Michigan Office of Administrative Hearings and Rules  
611 W. Ottawa Street  
Lansing, MI 48909  
Phone: 517-335-8658 Fax: 517-335-9512  
AGENCY REPORT TO THE  
JOINT COMMITEE ON ADMNINISTRATIVE RULES (JCAR)  
1. Agency Information  
Agency name:  
Insurance and Financial Services  
Division/Bureau/Office:  
Insurance  
Name of person completing this form:  
Catherine Hart  
Phone number of person completing this form:  
517-284-8720  
E-mail of person completing this form:  
HartC4@michigan.gov  
Name of Department Regulatory Affairs Officer reviewing this form:  
Sarah Wohlford  
2. Rule Set Information  
MOAHR assigned rule set number:  
2019-136 IF  
Title of proposed rule set:  
Utilization Review  
3. Purpose for the proposed rules and background:  
These rules are mandatory under Section 3157a of the Insurance Code, MCL 500.3157a, which was  
added by Public Act 21 of 2019. Section 3157a was intended to help lower overall costs of  
automobile insurance by ensuring that persons injured in motor vehicle accidents receive an  
appropriate level of care. Under that section, DIFS is required to promulgate rules that will establish  
criteria or standards for utilization review that identify utilization of treatment, products, services, or  
accommodations under the no-fault automobile insurance statute that are above the usual range of  
utilization based on medically accepted standards. “Utilization review” is the initial evaluation by an  
insurer or the Michigan Catastrophic Claims Association of the appropriateness, based on medically  
accepted standards, of the level and the quality of treatment, products, services, or accommodations  
provided under personal protection insurance benefits. The rules must include a process by which  
medical providers submit records to, and comply with, any decision of DIFS regarding utilization  
review.  
4. Summary of proposed rules:  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 2  
The proposed rules are mandatory under Section 3157a of the Insurance Code, MCL 500.3157a,  
which was added by Public Act 21 of 2019. Section 3157a(3) requires DIFS to promulgate rules to  
establish a utilization review program. The proposed rules are designed to impose standards for  
utilization review and establish an appeals process for health care providers to appeal to DIFS when  
they disagree with a benefit determination made by an automobile insurer.  
5. List names of newspapers in which the notice of public hearing was published and  
publication dates:  
The Daily Press (Escanaba): March 13, 2020  
Lansing State Journal: March 13, 2020  
Oakland Press: March 13, 2020  
6. Date of publication of rules and notice of public hearing in Michigan Register:  
4/1/2020  
7. Date, time, and location of public hearing:  
4/10/2020 09:00 AM at First Floor Forum , Michigan Library & Historical Center, 702 W. Kalamazoo  
St., Lansing, Michigan  
8. Provide the link the agency used to post the regulatory impact statement and cost-benefit  
analysis on its website:  
https://ARS.apps.lara.state.mi.us/Transaction/RFRTransaction?TransactionID=122  
9. List of the name and title of agency representative(s) attending public hearing:  
Sarah Wohlford, Senior Deputy Director  
Catherine Hart, Administrative Law Specialist  
10. Persons submitting comments of support:  
The following individuals recommended changes to the rules:  
•Maureen Kinsella (Michigan Brain Injury Provider Council)  
•Tim Hoste (Michigan Brain Injury Provider Council/NeuroRestorative)  
•Tom Judd (Michigan Brain Injury Provider Council)  
•Kris D. Curtis, MA, LPC, CRC  
•KJ Miller (Michigan Catastrophic Claims Association)  
•Lynn Brouwers (Rainbow Rehabilitation Center)  
•Steven Armenti (Medlogix)  
•Stephen Pontoni (Michigan Association for Justice)  
•Jeffrey Junkas (American Property Casualty Insurance Association)  
•Devin Hutchings (Eisenhower Center)  
•Pam Feinberg-Rivkin  
•Martha Levandowski  
•Kathleen Coll  
•Karen Gatko (McClaim Homecare)  
•John Prosser (Home Partners Homecare)  
•Kim Spanding (Onward Therapy Services)  
•Michael Andary  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 3  
•Geoff Byron (Therasupport)  
•John Cornack (Eisenhower Center)  
•Tom Judd  
•Amy Stewart (Stewart Rehab Services)  
•Jeff Friend  
•Lance Treece  
•Chuck Seigerman  
•Tammy Goulding (Rehab Without Walls)  
•Gregory Kirk (Onward Therapy Services)  
•Meg Scaling (Galaxy Brain & Therapy Center)  
•Tim Mucha  
•Monica VanAcker (Willowbrook Rehab Services)  
•Sarah Gibbs (Rehab Pathways Group)  
•Tobias Roberts (CRCI Case Management)  
•Dan Bogosian (Eisenhower Center)  
•Joseph Richert (Special Tree Rehab System)  
•Connie Demeulenaere (Therapeutic Rehab)  
•Karen Pusilo (Eisenhower Center)  
•Matt Ingram  
•Jennifer Johnson (Eisenhower Center)  
•Amy Baranek (Eisenhower Center)  
•Ron Kilpela (Eisenhower Center)  
•Denny Nystrom  
•Ghassan Souri (Assistive Technology of MI, Inc.)  
