MI HB5168

Requires insurers to implement standardized electronic prior authorization request systems by January 1, 2023, for treatments, products, services, and rehabilitative occupational training under workers' compensation coverage.

Mandates that prior authorization requirements be based on peer-reviewed, evidence-based clinical criteria developed by qualified entities or professional medical societies, with annual updates and flexibility for case-by-case deviations.

Establishes timeframes for prior authorization decisions: 9 calendar days for non-urgent requests (through December 31, 2023), then 7 calendar days thereafter; 72 hours for urgent requests; requests are automatically granted if insurers fail to respond within these timeframes.

Requires licensed physicians to make adverse determinations on non-drug prior authorizations and licensed physicians or pharmacists for prescription drug denials, with independent review by appropriately-credentialed physicians for appeals.

Mandates insurers report aggregated prior authorization data annually to the state department, which must publish deidentified reports by October 1 each year, and requires insurers to establish programs modifying authorization requirements based on provider performance and quality metrics.