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, before issuing an adverse determination on a prior authorization request, the organization provide the physician requesting the prior authorization with a reasonable opportunity to discuss the request with another physician who:
(1) practices in the same or a similar specialty, but not necessarily the same subspecialty; and
(2) has experience in treating the same category of population as the recipient on whose behalf the physician submitted the request.

Text of section effective on April 01, 2025