MI SB0612

Amends section 2212c of the Insurance Code of 1956 to change the deadline for developing a standard prior authorization methodology from January 1, 2015 to "by" January 1, 2015, and modifies terminology from "policy, certificate, or contract" to "health benefit plan."

Changes the expedited review standard from a 15-day review period to a 5 business day review period for prior authorization requests that may seriously jeopardize a patient's life or health.

Removes outdated subsections (8) and (9) regarding prior authorization timeframes (15 days for standard review, 72 hours for expedited review) that were set to begin January 1, 2016.

Adds new section 2212e establishing comprehensive requirements for insurers with health benefit plans, including mandatory standardized electronic prior authorization systems by January 1, 2022, with 5 business day decisions for standard requests and 2 business day decisions for urgent requests.

Requires clinical review criteria to be evidence-based, peer-reviewed, publicly available, and developed with input from practicing licensed health professionals; mandates adverse determinations be made by licensed physicians (or pharmacists for prescription drugs) under supervision of qualified medical directors; and establishes appeal procedures with independent reviewer requirements.