Michigan Compiled Laws Act 251 Of 2000 Patient's Right To Independent Review Act (550.1901 - 550.1929)

AN ACT to provide review of certain health care coverage adverse determinations made by health carriers; to prescribe eligibility, powers, and duties of certain independent review organizations; to prescribe the powers and duties of certain health carriers; to prescribe the powers and duties of certain persons; to prescribe the powers and duties of certain state officials; to provide for the reporting of certain information; to provide fees; and to provide penalties for violations of this act.

History: 2000, Act 251, Eff. Oct. 1, 2000

Section 550.1901 Short Title.
This act shall be known and may be cited as the “patient's right to independent review act”. History: 2000, Act 251, Eff. Oct. 1,
Section 550.1903 Definitions.
As used in this act: (a) "Adverse determination" means a determination by a health carrier or its designee utilization review organization that an admission,...
Section 550.1905 Scope.
(1) Except as otherwise provided in subsection (2), this act applies to all health carriers that provide or perform utilization review. (2) This act...
Section 550.1907 Right To Request External Review For Adverse Determination; Written Notice.
(1) A health carrier shall provide written notice to a covered person in plain English of the internal grievance and external review processes at...
Section 550.1909 Written Request To Commissioner.
Except for a request for an expedited external review under section 13, all requests for external review shall be made in writing to the...
Section 550.1911 Request For External Review; Commencement; Preliminary Review; Notice Of Acceptance; Duties Of Commissioner; 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 Commissioner; Notice Of Decision.
(1) Not later than 60 days after the date of receipt of a notice of an adverse determination or final adverse determination under section...
Section 550.1913 Expedited External Review.
(1) Except as provided in subsection (11), a covered person or the covered person's authorized representative may make a request for an expedited external...
Section 550.1915 Decision As Final Administrative Remedy; Other Remedies.
(1) An external review decision and an expedited external review decision are the final administrative remedies available under this act. A person aggrieved by...
Section 550.1917 Approved Independent Review Organizations; Application; Form; Fee; Expiration; Termination; Updated List.
(1) The commissioner shall approve independent review organizations eligible to be assigned to conduct external reviews under this act to ensure that an independent...
Section 550.1919 Approved Independent Review Organizations; Requirements.
(1) To be approved under section 17 to conduct external reviews, an independent review organization shall do both of the following: (a) Have and...
Section 550.1921 Independent Review Organization; Liability For Damages.
An independent review organization or clinical peer reviewer working on behalf of an independent review organization is not liable in damages to any person...
Section 550.1923 Maintenance Of Records; Report To Commissioner.
(1) An independent review organization assigned to conduct an external review under section 11 or 13 shall maintain for 3 years written records in...
Section 550.1925 Description Of Internal Grievance And External Review Procedures; Inclusion With Materials Provided To Covered Persons.
(1) Each health carrier shall include a description of the internal grievance and external review procedures in or attached to the policy, certificate, membership...
Section 550.1927 Rules.
The commissioner may promulgate rules pursuant to the administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to 24.328, necessary to carry out...
Section 550.1929 Cease And Desist Order; Additional Orders; Fines; Hearing; Injunction; Creation Of Cancer Clinical Trials; Disposition Of Funds.
(1) If the commissioner finds that a violation of this act has occurred, the commissioner shall reduce the findings and decision to writing and...

Last modified: October 10, 2016