•Margaret Lanham (Eisenhower Center)  
•Ashley El-Asri (Eisenhower Center)  
•Margaret Kroese (Hope Network Neuro Rehab)  
•Michael Shoemaker (Michigan Physical Therapy Association)  
•Debra Emery  
•Marcia TeVelde (Northern Comfort Specialized Care, Inc.)  
•Julie Novak (Michigan State Medical Society)  
•Case Management Society of America Board of Directors – Detroit Chapter  
•Chad Brendtke (Eisenhower Center)  
•William Bloom, Ph.D.  
•Tanja Taddonia (Eisenhower Center)  
•Lynn Rhodes (Rehab Care Provider)  
•Heidi Hess-Willis (Eisenhower Center)  
•Charlie Avila (Eisenhower Center)  
•Priscilla Scovic (Eisenhower Center)  
•Fonda Wilson (Eisenhower Center)  
•Don Lipsy (Sedgwick)  
•Marsha Hacker  
•Dianne Mateja (Review Works)  
•Stacy Rudd (Eisenhower Center)  
•Bernadette Skodack  
•Lorraine Zorbo (AdvisaCare)  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 4  
•Kim Nolan (Progressive Alternatives)  
•Linda Mound (Eisenhower Center)  
•Elizabeth Gava (Eisenhower Center)  
•Brittani Davis (Eisenhower Center)  
•Stephanie Harris (Eisenhower Center)  
•Brent Ewald  
•Eric Poe (Citizen United Reciprocal Exchange Auto Insurance)  
•Mark Schloemer (State Auto Insurance Companies)  
•Mary Ellen Clark  
•Laura Appel (Michigan Health & Hospital Association)  
•Dyck Van Koevering (Insurance Alliance of Michigan)  
•Katie Tucker (Sinas Dramis Law Firm), on behalf of: Coalition Protecting Auto No-Fault, Health  
Partners, Inc., Origami Brain Injury Rehab, and Rehab Without Walls, Inc.  
•Michele Hibbert-Iacobacci (Mitchell International)  
•Jeannie Kunz (Michigan Occupational Therapy Association)  
•Nicole Whitlow (Auto Club Group)  
•Erika Parker (Eisenhower Center)  
11. Persons submitting comments of opposition:  
There were no express comments of opposition. Please see the list of names in response to question  
no. 10 for names of commenters who recommended changes to the proposed rules via either written  
comment or during the virtual public hearing held on April 10, 2020.  
12. Identify any changes made to the proposed rules based on comments received during the  
public comment period:  
Name &  
Comments made at Written  
Agency Rationale Rule number  
Organization public hearing  
Comments  
for change  
& citation  
changed  
1
KJ Miller /  
Michigan  
Catastrophic  
Claims  
Association  
(MCCA)  
The MCCA  
requested  
revisions to  
clarify that the  
rules apply  
The requested  
changes were  
made to the  
revised proposed R 500.65(1)-  
rules for  
R 500.63(1)-  
(4); R 500.64  
(1)-(3);  
(3),(5)  
equally to the  
MCCA as to  
clarification.  
insurers. In  
addition, the  
MCCA requested  
that a subrule be  
added to reflect  
the existing  
practice that  
MCCA utilization  
review decisions  
are relied upon by  
servicing carriers.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 5  
2
Lynn  
The word “medical” in  
To avoid the  
R 500.61(i),  
Brouwers /  
Rainbow  
the definition of  
“medical care” could  
potential for any (l); R 500.62  
misinterpretation (1)(a); R  
Rehabilitation be interpreted to  
exclude non-medical  
treatment, training,  
of covered  
benefits, the  
revised proposed 500.62(1)(c);  
500.62(1)(b)  
(i)-(iii); R  
products, services, and  
accommodations.  
rules re-state  
“treatment,  
R 500.63(1),  
(2); R 500.64  
training, products, (1),(3);  
services, and  
R 500.66(1),  
accommodations” (2)  
instead of  
“medical care”  
throughout the  
proposed rules as  
appropriate.  
