Tex. Government Code § 540.0305
PHYSICIAN CONSULTATION BEFORE ADVERSE PRIOR AUTHORIZATION DETERMINATION
Texas · Texas Government Code · Status: effective
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- Citation
- Tex. Government Code § 540.0305, PHYSICIAN CONSULTATION BEFORE ADVERSE PRIOR AUTHORIZATION DETERMINATION, Texas, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/656322
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Full text
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.