(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.

Text of section effective on April 01, 2025