Text of section effective on April 01, 2025
Sec. 540.0302.  PRIOR AUTHORIZATION PROCEDURES FOR HOSPITALIZED RECIPIENT.  (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.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.