3
Maureen  
Kinsella /  
MBIPC  
The word “medical” in  
the definition of  
“medical care” could  
be interpreted to  
exclude non-medical  
treatment, training,  
products, services, and  
accommodations.  
To avoid the  
potential for any (l); R 500.62  
misinterpretation (1)(a); R  
of covered  
benefits, the  
revised proposed 500.62(1)(c);  
rules re-state  
“treatment,  
R 500.61(i),  
500.62(1)(b)  
(i)-(iii); R  
R 500.63(1),  
(2); R 500.64  
training, products, (1),(3);  
services, and  
R 500.66(1),  
accommodations” (2)  
instead of  
“medical care”  
throughout the  
proposed rules as  
appropriate.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 6  
The word  
4
Tim Hoste /  
Michigan Brain  
Injury Provider  
Council  
To avoid the  
R 500.61(i),  
“medical” in the potential for any (l); R 500.62  
definition of  
“medical care”  
could be  
misinterpretation (1)(a); R  
of covered  
benefits, the  
500.62(1)(b)  
(i)-(iii); R  
(MBIPC)  
interpreted to  
exclude non-  
medical  
revised proposed 500.62(1)(c);  
rules re-state  
“treatment,  
R 500.63(1),  
(2); R 500.64  
treatment,  
training, products, (1),(3);  
training,  
services, and  
R 500.66(1),  
products,  
services, and  
accommodations” (2)  
instead of  
accommodations. “medical care”  
throughout the  
proposed rules as  
appropriate.  
5
KJ Miller /  
MCCA  
The proposed  
rules lack  
The revised  
proposed rules  
R 500.61(i)  
sufficient detail to include a revised  
define what definition of  
standards would “medically  
be used in  
accepted  
relation to the  
defined term  
“generally  
accepted  
standards” to  
define what  
standards will be  
used and to  
provide  
standards.”  
clarification.  
The revised  
proposed rules  
include a revised  
definition of  
“medically  
6
Lynn  
Brouwers /  
Rainbow  
Rehabilitation would be used in  
relation to the defined  
term “generally  
The proposed rules  
lack sufficient detail to  
define what standards  
R 500.61(i)  
accepted  
accepted standards.”  
standards” to  
define what  
standards will be  
used and to  
provide  
clarification.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 7  
7
8
9
Stephen  
The proposed  
rules lack  
sufficient detail to include a revised  
define what definition of  
standards would “medically  
The revised  
proposed rules  
R 500.61(i)  
R 500.61(i)  
R 500.61(i)  
Pontoni /  
Michigan  
Association for  
Justice  
be used in  
accepted  
relation to the  
defined term  
“generally  
accepted  
standards” to  
define what  
standards will be  
used and to  
provide  
clarification.  
The revised  
proposed rules  
standards.”  
Don Lipsy /  
Sedgwick  
Claims  
The proposed  
rules lack  
sufficient detail to include a revised  
define what definition of  
standards would “medically  
be used in  
accepted  
relation to the  
defined term  
“generally  
accepted  
standards” to  
define what  
standards will be  
used and to  
provide  
clarification.  
The revised  
proposed rules  
standards.”  
Laura Appel /  
Michigan  
Health &  
Hospital  
Association  
(MHA)  
The proposed  
rules lack  
sufficient detail to include a revised  
define what definition of  
standards would “medically  
be used in  
accepted  
relation to the  
defined term  
“generally  
accepted  
standards” to  
define what  
standards will be  
used and to  
provide  
standards.”  
clarification.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 8  
10  
11  
12  
Dyck Van  
Koevering /  
Insurance  
Alliance of  
Michigan  
(IAM)  
The proposed  
rules lack  
sufficient detail to include a revised  
define what definition of  
standards would “medically  
The revised  
proposed rules  
R 500.61(i)  
R 500.61(i)  
R 500.61(i)  
be used in  
accepted  
relation to the  
defined term  
“generally  
accepted  
standards” to  
define what  
standards will be  
used and to  
provide  
clarification.  
