Texas · Through 89th 2nd Called Legislative Session, 2025

Tex. Government Code § 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.

Where this section sits in the code

GOVERNMENT CODE
TITLE 4. EXECUTIVE BRANCH
SUBTITLE I. HEALTH AND HUMAN SERVICES
CHAPTER 540. MEDICAID MANAGED CARE PROGRAM
SUBCHAPTER G. PRIOR AUTHORIZATION AND UTILIZATION REVIEW PROCEDURES

(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.

Collected 2026-08-27T01:47:16Z. Source file · JSON

Browse this collection