Sec. 3157a.
(1) By rendering any treatment, products, services, or accommodations to 1 or more injured persons for an accidental bodily injury covered by personal protection insurance under this chapter after July 1, 2020, a physician, hospital, clinic, or other person is considered to have agreed to do both of the following:
(a) Submit necessary records and other information concerning treatment, products, services, or accommodations provided for utilization review under this section.
(b) Comply with any decision of the department under this section.
(2) A physician, hospital, clinic, or other person or institution that knowingly submits under this section false or misleading records or other information to an insurer, the association created under section 3104, or the department commits a fraudulent insurance act under section 4503.
(3) The department shall promulgate rules under the administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to 24.328, to do both of the following:
(a) Establish criteria or standards for utilization review that identify utilization of treatment, products, services, or accommodations under this chapter above the usual range of utilization for the treatment, products, services, or accommodations based on medically accepted standards.
(b) Provide procedures related to utilization review, including procedures for all of the following:
(i) Acquiring necessary records, medical bills, and other information concerning the treatment, products, services, or accommodations provided.
(ii) Allowing an insurer to request an explanation for and requiring a physician, hospital, clinic, or other person to explain the necessity or indication for treatment, products, services, or accommodations provided.
(iii) Appealing determinations.
(4) If a physician, hospital, clinic, or other person provides treatment, products, services, or accommodations under this chapter that are not usually associated with, are longer in duration than, are more frequent than, or extend over a greater number of days than the treatment, products, services, or accommodations usually require for the diagnosis or condition for which the patient is being treated, the insurer or the association created under section 3104 may require the physician, hospital, clinic, or other person to explain the necessity or indication for the treatment, products, services, or accommodations in writing under the procedures provided under subsection (3).
(5) If an insurer or the association created under section 3104 determines that a physician, hospital, clinic, or other person overutilized or otherwise rendered or ordered inappropriate treatment, products, services, or accommodations, or that the cost of the treatment, products, services, or accommodations was inappropriate under this chapter, the physician, hospital, clinic, or other person may appeal the determination to the department under the procedures provided under subsection (3).
(6) As used in this section, "utilization review" means the initial evaluation by an insurer or the association created under section 3104 of the appropriateness in terms of both the level and the quality of treatment, products, services, or accommodations provided under this chapter based on medically accepted standards.
History: Add. 2019, Act 21, Imd. Eff. June 11, 2019 Popular Name: Act 218Popular Name: Essential InsurancePopular Name: No-Fault Insurance
Structure Michigan Compiled Laws
Chapter 500 - Insurance Code of 1956
Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)
218-1956-31 - Chapter 31 Motor Vehicle Personal and Property Protection (500.3101...500.3179)
Section 500.3101b - Repealed. 2011, Act 91, Imd. Eff. July 15, 2011.
Section 500.3101c - Standard Certified Statement.
Section 500.3101d - Qualification as Self-Insurer; Certificate; Issuance; Cancellation.
Section 500.3107 - Expenses and Work Loss for Which Personal Protection Insurance Benefits Payable.
Section 500.3107a - Basis of Work Loss for Certain Injured Persons.
Section 500.3107b - Reimbursement or Coverage for Certain Expenses Not Required.
Section 500.3108 - Survivor's Loss; Benefits.
Section 500.3113 - Person Not Entitled to Personal Protection Insurance Benefits.
Section 500.3116 - Value of Claim in Tort; Subtraction From or Reimbursement for Benefits.
Section 500.3121 - Liability for Accidental Damage to Tangible Property.
Section 500.3123 - Exclusions From Property Protection Insurance Benefits.
Section 500.3125 - Priorities in Claiming Property Protection Benefits.
Section 500.3131 - Residual Liability Insurance; Coverage.
Section 500.3141 - Notice of Accident.
Section 500.3143 - Assignment of Right to Future Benefits Void.
Section 500.3146 - Limitation of Action by Insurer for Recovery or Indemnity.
Section 500.3148 - Attorney's Fee; Restrictions.
Section 500.3151 - Submission to Mental or Physical Examination; Physician Requirements.
Section 500.3152 - Report of Mental or Physical Examination.
Section 500.3153 - Court Orders as to Noncompliance With MCL 500.3151 and 500.3152.
Section 500.3158 - Statement of Earnings; Report and Records From Medical Institution.
Section 500.3173 - Certain Persons Disqualified From Receiving Benefits Under Assigned Claims Plans.
Section 500.3176 - Taking Costs Into Account in Making and Regulating Rates.