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 550.1917 – 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 […]
Section 550.1921 – Independent Review Organization; Liability for Damages.
550.1921 Independent review organization; liability for damages. Sec. 21. An independent review organization or clinical peer reviewer working on behalf of an independent review organization is not liable in damages to any person for any opinions rendered during or upon completion of an external review conducted under this act, unless the opinion was rendered in […]
Section 550.1903 – Definitions.
550.1903 Definitions. Sec. 3. As used in this act: (a) “Adverse determination” means a determination by a health carrier or its designee utilization review organization that an admission, availability of care, continued stay, or other health care service that is a covered benefit has been reviewed and, based on the information provided, does not meet […]
Section 550.1905 – Scope.
550.1905 Scope. Sec. 5. (1) Except as otherwise provided in subsection (2), this act applies to all health carriers. (2) This act does not apply to a policy or certificate that provides coverage only for specified accident or accident-only coverage, credit, disability income, hospital indemnity, long-term care insurance, as that term is defined in section […]
Section 550.1907 – Right to Request External Review for Adverse Determination; Written Notice.
550.1907 Right to request external review for adverse determination; written notice. Sec. 7. (1) A health carrier shall provide written notice to a covered person of the internal grievance and external review processes at the time the health carrier sends written notice of an adverse determination. (2) Except as provided in subsection (3)(a), a request […]