Michigan House Bill HB4683

Michigan 2025-2026 Regular Session

• Introduced: 6/25/25
• Refer: 6/25/25

Caption

Insurance: health insurers; prior authorization requirements for mental health and substance use disorder; modify. Amends sec. 3425 of 1956 PA 218 (MCL 500.3425).

Summary

House Bill 4683 would amend Michigan’s Insurance Code to require health insurers that deliver, issue, or renew policies in the state to cover medically necessary inpatient, intermediate, and outpatient care for mental health and substance use disorders. The bill states that this coverage must be provided on terms and conditions no less favorable than those applied to comparable services, and it applies to both group and individual health insurance policies, while excluding limited classification policies such as accident-only, travel accident, and specified disease policies. The bill also tightens standards for how insurers may review and approve mental health and substance use disorder treatment. It would require utilization review and clinical review criteria to align with generally accepted standards of care, and it defines those standards by reference to evidence-based sources, professional associations, specialty societies, federal guidance, and FDA-approved drug labeling. The bill further defines “medically necessary” treatment in a way that emphasizes clinical appropriateness, recognized standards of care, and treatment aimed at screening, preventing, diagnosing, managing, or treating the disorder or its symptoms.

Impact

If enacted, the bill would expand and clarify mental health and substance use disorder parity requirements in Michigan insurance law by expressly mandating coverage for inpatient, intermediate, and outpatient treatment that is medically necessary. It would also constrain insurer utilization management by tying review criteria to generally accepted clinical standards, potentially limiting denials or restrictions based on insurer-specific policies that are more restrictive than accepted practice. The bill amends section 3425 of the Insurance Code and would affect health insurers, policyholders, and providers delivering behavioral health and addiction treatment services.

Sentiment

No committee transcripts or recorded votes were provided, so there is no direct evidence of debate or formal support/opposition in the available record. Based on the bill text and caption, the measure appears to be framed as a consumer-protection and access-to-care bill aimed at strengthening mental health and substance use disorder coverage. The overall tone of the legislation is pro-coverage and pro-parity, with an emphasis on medically necessary treatment and evidence-based review standards.

Contention

The main potential point of contention is the bill’s effect on insurer discretion, especially its requirement that utilization review and clinical review criteria not deviate from generally accepted standards of care. Insurers may view this as limiting their ability to manage costs or apply internal coverage rules, while supporters are likely to argue it prevents overly restrictive prior authorization and denial practices. Another possible issue is the scope of mandated coverage and whether the bill could increase premiums or administrative burden, though no specific objections are documented in the provided materials.