The revised  
proposed rules  
standards.”  
Michele  
Hibbert-  
Iacobacci /  
Mitchell  
International  
The proposed  
rules lack  
sufficient detail to include a revised  
define what definition of  
standards would “medically  
be used in  
accepted  
relation to the  
defined term  
“generally  
accepted  
standards” to  
define what  
standards will be  
used and to  
provide  
clarification.  
The revised  
proposed rules  
standards.”  
Nicole  
Whitlow / Auto  
Club Group  
The proposed  
rules lack  
sufficient detail to include a revised  
define what definition of  
standards would “medically  
be used in  
accepted  
relation to the  
defined term  
“generally  
accepted  
standards” to  
define what  
standards will be  
used and to  
provide  
standards.”  
clarification.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 9  
13  
Katie Tucker  
(for Sinas  
Dramis Law  
Insurers have long  
used third-party  
medical review  
The rule was  
stricken, and a  
new provision was 500.68  
The original  
draft R  
Firm, Coalition organizations (MROs)  
Protecting Auto to perform internal  
added to clarify  
that insurers may medical  
(regarding  
No-Fault,  
utilization review.  
still use MROs.  
review  
Health Partners, Therefore, the rule that  
organizations)  
was stricken;  
R 500.62(d)  
was revised.  
Inc., Origami  
Brain Injury  
Rehab, and  
purports to grant  
insurers permission to  
utilize MROs seems  
Rehab Without unnecessary and  
Walls, Inc.)  
KJ Miller /  
MCCA  
confusing.  
14  
Utilizing the  
provider’s  
The revised rate is R 500.63(4)  
a “reasonable and  
average hourly  
rate to  
customary fee.”  
compensate the  
provider for  
document  
provision and/or  
a written  
response to an  
insurer’s request  
for an  
explanation is too  
variable.  
Recommends  
using “reasonable  
and customary  
fee.”  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 10  
15  
Jeffrey Junkas /  
American  
Property  
Utilizing the  
provider’s  
average hourly  
rate to  
The revised rate is R 500.63(4)  
a “reasonable and  
customary fee.”  
Casualty  
Insurance  
Association  
(APCIA)  
compensate the  
provider for  
document  
provision and/or  
a written  
response to an  
insurer’s request  
for an  
explanation is too  
variable.  
Recommends  
using “reasonable  
and customary  
fee.”  
16  
Nicole  
Whitlow / Auto  
Club Group  
Utilizing the  
provider’s  
average hourly  
rate to  
The revised rate is R 500.63(4)  
a “reasonable and  
customary fee.”  
compensate the  
provider for  
document  
provision and/or  
a written  
response to an  
insurer’s request  
for an  
explanation is too  
variable.  
Recommends  
using “reasonable  
and customary  
fee.”  
17  
18  
Tim Hoste /  
MBIPC  
The timelines in Abbreviated  
R 500.64 and R timelines will lead R 500.65(1)  
500.65 should be to swifter  
R 500.63(2);  
abbreviated.  
resolutions.  
Abbreviated  
Lynn  
The timelines in R  
R 500.63(2);  
Brouwers /  
Rainbow Rehab should be abbreviated.  
500.64 and R 500.65  
timelines will lead R 500.65(1)  
to swifter  
resolutions.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 11  
19  
20  
21  
22  
Jeffrey Junkas /  
APCIA  
The timelines in Abbreviated  
R 500.64 and R timelines will lead R 500.65(1)  
500.65 should be to swifter  
R 500.63(2);  
abbreviated.  
resolutions.  
Laura Appel /  
MHA  
The timelines in Abbreviated  
R 500.64 and R timelines will lead R 500.65(1)  
500.65 should be to swifter  
R 500.63(2);  
abbreviated.  
resolutions.  
Nicole  
Whitlow / Auto  
Club Group  
The timelines in Abbreviated  
R 500.64 and R timelines will lead R 500.65(1)  
500.65 should be to swifter  
R 500.63(2);  
abbreviated.  
R 500.66(7)  
resolutions.  
