Section 550.1923 – Maintenance of Records; Report to Director.
550.1923 Maintenance of records; report to director. Sec. 23. (1) An independent review organization assigned to conduct an external review under section 11 or 13 shall maintain for 3 years written records in the aggregate and by health carrier on all requests for external review for which it conducted an external review during a calendar […]
Section 550.1925 – Description of Internal Grievance and External Review Procedures; Inclusion With Materials Provided to Covered Persons.
550.1925 Description of internal grievance and external review procedures; inclusion with materials provided to covered persons. Sec. 25. (1) A health carrier shall include a description of the internal grievance and external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage, or other evidence of coverage it provides to covered […]
Section 550.1927 – Rules.
550.1927 Rules. Sec. 27. The director may promulgate rules under the administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to 24.328, necessary to carry out this act. History: 2000, Act 251, Eff. Oct. 1, 2000 ;– Am. 2016, Act 274, Eff. Sept. 29, 2016
Section 550.1929 – Cease and Desist Order; Additional Orders; Fines; Hearing; Injunction; Creation of Cancer Clinical Trials; Disposition of Funds.
550.1929 Cease and desist order; additional orders; fines; hearing; injunction; creation of cancer clinical trials; disposition of funds. Sec. 29. (1) If the commissioner finds that a violation of this act has occurred, the commissioner shall reduce the findings and decision to writing and shall issue and cause to be served upon the person charged […]
Section 550.1909 – Written Request to Director; Manner; Electronic Communication.
550.1909 Written request to director; manner; electronic communication. Sec. 9. (1) Except for a request for an expedited external review under section 13, all requests for external review must be made in writing to the director. (2) A written notice required to be provided under this act must be provided in a culturally and linguistically […]
Section 550.1911 – Request for External Review; Commencement; Preliminary Review; Notice of Acceptance; Duties of Director; Incomplete Request; Nonacceptance; Assignment of Independent Review Organization; Duty of Health Carrier to Provide Documents; Reconsideration by Health Carrier of Its Adverse Determination; Recommendation; Considerations; Review by Director; Notice of Decision.
550.1911 Request for external review; commencement; preliminary review; notice of acceptance; duties of director; incomplete request; nonacceptance; assignment of independent review organization; duty of health carrier to provide documents; reconsideration by health carrier of its adverse determination; recommendation; considerations; review by director; notice of decision. Sec. 11. (1) Not later than 60 days or, after […]
Section 550.1913 – Expedited External Review.
550.1913 Expedited external review. Sec. 13. (1) Except as provided in subsection (12), a covered person or the covered person’s authorized representative may make a request for an expedited external review with the director within 10 days after the covered person receives an adverse determination if both of the following apply: (a) The adverse determination […]
Section 550.1915 – Decision as Final Administrative Remedy; Other Remedies.
550.1915 Decision as final administrative remedy; other remedies. Sec. 15. (1) An external review decision and an expedited external review decision are the final administrative remedies available under this act. A person aggrieved by an external review decision or an expedited external review decision may seek judicial review no later than 60 days from the […]
Section 550.1917 – Approved Independent Review Organizations; Application; Form; Fee; Expiration; Termination; Updated List.
550.1917 Approved independent review organizations; application; form; fee; expiration; termination; updated list. Sec. 17. (1) The director shall approve independent review organizations eligible to be assigned to conduct external reviews under this act to ensure that an independent review organization satisfies the minimum standards established under section 19. (2) The director shall develop an application […]
Section 550.1919 – Approved Independent Review Organization; Requirements.
550.1919 Approved independent review organization; requirements. Sec. 19. (1) To be approved under section 17 to conduct external reviews, an independent review organization must do all of the following: (a) Have and maintain written policies and procedures that govern all aspects of both the standard external review process and the expedited external review process under […]