Texas Insurance Code 4201.654 – Duration of Preauthorization Exemption
(a) A physician’s or provider’s exemption from preauthorization requirements under § 4201.653 remains in effect until:
(1) the 30th day after the date the health maintenance organization or insurer notifies the physician or provider of the health maintenance organization’s or insurer’s determination to rescind the exemption under § 4201.655, if the physician or provider does not appeal the health maintenance organization’s or insurer’s determination; or
(2) if the physician or provider appeals the determination, the fifth day after the date the independent review organization affirms the health maintenance organization’s or insurer’s determination to rescind the exemption.
(b) If a health maintenance organization or insurer does not finalize a rescission determination as specified in Subsection (a), then the physician or provider is considered to have met the criteria under § 4201.653 to continue to qualify for the exemption.
Terms Used In Texas Insurance Code 4201.654
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Rescission: The cancellation of budget authority previously provided by Congress. The Impoundment Control Act of 1974 specifies that the President may propose to Congress that funds be rescinded. If both Houses have not approved a rescission proposal (by passing legislation) within 45 days of continuous session, any funds being withheld must be made available for obligation.