05/11/2023

Michigan’s Prior Authorization Statute: In Effect June 1

Legislation was signed in April 2022 through the support of the MSMS-initiated and led Health Can’t Wait, a coalition with more than 50 health care, clinician, and patient advocacy organizations. This legislation puts more control back in the hands of clinicians and patients.

Public Act 60 of 2022 provides prior authorization (PA) reform with the goal of a quicker, more effective, and more transparent process. It does not repeal PA.

All provisions will be fully in effect as of June 1, 2023, including major components such as electronic submission and faster timelines.

These reforms apply to health care insurers (and their contracted third-party vendors) and health care professionals whose beneficiaries/patients have commercial insurance policies regulated by the Michigan Department of Insurance and Financial Services. They do not impact Medicaid, Medicare, Medicare Advantage, or self-funded plans.

Check insurers’ provider news, updates, portals, etc. to learn of any new processes related to online submission, appeals, eligibility, and PA requirements related to the law’s implementation.

Please review the key provisions below for additional details and requirements.

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