Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 353 - MEDICAID MANAGED CARE
Subchapter E - STANDARDS FOR MEDICAID MANAGED CARE
Section 353.427 - Accessibility of Information Regarding Medicaid Prior Authorization Requirements
Universal Citation: 1 TX Admin Code ยง 353.427
Current through Reg. 49, No. 38; September 20, 2024
(a) In this section, "accessible" means publicly available and capable of being found and read without impediment. Usernames and passwords cannot be required to view the information.
(b) A managed care organization (MCO) must maintain on its public-facing website the MCO's criteria and policy for prior authorizations and website links to any prior authorization request forms the provider uses.
(c) The MCO must maintain the following items on its website in an easily searchable and accessible format.
(1) Applicable timelines
for prior authorization requirements, including:
(A) the timeframe in which the MCO must make
a determination on a prior authorization request;
(B) a description of the notice the MCO
provides to a provider or member regarding the documentation required to
complete a prior authorization determination; and
(C) the deadline by which the MCO must submit
the notice described in subparagraph (B) of this paragraph.
(2) An accurate and up-to-date
catalogue of coverage criteria and prior authorization requirements, including:
(A) the effective date of a prior
authorization requirement, if the requirement is first imposed on or after
September 1, 2019;
(B) a list or
description of any supporting or supplemental documentation necessary to obtain
prior authorization for a specified service; and
(C) the date and results of each annual
review of the MCO's prior authorization requirements as required by Texas
Government Code §
533.00283(a).
(3) The process and contact
information for a provider or member to contact the MCO to:
(A) clarify prior authorization requirements;
and
(B) obtain assistance in
submitting a prior authorization request.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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