Michigan Office of Administrative Hearings and Rules  
Administrative Rules Division (ARD)  
611 W. Ottawa Street  
Lansing, MI 48909  
Phone: 517-335-8658 Fax: 517-335-9512  
REQUEST FOR RULEMAKING (RFR)  
1. Department:  
Insurance and Financial Services  
2. Bureau:  
Insurance  
3. Promulgation type:  
Full Process  
4. Title of proposed rule set:  
Utilization Review  
5. Rule numbers or rule set range of numbers:  
R 500.61 through R 500.85  
6. Estimated time frame:  
3 months  
Name of person filling out RFR:  
Catherine Hart  
E-mail of person filling out RFR:  
HartC4@michigan.gov  
Phone number of person filling out RFR:  
517-284-8720  
Address of person filling out RFR:  
530 W. Allegan St., 8th Floor  
Lansing, Michigan 48933  
7. Describe the general purpose of these rules, including any problems the changes are intended  
to address.  
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.  
8. Please cite the specific promulgation authority for the rules (i.e. department director,  
commission, board, etc.).  
The rules are mandatory under Section 3157a(3) of the Insurance Code, MCL 500.3157a(3),  
which requires DIFS to promulgate rules to establish a utilization review program.  
MCL 24.239  
RFR-Page 2  
A. Please list all applicable statutory references (MCLs, Executive Orders, etc.).  
MCL 500.3157a(3)  
B. Are the rules mandated by any applicable constitutional or statutory provision? If so, please  
explain.  
Yes; the rules are mandatory under Section 3157a(3) of the Insurance Code, MCL 500.3157a(3),  
which requires DIFS to promulgate rules to establish a utilization review program.  
9. Please describe the extent to which the rules conflict with or duplicate similar rules,  
compliance requirements, or other standards adopted at the state, regional, or federal level.  
These rules do not conflict with or duplicate similar regulations, compliance requirements or other  
standards adopted at the state, regional, or federal level. The utilization review program is a new  
requirement established by Public Act 21 of 2019, which substantially amended the provisions of  
the Insurance Code related to no-fault automobile insurance.  
10. Is the subject matter of the rules currently contained in any guideline, handbook, manual,  
instructional bulletin, form with instructions, or operational memoranda?  
No.  
11. Are the rules listed on the department’s annual regulatory plan as rules to be processed  
for the current year?  
No.  
12. Will the proposed rules be promulgated under Section 44 of the Administrative Procedures  
Act, 1969 PA 306, MCL 24.244, or under the full rulemaking process?  
Full Process  
13. Please describe the extent to which the rules exceed similar regulations, compliance  
requirements, or other standards adopted at the state, regional, or federal level.  
These rules do not exceed similar regulations, compliance requirements or other standards adopted  
at the state, regional, or federal level. The utilization review program is a new requirement  
established by Public Act 21 of 2019, which substantially amended the provisions of the Insurance  
Code related to no-fault automobile insurance.  
14. Do the rules incorporate the recommendations received from the public regarding any  
complaints or comments regarding the rules? If yes, please explain.  
No.  
15. If amending an existing rule set, please provide the date of the last evaluation of the rules  
and the degree, if any, to which technology, economic conditions, or other factors have changed  
the regulatory activity covered by the rules since the last evaluation.  
These rules do not amend an existing rule set.  
16. Are there any changes or developments since implementation that demonstrate there is no  
continued need for the rules, or any portion of the rules?  
No.  
17. Is there an applicable decision record (as defined in MCL 24.203(6) and required by MCL  
24.239(2))? If so, please attach the decision record.  
No  
MCL 24.239  
;