Tex. Gov't Code § 540.0305

Current with legislation from the 2023 Regular and Special Sessions signed by the Governor as of November 21, 2023.

Section 540.0305 - [Effective 4/1/2025] Physician Consultation Before Adverse Prior Authorization Determination

In addition to the requirements of Subchapter F, a contract between a Medicaid managed care organization and the commission to which that subchapter applies must require that, before issuing an adverse determination on a prior authorization request, the organization provide the physician requesting the prior authorization with a reasonable opportunity to discuss the request with another physician who:

(1) practices in the same or a similar specialty, but not necessarily the same subspecialty; and

(2) has experience in treating the same category of population as the recipient on whose behalf the physician submitted the request. (Gov. Code, Sec. 533.00282(b) (part).)

Tex. Gov't. Code § 540.0305

Added by Acts 2023, Texas Acts of the 88th Leg.- Regular Session, ch. 769,Sec. 1.01, eff. 4/1/2025.