Insurance: no-fault; treatment and service for injuries; revise standards and procedures for utilization reviews. Amends sec. 3157a of 1956 PA 218 (MCL 500.3157a).
Impact
By specifying the requirements for utilization reviews, HB4884 introduces a structured approach to evaluating treatments for accidental bodily injuries covered by insurance. The bill empowers insurers and regulatory bodies to impose standards that ensure medical practices adhere to generally accepted standards, aiming to mitigate instances of overutilization or unnecessary services. This legislative update may shift the balance of authority between healthcare providers and insurers, potentially affecting how treatments are delivered and compensated.
Summary
House Bill 4884 seeks to amend the Michigan insurance code specifically relating to the standards and procedures for utilization reviews pertaining to treatments and services covered under personal protection insurance. The bill underscores the obligations of healthcare providers— including physicians, hospitals, and clinics— to submit necessary treatment records for evaluation and to comply with appeals decisions made by the governing department. This legislative change is intended to establish clearer criteria for what constitutes appropriate treatment under the law, enhancing oversight of the medical service provisioning process.
Contention
While the bill aims to standardize procedures and combat fraudulent practices, concerns have been raised regarding potential administrative burdens it may place on healthcare providers. Critics argue that the bill's emphasis on detailed documentation and compliance could lead to a chilling effect on treatment decisions, whereby providers become hesitant to approve necessary but potentially scrutinized services. Additionally, there may be debates about the adequacy of the 'generally accepted standards,' particularly the exclusion of for-profit guidelines in determining the appropriateness of treatments offered.
Insurance: no-fault; choice of either an independent medical exam or a utilization review; require. Amends secs. 3151 & 3157a of 1956 PA 218 (MCL 500.3151 & 500.3157a).
Insurance: no-fault; treatment and services for injuries; revise limitations on charges. Amends sec. 3157 of 1956 PA 218 (MCL 500.3157). TIE BAR WITH: SB 0531'23
Insurance: no-fault; cross-reference to amended section of the insurance code; revise. Amends sec. 2111f of 1956 PA 218 (MCL 500.2111f). TIE BAR WITH: SB 0530'23
Insurance: no-fault; penalties for lapse of insurance policy; eliminate. Amends secs. 2116b, 2118 & 2120 of 1956 PA 218 (MCL 500.2116b et seq.) & repeals sec. 2116a of 1956 PA 218 (MCL 500.2116a).
Insurance: no-fault; choice of either an independent medical exam or a utilization review; require. Amends secs. 3151 & 3157a of 1956 PA 218 (MCL 500.3151 & 500.3157a).