Sec. 1272.060. UTILIZATION REVIEW

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A delegation agreement required by Section 1272.052 must provide that:
(1) enrollees shall receive notification at the time of enrollment of which entity is responsible for performing utilization review;
(2) the delegated entity or third party performing utilization review shall perform that review in accordance with Chapter 4201; and
(3) the delegated entity or third party shall forward utilization review decisions made by the entity or third party to the health maintenance organization on a monthly basis.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005. Amended by: Acts 2007, 80th Leg., R.S., Ch. 730 , Sec. 2G.004, eff. April 1, 2009.

                    
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