TAHP Comments on Incomplete Prior Authorization Rules
This rule is intended to implement portions of SB 1207 (86R), regarding prior authorization (PA) requests submitted with incomplete or insufficient information or documentation as well as requirements that MCOs post information related to PA requirements online.
We believe the rule does not fully align with language in SB 1207. The proposed rule:
- Reflects calendar days instead of business days for MCOs to make a final PA determination.
- Refers broadly to compliance with Texas Insurance Code Chapter 4201, yet federal and state Medicaid rules conflict in several instances.
Read the full letter.