Section 4201.657 - Effect of Appeal or Independent Review Determination(a) A health maintenance organization or insurer is bound by an appeal or independent review determination that does not affirm the determination made by the health maintenance organization or insurer to rescind a preauthorization exemption.(b) A health maintenance organization or insurer may not retroactively deny a health care service on the basis of a rescission of an exemption, even if the health maintenance organization's or insurer's determination to rescind the preauthorization exemption is affirmed by an independent review organization.(c) If a determination of a preauthorization exemption made by the health maintenance organization or insurer is overturned on review by an independent review organization, the health maintenance organization or insurer:(1) may not attempt to rescind the exemption before the end of the next evaluation period that occurs; and(2) may only rescind the exemption after if the health maintenance organization or insurer complies with Sections 4201.655 and 4201.656.Tex. Ins. Code § 4201.657
Added by Acts 2021, Texas Acts of the 87th Leg. - Regular Session, ch. 1018,Sec. 5, eff. 9/1/2021, op. for a request for preauthorization of health care services made on or after January 1, 2022.