The bill amends the "Patient's Right to Independent Review Act" by updating the definitions and terms used within the act, specifically in Section 3 (MCL 550.1903). Key definitions include "adverse determination," which refers to a health carrier's decision to deny, reduce, or terminate a covered health care service based on medical necessity, and "utilization review," which encompasses various techniques to evaluate the necessity and appropriateness of health care services. The bill also clarifies terms such as "authorized representative," "case management," and "health carrier," ensuring that they align with current practices and regulations in health care.

Additionally, the bill introduces new language regarding the types of facilities that fall under the act, including those providing outpatient services and substance use disorder programs, and specifies the role of independent review organizations in conducting external reviews of adverse determinations. The amendments aim to enhance the clarity and effectiveness of the law, ensuring that patients' rights to independent review are upheld while also streamlining the definitions and processes involved in health care service evaluations. The enactment of this bill is contingent upon the passage of House Bill No. 5729.

Statutes affected:
House Introduced Bill: 550.1903