Tex. Gov't Code § 540.0302 · Subchapter G. PRIOR AUTHORIZATION AND UTILIZATION REVIEW PROCEDURES
PRIOR AUTHORIZATION PROCEDURES FOR HOSPITALIZED RECIPIENT.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(a) This section applies only to a prior authorization request submitted with respect to a recipient who is hospitalized at the time of the request.
(b) 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, notwithstanding any other law, the organization review and issue a determination on a prior authorization request to which this section applies according to the following time frames:
(1) within one business day after the organization receives the request, except as provided by Subdivisions (2) and (3);
(2) within 72 hours after the organization receives the request if a provider of acute care inpatient services submits the request and the request is for services or equipment necessary to discharge the recipient from an inpatient facility; or
(3) within one hour after the organization receives the request if the request is related to poststabilization care or a life-threatening condition.
Notes and commentary — not statutory text
History
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
Source of truth
- Edition
- Current through the 89th 2nd Called Legislative Session, 2025
- Official file
- https://statutes.capitol.texas.gov/Docs/GV/htm/GV.540.htm
- Text hash
- sha256 3a64e9276af0be8d715373c66f8910a28122cf3614d1fc638aa896fc81b8e3cf
- Composed by
- compose_tx.py 2026-10-05: the Legislative Council's chapter files read in document order; verify_tx.py's independent reading (lxml DOM walk) agrees character for character
Procedural information only. Not legal advice and not a substitute for the advice of an attorney. Confirm the current text with the official publisher before relying on it.