Section 540.0302 - [Effective 4/1/2025] 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. (Gov. Code, Sec. 533.002821.)Tex. Gov't. Code § 540.0302
Added by Acts 2023, Texas Acts of the 88th Leg.- Regular Session, ch. 769,Sec. 1.01, eff. 4/1/2025.