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Current as of January 01, 2024 | Updated by Findlaw Staff
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, before issuing an adverse determination on a prior authorization request, the organization provide the physician requesting the prior authorization with a reasonable opportunity to discuss the request with another physician who:
(1) practices in the same or a similar specialty, but not necessarily the same subspecialty; and
(2) has experience in treating the same category of population as the recipient on whose behalf the physician submitted the request. (Gov. Code, Sec. 533.00282(b) (part).)
Cite this article: FindLaw.com - Texas Government Code - GOV'T § 540.0305. Physician Consultation Before Adverse Prior Authorization Determination - last updated January 01, 2024 | https://codes.findlaw.com/tx/government-code/gov-t-sect-540-0305/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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