The revised rules R 500.64(3);  
Tim Hoste /  
MBIPC  
should be revised clarify that  
to clarify that providers can  
providers are not appeal to DIFS in  
R 500.65(7)  
required to  
two  
exhaust their  
administrative  
circumstances: 1)  
when an insurer  
remedies via the denies a claim on  
utilization review the basis that a  
process.  
provider  
overutilized care  
without requesting  
additional  
information from  
the provider; or 2)  
when an insurer  
has requested an  
explanation from a  
provider for the  
necessity of the  
care and  
subsequently  
denies the claim.  
The revised rules  
also clarify that  
any decision made  
by DIFS under the  
utilization review  
process is subject  
to judicial review  
as a contested case  
under MCL  
500.244.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 12  
23  
Maureen  
Kinsella /  
MBIPC  
R 500.66(7) should be  
The revised rules R 500.64(3);  
revised to clarify that  
providers are not  
required to exhaust  
their administrative  
remedies via the  
utilization review  
process.  
clarify that  
R 500.65(7)  
providers can  
appeal to DIFS in  
two  
circumstances: 1)  
when an insurer  
denies a claim on  
the basis that a  
provider  
overutilized care  
without requesting  
additional  
information from  
the provider; or 2)  
when an insurer  
has requested an  
explanation from a  
provider for the  
necessity of the  
care and  
subsequently  
denies the claim.  
The revised rules  
also clarify that  
any decision made  
by DIFS under the  
utilization review  
process is subject  
to judicial review  
as a contested case  
under MCL  
500.244.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 13  
24  
Lynn  
Brouwers /  
R 500.66(7) should be  
revised to clarify that  
The revised rules R 500.64(3);  
clarify that  
R 500.65(7)  
Rainbow Rehab providers are not  
required to exhaust  
their administrative  
remedies via the  
providers can  
appeal to DIFS in  
two  
circumstances: 1)  
when an insurer  
denies a claim on  
the basis that a  
provider  
utilization review  
process.  
overutilized care  
without requesting  
additional  
information from  
the provider; or 2)  
when an insurer  
has requested an  
explanation from a  
provider for the  
necessity of the  
care and  
subsequently  
denies the claim.  
The revised rules  
also clarify that  
any decision made  
by DIFS under the  
utilization review  
process is subject  
to judicial review  
as a contested case  
under MCL  
500.244.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 14  
25  
Stephen  
R 500.66(7)  
The revised rules R 500.64(3);  
Pontoni / MAJ  
should be revised clarify that R 500.65(7)  
to clarify that  
providers can  
providers are not appeal to DIFS in  
required to  
two  
exhaust their  
administrative  
circumstances: 1)  
when an insurer  
remedies via the denies a claim on  
utilization review the basis that a  
process.  
provider  
overutilized care  
without requesting  
additional  
information from  
the provider; or 2)  
when an insurer  
has requested an  
explanation from a  
provider for the  
necessity of the  
care and  
subsequently  
denies the claim.  
The revised rules  
also clarify that  
any decision made  
by DIFS under the  
utilization review  
process is subject  
to judicial review  
as a contested case  
under MCL  
500.244.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 15  
26  
Katie Tucker  
(for Sinas  
Dramis Law  
R 500.66(7) should be  
revised to clarify that  
providers are not  
The revised rules R 500.64(3);  
clarify that  
R 500.65(7)  
providers can  
Firm, Coalition required to exhaust  
Protecting Auto their administrative  
appeal to DIFS in  
two  
No-Fault,  
Health Partners, utilization review  
Inc., Origami  
Brain Injury  
Rehab, and  
remedies via the  
circumstances: 1)  
when an insurer  
denies a claim on  
the basis that a  
provider  
process.  
Rehab Without  
Walls, Inc.)  
overutilized care  
without requesting  
additional  
information from  
the provider; or 2)  
when an insurer  
has requested an  
explanation from a  
provider for the  
necessity of the  
care and  
subsequently  
denies the claim.  
The revised rules  
also clarify that  
any decision made  
by DIFS under the  
utilization review  
process is subject  
to judicial review  
as a contested case  
under MCL  
500.244.  
27  
Julie Novak /  
Michigan State  
Medical  
Insurers should  
pay interest on  
overdue benefits. added to clarify  
that insurers  
An additional  
provision was  
R 500.65(6)  
Society  
remain obligated  
by statute (MCL  
500.3142) to pay  
interest on  
overdue benefits,  
regardless of  
whether the  
provider files an  
appeal with DIFS.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 16  
13.Date report completed:  
6/30/2020  
MCL 24.242 and 24.245  
;