Tex. Gov’t Code § 533.00282. Utilization Review and Prior Authorization Procedures: Medicaid Managed Care Program – Texas

Status: Enacted
Year Enacted: 2019
File: Download

A contract between a Medicaid managed care organization and the commission 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 practices in the same or a similar specialty, but not necessarily the same subspecialty, and has experience in treating the same category of population as the recipient on whose behalf the request is submitted.

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