcare providers for treatments that deviate from standard practices, and it provides a process for appealing determinations of overutilization or inappropriate treatment. The bill emphasizes that insurers must comply with departmental decisions regarding these matters. Notably, the definition of "utilization review" is updated to clarify its meaning in the context of evaluating the appropriateness of treatments based on medically accepted standards.

Statutes affected:
Senate Introduced Bill: 500.3157