Texas Administrative Code
Title 25 - HEALTH SERVICES
Part 1 - DEPARTMENT OF STATE HEALTH SERVICES
Chapter 27 - CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN
Subchapter B - CLIENT SERVICES
Section 27.13 - Prior Authorization
Current through Reg. 49, No. 38; September 20, 2024
(a) The department may establish policies and procedures that providers must follow in order to obtain prior authorization for services.
(b) Following intake completion, the initial prior authorization request must be supported by required documentation and submitted to the department for review and disposition. If the documentation supports eligibility, a comprehensive visit and follow-up visit(s) will be prior-authorized. The number of follow-up visit(s) that is prior-authorized will be based on the client's level of need, level of medical involvement, and complicating psychosocial factors documented on the request.
(c) Any additional requests for comprehensive or follow-up visit(s) must be prior-authorized. Required documentation must be submitted to the department for review and disposition before any additional services may be prior-authorized.
