Sec. 1217.005. ADVISORY COMMITTEE ON UNIFORM PRIOR AUTHORIZATION FORMS. (a) The commissioner shall appoint a committee to advise the commissioner on the technical, operational, and practical aspects of developing the single, standard prior authorization form required under Section 1217.004 for requesting prior authorization of health care services, including:
(1) requirements for the health benefit plan issuer or agent of the health benefit plan issuer to acknowledge receipt of the standard form;
(2) timelines under which the health benefit plan issuer or agent of the health benefit plan issuer must acknowledge receipt of the standard form; and
(3) implications, including administrative penalties, for the failure of a health benefit plan issuer or agent of a health benefit plan issuer to:
(A) timely acknowledge receipt of the standard form; or
(B) use or accept the form.
(b) The commissioner shall consult the advisory committee with respect to any rule relating to a subject described by Section 1217.004 before adopting the rule and may consult the committee as needed with respect to a subsequent amendment of an adopted rule.
(c) The advisory committee shall be composed of an equal number of members from each of the following groups of stakeholders:
(1) physicians;
(2) health care providers other than physicians;
(3) hospitals;
(4) representatives of health benefit plans; and
(5) Health and Human Services Commission representatives.
(d) A physician may not serve on the advisory committee as a physician member under Subsection (c)(1) if the physician is or has been employed by or consults or has consulted for an insurance company.
(e) A member of the advisory committee serves without compensation.
(f) Section 39.003(a) of this code and Chapter 2110, Government Code, do not apply to the advisory committee.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1198 (S.B. 1216), Sec. 1, eff. September 1, 2013.
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